Chronic Asthma, Multimorbidity, Population Medicine
Conditions
Keywords
Suspected Asthma, Multimorbidity Interventions and Management, Clustered RCT, Pay-for-population Mechanism
Brief summary
Study Participants: Suspected asthma population, defined as individuals whose score of asthma screening questionnaire used in ECRHS study exceeds 0 and whose age is 35 and above. Intervention: Within the intervention arm, we have constructed a population-based pay-for-performance mechanism to encourage medical practitioners to care for population health. For study participants in the intervention arm, we will ask them to finish an online ECRHS questionnaire with notification of his or her suspected asthma status. Individuals whose score of ECRHS asthma screening exceeds 0 will be given a face-to-face survey, simple physical examination, pulmonary function tests, and provide a multi-component intervention at baseline. For suspected asthma population in the intervention arm, we provide community-based spirometry pulmonary function test (PFT) and education; If individuals whose FEV1 improved by ≥12% and ≥200 mL following bronchodilator administration with 400 ug salbutamol, they will be spirometry-defined undiagnosed asthma patient and will be encouraged to seek treatment and medication to the superior hospitals. Additionally, we provide (1) two digital health intervention programs to smokers and individuals with mental health issues; (2) CBT-based health education for study participants with abnormal BMI; (3) active recruitment into National Essential Public Health Program in China for those with abnormal blood pressure and blood glucose. Intensive follow-ups will be conducted at month 3 (telephone interview), month 6 (face-to-face with full steps of physical examination), and month 12. Comparison: Those who are assigned in the control arm, we will ask them to finish the same ECRHS online questionnaire with notification of his or her suspected asthma status and a face-to-face survey. No physical examinations, community-based pulmonary function tests will be given. Outcomes: The primary outcomes are asthma knowledge, lung function testing, and ACT score at month 12.
Interventions
COMBINATION_PRODUCTMulti-component Intervention Package
1. Community-based spirometry pulmonary function tests and result interpretations and health education for asthma; 2. A digital health intervention program, NicQuit, for smokers(very familiar with intelligent mobile phone); 3. A digital health intervention program, EmoEase, for individuals whose WEMWBS questionnaire score is lower than 45(very familiar with intelligent mobile phone); 4. Health education to smokers for smoking cessation; 5. Health education to individuals with mental health issues; 6. Encouragement to seek professional medication treatment in superior hospitals for undiagnosed asthma patients; 7. To actively include individuals whose blood pressure's higher than 140/90 mmHg or/and whose random blood glucose higher than 11.1 mmol/L into the National Essential Public Health Service in China; 8. A CBT-based health education to the BMI abnormal, i.e., BMI \> 24.0 or BMI \< 18.5; 9. Pay-for-population mechanism for medical practitioners.
Sponsors
Peking Union Medical College
China-Japan Friendship Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
35 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Aged 35 and above; * Score of ECRHS asthma screening questionnaire exceeds 0; * Residents who have lived in one township over the past 3 months and plan to reside in the same township in the upcoming year; * Finished the informed consent
Exclusion criteria
* Pregnancy and other conditions that are not allowed to finish pulmonary function tests; * Severe cognitive disorder or total loss of capability of daily living
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Chronic Diseases Controlled | 1 year | Among all objectively measured diseases (asthma, COPD, BMI, hypertensions, type 2 diabetes, depression symptoms, anxiety symptoms), the number of chronic diseases controlled defined by objective measurement at month 12. |
| Lung function testing | 1 year | Definition: Have you ever had a pulmonary function test?; Variable type: Binary; Measurement: Respondent's answer to the question; |
| ACT score | 1 year | Definition: Asthma Control Test score Variable type: Continuous; Measurement: Respondent's answer to the question; Introduction to ACT score: Asthma control test (ACT), ranging from 0 to 25, the lower the score, the better asthma controlled. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Self-rated health status | 1 year | Definition: General self-assessed health status; Variable type: Continuous; Measurement: EQ-5D scale; Introduction to EQ-5D-5L scale: The 5-level EQ-5D version (EQ-5D-5L) was introduced by the EuroQol Group in 2009 to improve the instrument's sensitivity and to reduce ceiling effects, as compared to the EQ-5D-3L. The scale could be transferred to health utility value, ranging from 0 to 1 continuously. 0 represents death and 1 represents perfect health. |
| Asthma Knowledge | 1 year | Definition: The first 7 questions within Chinese version Patient Asthma Knowledge Questionnaire, the higher the score, the more correct statements the respondents will have chosen. Variable type: Continuous; Measurement: Respondent's answer to the question; |
| Bronchial Asthma Screening | 1 year | Definition: Have you ever been screened for bronchial asthma by a doctor? Variable type: Binary; Measurement: Respondent's answer to the question; |
| Bronchial Asthma Diagnosis | 1 year | Definition: Have you ever been diagnosed with bronchial asthma? Variable type: Binary; Measurement: Respondent's answer to the question; |
| Bronchial Asthma Treatment | 1 year | Definition: Have you followed the treatment therapy from the professional physicians for asthma? Variable Type: Binary; Measurement: Respondent's answer to the question; |
| Bronchial Asthma Control | 1 year | Definition: ACT score to categorize whether controlled or not Variable Type: Binary; Measurement: Respondent's answer to the question; |
| Blood pressure | 1 year | Definition: Systolic and diastolic blood pressure (mmHg); Variable type: Continuous; Measurement: Omron portable automatic blood pressure monitor; |
| Blood Glucose | 1 year | Definition: Reference standard for average plasma glucose concentration over a period of time; Variable type: Continuous; Measurement: Blood glucose meter; |
| Waist circumference | 1 year | Definition: Waist circumference (cm); Variable type: Continuous; Measurement: Soft measuring tape; |
| BMI | 1 year | Definition: Body mass index (BMI), weight divided by height squared (kg/m²); Variable type: Continuous; Measurement: Calculation; |
| Number of Outpatient Visits | 1 year | Definition: Outpatient visits and type of hospital; Variable type: Count; Measurement: Survey data/insurance/outpatient data; |
| Number of Inpatient Visits | 1 year | Definition: Inpatient visits and type of hospital; Variable type: Count; Measurement: Survey data/insurance/outpatient data; |
| Medical expenditure within a family over the past year | 1 year | Definition: Healthcare-related expenditures; Variable type: Continuous; Measurement: Survey data/insurance/outpatient/inpatient data; |
| Depression Symptoms | 1 year | Definition: Emotional disorders, including sadness, loss, and anger; Variable type: Continuous; Measurement: PHQ-9; Introduction to PHQ-9: Patient Health Questionnaire- 9 items (PHQ-9), ranging from 0 to 27, the higher the score, the severer the depression symptoms for the respondents will be. |
| Anxiety Symptoms | 1 year | Definition: Unpleasant state of inner turmoil; Variable type: Continuous; Measurement: GAD-7; Introduction to GAD-7: General Anxiety Disorder - 7 (GAD-7), ranging from 0 to 21, the higher the score, the severer the anxiety symptoms for the respondents will be. |
| Warwick-Edinburgh Mental Well-being Scale, WEM -WBS score | 1 year | Definition: Reflects overall mental health problems; Variable type: Continuous; Measurement: WEMWBS; Introduction to WEMWBS: Warwick-Edinburgh Mental Well-being Scale, ranging from 14 to 70, the lower the score, the worse one's general mental health will be. |
| Family level annual consumption expenditure | 1 year | Definition: Annual total household expenditure Variable type: Categorical Measurement: Answer to a question covering local expenditure categories by the household representative |
| Employment status | 1 year | Definition: Main occupation and type; Variable type: Categorical; Measurement: Respondent's answer to the question; |
| Productivity Loss | 1 year | Definition: Productivity loss due to illness or health problems from Working Productivity and Activity Impairment-General Health Chinese version 2.0; Variable type: Continuous; Measurement: Respondent's answer to the question; WPAI outcomes are expressed as impairment percentages, with higher numbers indicating greater impairment and less productivity, i.e., worse outcomes, as follows: Questions: 1. = currently employed 2. = hours missed due to health problems 3. = hours missed other reasons 4. = hours actually worked 5. = degree health affected productivity while working 6. = degree health affected regular activities Scores: Multiply scores by 100 to express in percentages. Percent work time missed due to health: Q2/(Q2+Q4) Percent impairment while working due to health: Q5/10 Percent overall work impairment due to health: Q2/(Q2+Q4)+\[(1-(Q2/(Q2+Q4)))x(Q5/10)\] Percent activity impairment due to health: Q6/10 |
| FEV1 measurement | 1 year | Definition: Forced Expiratory Volume in one second (FEV1); Variable type: Continuous; Measurement: Pulmonary function test, portable spirometry; |
| HBP Screening | 1 year | Definition: Have you ever had your blood pressure measured by a doctor, nurse, or other healthcare professional? Variable type: Binary; Measurement: Respondent's answer to the question; |
| HBP Diagnosis | 1 year | Definition: Have you ever been diagnosed with hypertension by a doctor? Variable type: Binary; Measurement: Respondent's answer to the question; |
| HBP Treatment | 1 year | Definition: Are you currently taking any antihypertensive medication prescribed by a doctor or other healthcare professional? Variable type: Binary Measurement: Respondent's answer to the question |
| HBP Control | 1 year | Definition: Blood pressure within the normal range at the end-of-year follow-up; Variable type: Binary; Measurement: Blood pressure measurement; |
| T2DM Screening | 1 year | Definition: Have you ever had your blood glucose measured by a doctor, nurse, or other healthcare professional? Variable type: Binary; Measurement: Respondent's answer to the question; |
| T2DM Diagnosis | 1 year | Definition: Have you ever been diagnosed with T2DM by a doctor? Variable type: Binary; Measurement: Respondent's answer to the question; |
| T2DM Treatment | 1 year | Definition: Are you currently receiving a type 2 diabetes treatment plan prescribed by a doctor or other healthcare professional? Variable type: Binary Measurement: Respondent's answer to the question |
| T2DM Control | 1 year | Definition: Blood glucose within the normal range at the end-of-year follow-up; Variable type: Binary; Measurement: Blood glucose measurement; |
| Smoking Status | 1 year | Definition: Do you currently smoke? Variable type: Binary; Measurement: Respondent's answer to the question ; |
| Smoking Amount | 1 year | Definition: How many cigarettes do you smoke per day on average? Variable type: Count; Measurement: Respondent's answer to the question; |
| Drinking Status | 1 year | Definition: Frequency of alcohol consumption in the past 3 months; Variable type: Categorical; Measurement: Respondent's answer to the question; |
| Sugar Consumption | 1 year | Definition: Frequency of consumption of sugary foods/drinks; Variable type: Categorical; Measurement: Respondent's answer to the question; |
| Salted Vegetables Consumption | 1 year | Definition: Frequency of consumption of salty vegetables; Variable type: Categorical; Measurement: Respondent's answer to the question; |
| Vegetable Consumption | 1 year | Definition: Frequency of consumption of vegetable; Variable type: Categorical; Measurement: Respondent's answer to the question; |
| Physical exercise | 1 year | Definition: Frequency of physical exercise; Variable type: Categorical; Measurement: Respondent's answer to the question; |
| Self-awareness of COPD | 1 year | Definition: Have you ever been diagnosed with COPD? Variable type: Binary; Measurement: Respondent's answer to the question; |
| COPD-Knowledge | 1 year | Definition: COPD Knowledge Questionnaire(Excerpt); Variable type: Continuous; Measurement: Respondent's answer to the questions; |
| mMRC score | 1 year | Definition: score for mMRC questionnaire Variable type: Categorical Measurement: Respondent's answers to the question Introduction to mMRC: Modified Medical Research Council, categorical value, level 0 represents a good respiratory condition, while the maximum level 4 represents a very bad respiratory condition. |
| Smoking Dependence | 1 year | Fagerström test for nicotine dependence (FTND) is a scale that measures the nicotine dependence of smokers, ranging from 0 to 10, the higher the value, the worse the nicotine dependence will be. Heaviness Index of Smoking (HIS) could also be calculated using part of the scale, ranging from 0 to 6, and higher score means worse nicotine dependence. |
Countries
China
Contacts
PRINCIPAL_INVESTIGATORSimiao Chen, Ph.D.
Peking Union Medical College
Outcome results
None listed