Asthma
Conditions
Brief summary
The Breathe Well Study is a pragmatic, controlled trial to assess the effectiveness, cost-effectiveness, and implementation of the Breathe Well intervention, which combines evidence-based EHR and interactive behavior-change technologies (IBCT) and team-based care to improve asthma outcomes.
Detailed description
Breathe Well uses the Kaiser Permanente Electronic Health Record (EHR) to identify asthma exacerbation risk factors. For patients with a history of frequent exacerbations or B-agonist overuse, the EHR notifies a nurse who uses an EHR-generated tailored clinical report and patient directed decision support tool to engage and empower patients to develop an action plan in collaboration with providers. EHR-templated notes and order sets facilitate care plan execution. Poor controller medication adherence or unaddressed smoking results in the patient being automatically enrolled in an IBCT medication refill or smoking cessation program. Breathe Well uses multiple EHR functions and a patient and provider team to address barriers to evidence-based asthma care for providers.The study will be conducted in 26 primary care clinics of Kaiser Permanente Colorado (KPCO) using a pragmatic clinical trial design. Up to 15,000 high-risk asthma patients will be assigned to Breathe Well or guideline-based usual care based on their clinic.
Interventions
BEHAVIORALIVR call/text
For patients under filling their inhaled corticosteroid or overusing B-agonist, the patient is contacted via IVR call or text
BEHAVIORALEmail
Patients under filling their inhaled corticosteroid or overusing B-agonist, the the patient is contacted via email
Sponsors
Kaiser Permanente
National Jewish Health
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Masking description
This is a pragmatic controlled trial. Participants randomized to the intervention group will know when they receive the intervention, which will consist of an automated contact by IVR call/text, or email.
Intervention model description
Participants were randomized to either 1) usual care or 2) Interactive Voice Response (IVR) or 3) email. Those in the groups 2 or 3 will receive the intervention only if they smoke, underuse controller medication, or overuse rescue medication.
Eligibility
Sex/Gender
ALL
Age
19 Years to 99 Years
Healthy volunteers
No
Inclusion criteria
Adults with ≥1 EHR of these indicators of an asthma care gap in the EHR will be eligible. 1. B-agonist overfilling 2. inhaled corticosteroid (ICS) underfilling 3. current smoker 4. asthma exacerbation in the last year
Exclusion criteria
1. limited life expectancy 2. diagnosis of chronic obstructive pulmonary disease 3. lack of a pharmacy benefit because medication use cannot be captured.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Asthma Exacerbations | 12 months | Defined as number of urgent care visits, hospitalizations, or prescriptions of an oral corticosteroid |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Controller medication adherence | 12 months | Days of medication possession will be calculated for each patient |
Countries
United States
Outcome results
None listed