Getting teens with asthma to stick to their medication regimens has never been easy, but a quality improvement project at Cincinnati Children’s suggests a way to succeed.
By bundling a set of chronic care interventions and making sure nearly every patient received that care, researchers report sharply improved adherence rates and outcomes. Results were published online Jan. 27, 2014, in Pediatrics.
The percentage of teens receiving the full bundle of evidence-based care jumped from 38 percent to nearly 100 percent. The percentage of teens with “well-controlled” asthma tripled; from 10 percent to 30 percent.
“Improving asthma is particularly difficult for teenagers, whose adherence to treatment is often poor and whose outcomes are 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 interventions included:
- Using evidence-based algorithms and decision support tools to provide more consistent treatment
- Incorporating databases and tracking tools to record symptoms and set triggers for medication adjustments
- Supporting self-management through self-assessments, personal action plans and more
- Increasing care coordination and outreach among healthcare providers
- Linking teens to community resources
- Following up with patients whose asthma is not well-controlled.
“Patients and parents who were confident in their ability to manage their asthma increased from 70 percent to 85 percent,” Britto says. “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 US. Asthma results in an estimated 10.5 million missed school days, 640,000 emergency visits, and 157,000 hospitalizations each year.
The study was based on results from 322 asthma patients seen from 2007 to 2011 at a new primary care clinic at Cincinnati Children’s. Researchers believe this was the first initiative conducted exclusively among teens to show significant improvement in their asthma outcomes.