Quality Improvement Initiative Improves Asthma Outcomes in Teens

CINCINNATI—Researchers at Cincinnati Children’s Hospital Medical Center have successfully carried out what is believed to be the first initiative conducted exclusively among teenagers to show significant improvement in their asthma outcomes.

The quality improvement initiative, conducted in a primary care setting, dramatically improved asthma control and outcomes for high-risk adolescents.

The study is published online in the journal Pediatrics.

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

"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 health care providers; linking these teens to community resources; and following-up with patients whose chronic asthma is not well-controlled.”

From 2007 to 2011, Britto and her colleagues at Cincinnati Children’s focused improvement efforts on 322 primary care patients, all of whom had asthma. Only 10 percent, however, had optimally well-controlled asthma. By August 2009, the proportion of these patients had increased to 30 percent and remained at that level over time.

Moreover, the initiative resulted in nearly 100 percent of patients receiving an evidence-based care bundle of tools to control their asthma. These tools included an action plan (which included goal setting and learning how to overcome barriers) and controller medications at the most recent doctor visit. Prior to the initiative, only 38 percent 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.

"Patients and parents who were confident in their ability to manage their asthma increased from 70 percent to 85 percent,” says Britto. "But patients with chronically poor asthma control are likely to need additional interventions.”

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