Asthma
Conditions
Brief summary
The overall goal is to identify best practices for improving health outcomes for patients with asthma using comparative effectiveness research within an Agency for Healthcare Research and Quality (AHRQ) Practice-Based Research Network (PBRN). This goal will be achieved by completing the following aims: (1) Create a centralized database for comparative effectiveness research on asthma by combining clinical and billing data from one of the largest healthcare systems in the country (Carolinas Healthcare System) with data from the school system, Medicaid, and patient and community-level datasets; (2) Deploy a fully developed integrated approach to asthma management based on the Chronic Care Model; (3) Develop and implement a shared decision making approach for asthmatic patients from disadvantaged backgrounds; (4) Implement an electronic data collection system for an existing CDC funded school-based asthma intervention that will allow program evaluation and link school nurses with providers; (5) Evaluate and compare the effectiveness of these three asthma management strategies on: overall healthcare consumption and medical costs; quality of life, school absenteeism and performance; asthma clinical measures; and medication utilization; and (6) Disseminate findings across the state via the statewide PBRN and other network partners. This project has the potential to impact over 30,000 asthma patients across the Carolinas including many patients from disadvantaged backgrounds.
Interventions
BEHAVIORALelectronic medical record
Decision Support, Asthma Action Plans, and Population Management Reporting (EAP)
OTHERIntegrated Approach to Care
Patients within the IAC group will also receive their own copy of an asthma action plan to allow for some degree of self-management support. In addition, IAC practices receive assistance from a practice coach trained in practice redesign and rapid cycle process improvement.
OTHERusual care
No EMR
OTHERShared Decision Making
The research team will develop the SDM intervention during the first 6 months of the study. The team will model this intervention on the randomized control trial performed by Dr. Sandra Wilson and colleagues within the Kaiser Permanente Clinics in California and Oregon
OTHERschool based care
the research team will start an electronic data capture system linking school data and the clinical EMR (Cerner Power Chart) that will be implemented over the first year. Flow of data between schools and the hospital system will allow the children who have a regular source of care as well as those without a medical home to be treated with a unified asthma program by the school nurse and the hospital system.
Sponsors
Wake Forest University Health Sciences
Study design
Allocation
NON_RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
all with asthma diagnosis
Exclusion criteria
none
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Reducing Hospitalizations and Emergency Department Visits | 2011-2013 | Quality goals will be measured by the percentage of patients who reach the goal out of all patients identified with the disease through healthcare system data. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Improving Adherence to Medication | 2011-2013 | Quality goals will be measured by the percentage of patients who reach the goal out of all patients identified with the disease. |
| Improve Quality of Life | 2011-2013 | Measured via Survey |
| Reduced School Absenteeism | 2011-2013 | measured with school absenteeism data |
| Improved Self-Efficacy | 2011-2013 | survey |
| Improved School Performance | 2011-2013 | measured by yearly end of grade results |
Countries
United States
Outcome results
None listed