Much of the asthma care in the United States is based on visiting the doctor when a child is having asthma symptoms.

The method, devised by Kevin Weiss, M.D., professor of medicine and director of the Center for Healthcare Studies at Northwestern University Feinberg School of Medicine, and colleagues, involves providing regularly planned scheduled visits with specially trained nurses to help families learn how to anticipate asthma symptoms and to develop skills to better self-manage them. In addition, physicians receive extra education in asthma management.

Weiss is also affiliated with the Midwest Center for Health Services and Policy Research, Hines Veterans Administration Hospital, Maywood, Ill.

After two years, the researchers found that, compared to children in usual care, kids in planned-care practices had 13 fewer days of symptoms per year; needed a third less rescue medication, such as a steroid inhaler; and used their medication as prescribed, according to parents' reports.

Data from the Centers for Disease Control and Prevention show that nearly 9 percent of all children in the United States have asthma. Most children with asthma receive their treatment from primary care providers.

"Our research shows that we can improve children's asthma by doing better job of organizing their routine care," said Weiss, who was principal investigator on the study.

"Pediatricians generally do a great job with well-child care, scheduling check-ups and shots at two weeks, two months, four months and so on. Our research shows the benefits of organizing care for chronic conditions like asthma in much the same way," Weiss said. The "planned-care method" consists of patients having regularly scheduled, planned visits with a specially trained asthma care nurse who assesses the patient's day-to-day asthma control and shares her assessment with the child's physician. The nurse also helps families learn about asthma, how to manage symptoms and how to prevent asthma from getting worse.

In addition, doctors in the practice follow the "peer leader method," where one physician from each practice receives special training and encourages other doctors in the practice to follow the guidelines.

"Our profession has developed some great evidence-based guidelines for asthma care and we know that if we follow them, children have improved outcomes," said pediatrician Paula Lozano, M.D., first author on the study and a researcher at Group Health Cooperative, Seattle.

"The fact is, a busy primary care doctor cannot possibly provide all the guidance that's needed. But if we reorganize our practice teams, we can do it," Lozano said.

The study included 638 children ages 3 to 17 as they received care for more than two years at the Group Health Cooperative in Seattle, the Rush Prudential Health Plan in Chicago and 16 practices eastern Massachusetts--each affiliated with several insurers, including Harvard Pilgrim Health Care and Blue Cross Blue Shield of Massachusetts.

The study was funded by a four-year $6 million grant from the Agency for Health Care Research and Quality, which is part of the federal Department of Health and Human Services and the National Heart Lung and Blood Institute at the National Institutes of Health.

Working with Weiss and Lozano were researchers from Harvard Medical School, the Group Health Cooperative, Regenstreif Institution for Heath Care and the University of Washington.