Using the expanded chronic care model in an international initiative to address the chronicity of pediatric asthma in a clinical setting

Asthma is a leading chronic condition among youth, causing disability as well as direct and indirect health-related costs. Given the international burden of pediatric asthma, Italian and American clinicians and public health professionals designed a clinical health promotion initiative to monitor and address the medical, social, and psychological issues impacting the health of children and adolescents with asthma. Specifically, this intervention was designed to appropriately manage and reduce the use of asthma-related medications in youth, ages five through 18, through intervention and tracking patients' determinants of health with a clinical informatics system. Based on the tenets of the Expanded Chronic Care Model, a comprehensive, clinical tool was developed to improve the health and well-being of pediatric asthma patients. A recently enhanced database containing 150-questions was developed for this clinical practice of several hundred pediatric patients. This database was further expanded to include 25, validated health promotion questions that allow for a longitudinal monitoring of patient outcomes. With this information, clinicians are able to pinpoint health concerns that may contribute to or exacerbate a patient's asthma symptoms. Contingent on patients' self-reported conditions, individuals were referred to one or more interventions that address physical activity, nutrition, tobacco exposure, violence, and well-being. Preliminary health data is reported for consenting patients who received the intervention (n=13) and patients who did not (n=6). All patients received a motivational interview and consultation with a physician. Initially, the treatment group had a significantly higher BMI (p<0.01) and had one or more underlying health concerns. Shortly after beginning the intervention, the treatment group had better asthma control compared to the non-intervention group (p=0.16). Nocturnal symptoms decreased significantly for both groups (p=0.02) as did reported exacerbations (p=0.06). The percentage of children who controlled their asthma with therapy slightly increased over time and the percentage of children who increased their control without medication also increased over time, bordering significance. Since the analysis of this pilot data, 86 additional patients have joined the study. This international collaboration has successfully developed a clinical informatics system to track asthma-related outcomes and identify areas of needed individual patient improvement. A holistic approach to healthcare is needed to successfully address chronic conditions. This pilot project demonstrates some of the preliminary benefits of developing clinical tools and health promotion initiatives in a hospital-based setting. Unlike many other clinical interventions, this initiative addresses the chronicity of pediatric asthma as well as prevention.