During the last two decades, there has been an increasing number of quality improvement programs for patients with chronic diseases that aim to enhance the efficiency and outcomes of chronic care. While such programs have been well generated, the evaluation tools for these real-world implementations are somewhat underdeveloped, particularly for programs that originated at the upper level of the health care system (i.e., programs that attempt to change the organizational and environmental structure of a system rather than solely individual patients). Therefore, the purpose of this study is to employ an innovative approach called a multiple baseline design to investigate naturalistic, multi-setting quality improvement programs. A multiple baseline design is a novel analytical tool in healthcare research and a class of interrupted time series analysis that involves both repeated measurements of outcomes over a period and the serial introduction of an intervention to each study unit on a staggered schedule. This study uses a multi-geographical state, community-based change program for children with asthma that has been developed in the four South Central States as an example of real-life, upper-level improvement efforts. This study also proposes the use of both longitudinal patient-level administrative claims data and clinic-level performance indicators to determine if the community-based change program subsequently decreased unnecessary utilization of health services among children with asthma. The unnecessary utilization that is imperative for healthcare policies includes emergency department visits and hospitalizations. The insights gained from this study could facilitate policy decision making if a huge investment at the upper level enhances chronic illness care.