Urban core, difficult-to-treat asthma patients present a multitude of challenges, including severe disease, comorbidities and psychosocial barriers to successful treatment. At Cincinnati Children’s, we try to take all of these factors into account in a robust and comprehensive approach to caring for these patients. By improving asthma control and decreasing hospitalizations and emergency room visits within the urban group, we are closing the gap in effective care between urban and surrounding populations.

Our Asthma Center tracks quality improvement parameters, such as monthly percent of patients with exacerbations and percent of patients who have well-controlled asthma. The goal is to have 65 percent of asthma patients well controlled. In FY16, our median was above goal at 66.4 percent, with several months — including September 2015 — logging 70 percent.

This is a significant accomplishment as September is typically the month with the highest risk of asthma exacerbation. However, we are most proud of the progress in our Difficult-to-Treat (DTT) Asthma clinic. There, patients with the most severe asthma and the most complex disease, challenging social situations, and comorbidities are served by clinicians from multiple disciplines, including a social worker and a psychologist specializing in adherence.

By determining asthma phenotypes — e.g., neutrophilic vs. eosinophilic — we deliver personalized, targeted medical therapy. At the same time, we routinely assess for barriers to asthma control, work with patients to find solutions and coordinate with schools to provide as much support as possible. Through these efforts, from July 2014 to July 2016 our percentage of difficult-to-treat patients with well-controlled asthma went from 54 to 66 percent, with decreased healthcare utilization, and we were able to maintain good control in 63 percent of DTT patients during September 2015.

These measures help patients who come to the clinic. For those who don’t, we have instituted a technology-based pilot program to see whether telehealth visits conducted at school nurses’ offices or school clinics by Cincinnati Children’s medical and self-management specialists can improve asthma outcomes. Funded by the Luther and Verizon Foundations, this program includes a Propeller Health inhaler monitoring system that transmits data on inhaler use. Preliminary results for the first 10 of 30 students enrolled are promising and suggest improved asthma control over time. More definitive results should be available by fall 2017. If successful, the program will be distributed across Cincinnati.