Asthma
Conditions
Keywords
asthma, clinical decision support, CHICA
Brief summary
This study seeks to improve physician adherence to four recommendations of the NHLBI asthma treatment guidelines: 1. Improve case detection of asthma among patients with pulmonary symptoms, 2. Grade all asthma patients asthma, identifying those with persistent versus intermittent asthma, 3. Improve rates of use of controller medications - particularly inhaled steroids - among patients with persistent asthma, 4. Provide an asthma treatment plan for all asthma patients.
Detailed description
Objectives: Improve physician adherence to four recommendations of the NHLBI asthma treatment guidelines: 1. Improve case detection of asthma among patients with pulmonary symptoms, 2. Grade all asthma patients asthma, identifying those with persistent versus intermittent asthma, 3. Improve rates of use of controller medications - particularly inhaled steroids - among patients with persistent asthma, 4. Provide an asthma treatment plan for all asthma patients. Design: This will be a randomized controlled trial. Patients registering for appointments at the PCC Pediatric clinic will be randomized to an intervention or control arm. Patients in the intervention arm, and the physicians who see them, will receive the full intervention. Patients in the control arm will receive usual care. Intervention: The CHICA computer system has been in regular use at the PCC Pediatrics clinic since November 4, 2004. At patient check-in, CHICA produces a health survey that parents complete in the weighting room. The survey is scanned into CHICA before the physician encounter. CHICA produces a worksheet for the physician that includes prompts and reminders based date from the health survey and the electronic medical record. The completer worksheet is scanned back into CHICA. Intervention and control groups will continue to use this system In the intervention group, CHICA will include a question asking for the presence of asthma or asthma symptoms on the health survey. If the family responds that asthma or symptoms of asthma are present, CHICA will: 1. Alert the physician and ask him or her to confirm or deny the presence of asthma and to rate the asthma as persistent or intermittent, 2. Generate a chart showing the criteria for each asthma grade, 3. Recommend controller medications if the patient has persistent asthma and ask the physician to document if controllers were prescribed, 4. Generate a partially completed treatment plan for the physician to complete and give to the patient. For patients confirmed to have asthma, CHICA will place a question on the health survey at subsequent visits that assesses symptoms. For patients who have been prescribed controller medications, CHICA will put a question on the health survey asking about patient adherence to the medication. The physician worksheet will alert the physician to changes in the patient's symptom status or to non-adherence to controller medication, in compliance with NHLBI guidelines. Outcome Measures: To determine the rates of asthma case finding in the intervention and control groups, we will pull the RMRS electronic records of all patients seen during the first 6 months of the trial and determine the prevalence of diagnoses for asthma (ICD-9 code equal to 493.\*). After 6 months of running the trial, we will randomly select from those patients in the trial who have an ICD-9 diagnosis of asthma (493.\*), 75 patients from the intervention group and 75 patients from the control group. The paper shadow charts for these patients will be pulled from the chart room at the PCC Pediatrics clinic. Trained chart reviewers will document the following: 1. Has the patient's asthma been graded as intermittent or persistent? 2. Is there documentation of an asthma treatment plan? 3. Has the patient been prescribed a controller medication?
Interventions
OTHERCHICA Asthma Module
This module was added to CHICA to help diagnose and manage asthma
OTHERCHICA Control
This is CHICA without the asthma module, and was used as a control
Sponsors
Indiana University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
ALL
Age
3 Years to 11 Years
Healthy volunteers
Yes
Inclusion criteria
* Families who visit the Wishard/IUMG Primary Care Center (PCC) pediatric clinic are eligible for our study. Families are randomly assigned to either the control or intervention group, where they will remain for the study's duration. No blocking or other methods of stratification are used. There are no additional
Exclusion criteria
. Data collection will occur for a minimum of 6 months and not to exceed two years
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Diagnosis Rate of Asthma | one year |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| CHICA Control This arm received CHICA without the asthma module
CHICA Control: This is CHICA without the asthma module, and was used as a control | 1,016 |
| CHICA Asthma Module This arm received the CHICA asthma module
CHICA Asthma Module: This module was added to CHICA to help diagnose and manage asthma | 1,082 |
| Total | 2,098 |
Baseline characteristics
| Characteristic | CHICA Control | CHICA Asthma Module | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 1016 Participants | 1082 Participants | 2098 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants |
| Sex: Female, Male Female | 515 Participants | 530 Participants | 1045 Participants |
| Sex: Female, Male Male | 501 Participants | 552 Participants | 1053 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 1,016 | 0 / 1,082 |
| serious Total, serious adverse events | 0 / 1,016 | 0 / 1,082 |
Outcome results
Primary
Diagnosis Rate of Asthma
Time frame: one year
Population: We excluded those participants who had a previous diagnosis of asthma in the 14 months before the start of the study. This left the numbers seen above.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| CHICA Control | Diagnosis Rate of Asthma | 54 Participants |
| CHICA Asthma Module | Diagnosis Rate of Asthma | 87 Participants |