Teen asthma outcomes better with quality improvement initiative

A quality improvement initiative, conducted in a primary care setting, dramatically improved asthma control and outcomes for high-risk adolescents, according to a study published online in Pediatrics.

From 2007 to 2011, researchers at Cincinnati Children’s Hospital Medical Center focused improvement efforts on 322 adolescent primary care patients with asthma. Only 10%, however, had optimally well-controlled asthma. By August 2009, the proportion of these patients with well-controlled asthma had increased to 30% and remained at that level over time. This is reportedly the first initiative conducted exclusively among teenagers to show significant improvement in their asthma outcomes.

Almost all of the patients received an evidence-based care bundle of tools to control their asthma, which included an action plan and controller medications at the most recent doctor visit. Prior to the initiative, only 38% had received this bundle. Ninety percent of patients also received a self-management bundle of tools, including a patient self-assessment and a personal action plan. Formal self-management support had not been in place prior to this initiative. Confidence of patients and parents to manage their asthma increased from 70% to 85%. But patients with chronically poor asthma control are likely to need additional interventions, according to the study authors.

“Improving asthma is particularly difficult for teenagers, whose adherence to treatment is often poor and outcomes worse than those of younger patients,” said senior study author Maria Britto, MD, director of the Center for Innovation in Chronic Disease Care at Cincinnati Children’s, in a press release.

“We were able to achieve sustained improvement in patients whose chronic asthma is not well-controlled by implementing a package of chronic care interventions. These included standardized and evidence-based care; self-management support, such as self-monitoring by using diaries and journals; care coordination and active outreach among healthcare providers; linking these teens to community resources; and following up with patients whose chronic asthma is not well-controlled,” Dr Britto said.

Asthma is the most common chronic disease of childhood, affecting 7 million children in the United States, more than 9% of all children in the United States. Asthma results in an estimated 10.5 million missed school days, 640,000 emergency visits, and 157,000 hospitalizations each year.