Coordinated evidence-based care improves asthma outcomes for high-risk adolescents

By Reuters Staff

NEW YORK (Reuters Health) - A coordinated program of standardized evidence-based care can improve asthma control in high-risk adolescents in primary care, researchers say.

Asthma outcomes are worse for adolescents than for younger patients, but previous studies showed no significant improvement in key asthma outcomes despite several types of interventions.

Dr. Terri L. Byczkowski from Cincinnati Children's Hospital Medical Center in Ohio and colleagues developed a quality improvement initiative, guided by the Chronic Care Model, to improve asthma control and outcomes for high-risk adolescents in a primary care setting.

The initiative included delivery system redesign to provide standardized and evidence-based care, productive interactions between informed patients and prepared clinicians, self-management support, community linkages, clinical information systems, and decision support.

The researchers studied the impact of their intervention in 322 patients with asthma, only about 10% of whom had optimally well-controlled asthma at baseline. This proportion increased to 20% after the implementation of the first components of the intervention and to more than 30% after full implementation.

Prior to implementation of the initiative, only 38% of patients received three main elements of evidence-based care (condition/severity documented in chart, action plan, and controller medication at most recent visit). This value reached or exceeded 94% early after implementation, and by the most recent period 100% of patients with asthma received the evidence-based care bundle.

Similarly, the proportion of patients receiving a patient self-assessment, a stage-of-readiness tool, and a personal action plan increased from 0% at baseline to a plateau of just under 90% after implementation.

After implementation of self-management interventions, the proportion of patients and their parents who were confident in their ability to manage the asthma increased from a low of 70% to a high of around 85%, according to the January 27 Pediatrics online report.

Among the 50 chronically not-well-controlled patients who remained in the practice, 60% experienced at least a two-point improvement in their median modified asthma control score in the intervention year, compared with the previous year.

Moreover, by the last assessment, the clinic achieved >90% reliability in its processes to address major family concerns through community connections.

"Our quality improvement initiative is among the first to show sustained improvement in asthma control in adolescent patients," the researchers conclude. "By using the outcome of optimal asthma symptom control, we tripled the proportion of patients who achieved that level of control over the course of our initiative."

"Additional interventions are likely needed for patients with chronically poor asthma control," the authors say.

Dr. Byczkowski declined a request for comments.

SOURCE: http://bit.ly/1ftKt1G

Pediatrics 2014;133:e418-e427.

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