Improving outcomes for underserved adolescents with asthma.
OBJECTIVE
Asthma is the most common chronic disease of childhood. Treatment adherence by adolescents is often poor, and their outcomes are worse than those of younger patients. We conducted a quality improvement initiative to improve asthma control and outcomes for high-risk adolescents treated in a primary care setting.


METHODS
Interventions were guided by the Chronic Care Model and focused on standardized and evidence-based care, care coordination and active outreach, self-management support, and community connections.


RESULTS
Patients with optimally well-controlled asthma increased from ∼10% to 30%. Patients receiving the evidence-based care bundle (condition/severity characterized in chart and, for patients with persistent asthma, an action plan and controller medications at the most recent visit) increased from 38% to at or near 100%. Patients receiving the required self-management bundle (patient self-assessment, stage-of-readiness tool, and personal action plan) increased from 0% to ∼90%. Patients and parents who were confident in their ability to manage their or their adolescent's asthma increased from 70% to ∼85%. Patient satisfaction and the mean proportion of patients with asthma-related emergency department visits or hospitalizations remained stable at desirable levels.


CONCLUSIONS
Implementing interventions focused on standardized and evidence-based care, self-management support, care coordination and active outreach, linkage to community resources, and enhanced follow-up for patients with chronically not-well-controlled asthma resulted in sustained improvement in asthma control in adolescent patients. Additional interventions are likely needed for patients with chronically poor asthma control.
Division of Adolescent Medicine, Center for Innovation in Chronic Disease Care.
Maria T
MT
Britto
Anna-Liisa B
AL
Vockell
Jennifer Knopf
JK
Munafo
Pamela J
PJ
Schoettker
Janet A
JA
Wimberg
Raymond
R
Pruett
Michael S
MS
Yi
Terri L
TL
Byczkowski
D000293:Adolescent; D001249:Asthma / Q000628:therapy*; D006801:Humans; D058996:Quality Improvement; D016896:Treatment Outcome; D035862:Vulnerable Populations
adolescents; asthma; care coordination; evidence-based care; quality improvement; self-management