Redesigning Ambulatory Care Delivery to Enhance Asthma Control in Children

The investigators have developed a tool to facilitate asthma self-management in children, the electronic-AsthmaTracker (e-AT). The e-AT changes ambulatory asthma care delivery to a new model that is continuous and proactive, focusing on prevention and control, rather than reactive and focusing on management of asthma attacks. The e-AT 1) engages parents in weekly monitoring of their child's chronic asthma symptoms, 2) guides parents to recognize warning signs of asthma attacks in order to prompt appropriate interventions and timely visits to Primary Care Providers, and 3) provides Primary Care Providers with real-time, objective patient data to assess the effectiveness of asthma therapy and prompt adjustments. In a preliminary study of the paper-based version of the AT, frequent users had significantly fewer emergency department (ED) and hospital visits. Parent comments during the e-AT pilot testing revealed that the tool was useful in helping them manage their child's asthma and were interested in assessing the tool's effectiveness and in identifying and addressing barriers to their sustained use of the e-AT.

Improving asthma control in children will be facilitated by broad e-AT dissemination, and by identifying and addressing critical factors that contribute to parent sustained participation in self-management. The investigators propose to assess the effectiveness of the new ambulatory care model supported by the e-AT and conduct an e-AT process evaluation, assessing barriers and facilitators of sustained parent use. The investigators will engage parents throughout this study to identify and address themes that matter to them. The target population is children with persistent asthma, ages 2-17 years. The investigators have engaged 10 parents since conception of this project, from the planning to design and validation of the paper-AT, and the design and pilot testing of the e-AT. Input from parents was received through 3 iterative focus groups (one for the paper-AT and 2 for the e-AT) and facilitated discussions to inform the development of this proposal including research objectives and outcome measures. In addition, the investigators have recruited other key stakeholders for whom the results of the research will be relevant.

Study Overview

• Status: Completed
• Conditions: Asthma
• Intervention / Treatment: Other: Experimental: Standard vs Intensive e-AT Intervention

Detailed Description

Through the following specific aims, the investigators will:

Aim 1: Assess the effectiveness of the new ambulatory care model, by comparing outcomes at the 1.a. child (child's quality of life (QOL), asthma control, missed school days), 1.b.parent (satisfaction, parent missed work days) and 1.c. clinic (ED/hospital visits) levels, between clinics randomly assigned to either the standard e-AT intervention vs. intensive e-AT intervention. 1.d. Use non randomized comparisons to determine the effectiveness of the e-AT relative to a control group (usual care) in which the e-AT was not used

Aim 2: Assess the association of QOL, asthma control, and ED/hospital admissions with the prior frequency of e-AT use and assess if the association differs between parent subgroups (high vs. low literacy, Medicaid vs. private insurance, and frequent vs. less frequent e-AT users).

Aim 3: Determine the association of demographic, socio-economic, behavioral, and technology factors with sustained parent participation in asthma self-management.

The outcome measures are:

Primary Outcome:

1. Child quality of life (QOL)

   Secondary Outcomes:

2. Child asthma control
3. Child interrupted/missed school days
4. Child use of oral steroids (surrogate measure of an asthma exacerbation)
5. Parent satisfaction with care
6. Parent interruption/missed work days
7. Clinics: ED/Hospital admissions

• Study Type: Interventional
• Enrollment (Actual): 926
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Utah
    • Salt Lake City, Utah, United States, 84113
      • University of Utah

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 2 years to 17 years (Child)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Facility Eligibility

Clinics are eligible for participation if they meet the following criteria:

1. Primary care clinics with the clinical leadership to adopt use of e-AT for asthma management.
2. Have patients between 2 and 17 years of age with persistent asthma.
3. Ability of the facility to accommodate patient enrollment and training about use of e-AT.

Patient Inclusion Criteria

1. Children ages 2 through 17 years and their parents (main parents or caregiver)
2. English speakers
3. Children who received or are receiving asthma treatment (at participating clinics).
4. Parents have Internet access
5. Children with persistent asthma.

Patient Exclusion Criteria:

As this is a pragmatic trial assessing evidence of the e-AT in a real clinical environment, no patients will be excluded as long as they meet inclusion criteria. However, during the time of analysis, we will conduct a sub-analysis, comparing the effectiveness of the new care model among patients with or without co-morbid conditions that may affect measured asthma outcomes. These include patients with a history or increased risk of pulmonary disease (cystic fibrosis, bronco-pulmonary dysplasia, aspiration pneumonia, severe Cerebral Palsy (CP) with aspiration risk, technology dependency (gastrostomy tube, tracheostomy), history of congenital heart disease requiring surgical correction or with complicating congestive heart failure requiring medical management, immunodeficiency (including patients on immunosuppressants), and malignancies.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Standard e-AT Intervention; Patients in Standard e-AT or standard intervention group will receive a daily (if a participant forgets to complete his/her weekly assessment) email and text reminders with a link to the e-AT website to help patient/parent participants to comply with their weekly assessment of patient's level of asthma control. Note: patient/parent participants are required to complete their asthma control assessment 1x/week. The e-AT is now set up to send a weekly reminder to participants with a link to the website. If a participant does not complete an assessment within a week of the last assessment, the reminder will be sent daily until the patient/parent complies and the system resets to weekly.	Other: Experimental: Standard vs Intensive e-AT Intervention; Patients will be self-monitoring their symptoms weekly using the e-AT, either the Standard or Intensive versions of the e-AT, completing the Asthma Control Test. As patients complete their assessments each week, the clinics will be able to see how each patient is doing, and follow-up when a patient is showing high symptoms for that week, potentially avoiding Emergency Room visit, and/or hospitalization.
Experimental: Intensive e-AT Intervention; Participants in the intensive e-AT or adherence support intervention will receive everything as those in Standard Intervention. In addition, they will see a progress bar display, which adds 25 points each time they complete an assessment. When this bar reaches 100 points, a pop-up message with fireworks will appear to congratulate them about the milestone. The progress bar resets to zero after it reaches 100 points. Participants will also see a leader board allowing them to compare themselves with the 5 best users to increase compliance.	Other: Experimental: Standard vs Intensive e-AT Intervention; Patients will be self-monitoring their symptoms weekly using the e-AT, either the Standard or Intensive versions of the e-AT, completing the Asthma Control Test. As patients complete their assessments each week, the clinics will be able to see how each patient is doing, and follow-up when a patient is showing high symptoms for that week, potentially avoiding Emergency Room visit, and/or hospitalization.
No Intervention: Usual Care (Non-Randomized Cohort); Both arms (Intensive and standard e-AT interventions) will be compared to each other as well as to a non-randomized cohort who did not receive the e-AT interventions. These non-randomized cohort will be matched 2:1 to each randomized individuals.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient Quality of Life (QOL), Compared Mean QOL Change From Baseline at Each Follow-up Assessment Between the Clinics Assigned to the Intensive and Standard e-AT Interventions	Patient QOL and missed school days was collected longitudinally through surveys of the study population defined above. The QOL questionnaire included the Integrated Therapeutics Group Child Asthma Short Form (ITG-CASF) and was used at baseline (at first assessment), 3, 6, and 12 months in the study. Items within QOL scales are summed and linearly transformed from 0 to 100, with higher scores indicating better functioning.	Quality of Life assessed at baseline, then compared to 3 months, 6 months, and 12 months after intervention.
Patient Quality of Life (QOL), Overall Longitudinal Change (From Baseline) Within All Subjects (Who Received the e-AT Intervention)	Patient QOL and missed school days was collected longitudinally through surveys of the study population defined above. The QOL questionnaire included the Integrated Therapeutics Group Child Asthma Short Form - ITG-CASF and was used at baseline (at first assessment), 3, 6, and 12 months in the study. Items within scales are summed and linearly transformed from 0 to 100, with higher scores indicating better functioning.	Average Baseline QOL was compared to QOL scores at 3, 6 and 12 month follow-up QOL

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Parent Satisfaction With Care, Standard vs Intensive	Parent satisfaction data was collected at baseline and at 12 months in the study. The scale ranges from 1-5, with 1 being "Very Dissatisfied" and 5 "Very Satisfied".	Changes in satisfaction was compared between 12 month follow-up and baseline satisfaction across Standard and Intensive interventions
Child Interrupted/Missed School Days, Standard vs Intensive	Number of child interrupted/missed school days were collected longitudinally at the same time as collecting the QOL scores: baseline, 3, 6, and 12 months in the study. Number of child interrupted/missed school days during the 3 months prior to baseline, 3, 6, and 12 months follow-up surveys were counted.	Interrupted/missed school days were collected at baseline, 3, 6, and 12 month follow-ups
Parent Interrupted/Missed Work Days, Standard vs Intensive	Number of parent interrupted/missed work days were collected longitudinally at the same time as collecting the QOL scores: baseline, 3, 6, and 12 months in the study. Number of parent interrupted/missed work days during the 3 months prior to baseline, 3, 6, and 12 months follow-up surveys were counted.	Interrupted/missed work days were measured baseline 3, 6, and 12 months
Asthma Control Change, Standard vs Intensive	Asthma control information was collected weekly through the e-AT for 1 year. Asthma control was measured using the Asthma Control Test (ACT), which had a score ranging from 5 to 25, with 5 being poor control and 25 being optimal control. The analysis compared the mean change in scores from baseline to quarters 1, 2, 3, and 4.	Average baseline ACT scores compared to average ACT scores at quarter 1, 2, 3 and 4, and between Standard vs. Intensive
Emergency Department (ED)/Hospitalization, Standard vs Intensive	ED and hospital admissions were evaluated using data collected through Intermountain Healthcare claims data and ED visits and hospital encounters. We evaluated number ED and hospital admissions 12 months prior to intervention and 12 months post intervention	Change in 1 year ED/hospital admission between 12-month prior and 12 month post e-AT use
Parent Satisfaction With Care, Overall (Change Overtime From Baseline to 12 Months)	Parent satisfaction data was collected using a modified version of patient satisfaction survey developed and validated by Varni et al. at baseline and at 12 months in the study. The scale ranged from 1-5, with 1=Very Dissatisfied and 5=Very Satisfied.	Satisfaction at 1 year following e-AT use was compared to baseline satisfaction scores
Child Asthma Control Overall (Comparing Change of Asthma Control From Baseline to Quarter 1, Quarter 2, Quarter 3 and Quarter 4)	Asthma control information was collected through the e-AT, comparing change of asthma control from baseline to quarter 1, quarter 2, quarter 3 and quarter 4. Asthma control was measured using the Asthma Control Test (ACT), which scale ranged from 5-25, with 5=poorly controlled and 25=well controlled. Each patient submitted an ACT score weekly for 12 months.	baseline ACT scores were compared to quarters 1, 2, 3, 4.
Child Interrupted/Missed School Days, Overall (Longitudinal Changes Overtime)	Number of child interrupted/missed school days were collected longitudinally (information includes mean at baseline, 3, 6, and 12 months in the study).	1 year
Parent Interrupted/Missed Work Days, Overall (Longitudinal Change Overtime)	Number of parent interrupted/missed work days were collected longitudinally at the same time as collecting the QOL scores: Information includes mean at baseline, 3, 6, and 12 months in the study.	1 year
ED/Hospital Admissions, e-AT Overall (Pre vs. Post e-AT Use Within Subjects That Received the e-AT Intervention)	ED/hospital re-admission data were compared between prior and post 12 month period (for both intensive and standard interventions overall) when e-AT was administered.	1 year
Use of Oral Steroid, Overall	Use of oral steroid was evaluated using data collected through Intermountain Healthcare claims data and oral steroids prescribed. Comparison was made between prior and post e-AT (both interventions) overall.	1 year
ED/Hospital Admission, Early vs. Late Patients	ED and hospital admission was evaluated using data collected through Intermountain Healthcare claims data and ED visits and hospital encounters. Analyses (at the patient level) comparing the rates of ED/hospital admissions between a 1 year period following initiation of the e-AT for those in both standard and intensive e-AT groups who were enrolled early during the study period (patients with enrollment dates between January 2014 and December 2014) to rates of ED/hospital admissions for patients who started the e-AT later (patients with enrollment dates between January 2015 and December 2015), during a 1-year period prior to the late patient starting the e-AT.	1 year following e-AT use for early and late starting patients
Oral Steroid Use, Early vs. Late Patients	Oral steroid use data was collected through Intermountain Healthcare claims data and clinics prescribing oral steroid. Oral steroid use was evaluated using data collected through Intermountain Healthcare claims data and oral steroids prescribed. Analyses (at the patient level) comparing the rates oral steroid use between a 1 year period following initiation of the e-AT for those in both standard and intensive e-AT groups who were enrolled early during the study period (patients with enrollment dates between January 2014 and December 2014) to rates of oral steroid use for patients who started the e-AT later (patients with enrollment dates between January 2015 and December 2015), during a 1-year period prior to the late patient starting the e-AT.	1 year
ED/Hospital Admission, Early vs Late Starting Clinics (During the 3 Months When Late Starting Clinics Have Not Used the e-AT)	ED and hospital admission evaluated using data collected through Intermountain Healthcare claims data and ED visits and hospital encounters. Statistical analysis was not conducted since the numbers of ED/Hospital admissions was very small (2 and 0) in both group (during the 3 months study window). Here we used intent-to-treat analysis and included the overall 325 (rather than 318 used in analysis of other outcomes) participants.	3-month period prior to the late clinics starting the e-AT
Oral Steroid Use, Early vs Late Starting Clinics (During the 3 Months When Late Starting Clinics Have Not Started the e-AT)	Use of oral steroid was evaluated using data collected through Intermountain Healthcare claims data and oral steroids prescribed. Statistical analysis was not conducted since the numbers of ED/Hospital admissions was very small (2 and 0) in both group (during the 3 months study window). Here we used intent-to-treat analysis and included the overall 325 (rather than 318 used in analysis of other outcomes) participants	3 month period prior to the late clinics starting the e-AT
ED/Hospital Admissions, e-AT vs Usual Care	Non randomized comparison of ED and hospital admissions between e-AT interventions (both intensive and standard) compared usual care (matched control patients drawn from non-participating clinics) in the prior vs. post e-AT intervention time periods.	1 year
Oral Steroid Use, e-AT vs Usual Care	Non randomized comparison of use of oral steroid between e-AT interventions (both intensive and standard) compared usual care (matched control patients drawn from non-participating clinics) in the prior vs. post e-AT intervention time periods.	1 year

Collaborators and Investigators

• Sponsor: University of Utah
• Collaborators: Patient-Centered Outcomes Research Institute
• Investigators: Principal Investigator: Flory Nkoy, MD, MS, MPH, University of Utah

Publications and helpful links

General Publications

• Jovicic A, Holroyd-Leduc JM, Straus SE. Effects of self-management intervention on health outcomes of patients with heart failure: a systematic review of randomized controlled trials. BMC Cardiovasc Disord. 2006 Nov 2;6:43. doi: 10.1186/1471-2261-6-43.
• Joseph CL, Peterson E, Havstad S, Johnson CC, Hoerauf S, Stringer S, Gibson-Scipio W, Ownby DR, Elston-Lafata J, Pallonen U, Strecher V; Asthma in Adolescents Research Team. A web-based, tailored asthma management program for urban African-American high school students. Am J Respir Crit Care Med. 2007 May 1;175(9):888-95. doi: 10.1164/rccm.200608-1244OC. Epub 2007 Feb 8.
• National Asthma Education and Prevention Program. Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007. J Allergy Clin Immunol. 2007 Nov;120(5 Suppl):S94-138. doi: 10.1016/j.jaci.2007.09.043. Erratum In: J Allergy Clin Immunol. 2008 Jun;121(6):1330.
• Smith DH, Malone DC, Lawson KA, Okamoto LJ, Battista C, Saunders WB. A national estimate of the economic costs of asthma. Am J Respir Crit Care Med. 1997 Sep;156(3 Pt 1):787-93. doi: 10.1164/ajrccm.156.3.9611072.
• Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J. Self-management approaches for people with chronic conditions: a review. Patient Educ Couns. 2002 Oct-Nov;48(2):177-87. doi: 10.1016/s0738-3991(02)00032-0.
• Nathan RA, Sorkness CA, Kosinski M, Schatz M, Li JT, Marcus P, Murray JJ, Pendergraft TB. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol. 2004 Jan;113(1):59-65. doi: 10.1016/j.jaci.2003.09.008.
• Chapman KR, Boulet LP, Rea RM, Franssen E. Suboptimal asthma control: prevalence, detection and consequences in general practice. Eur Respir J. 2008 Feb;31(2):320-5. doi: 10.1183/09031936.00039707. Epub 2007 Oct 24.
• Liu AH, Zeiger R, Sorkness C, Mahr T, Ostrom N, Burgess S, Rosenzweig JC, Manjunath R. Development and cross-sectional validation of the Childhood Asthma Control Test. J Allergy Clin Immunol. 2007 Apr;119(4):817-25. doi: 10.1016/j.jaci.2006.12.662. Epub 2007 Mar 13.
• New NHLBI guidelines for the diagnosis and management of asthma. National Heart, Lung and Blood Institute. Lippincott Health Promot Lett. 1997 Aug;2(7):1, 8-9. No abstract available.
• CDC. National Health Interview Survey (NHIS) Data2009. http://www.cdc.gov/asthma/nhis/09/data.htm
• Akinbami LJ, Moorman JE, Liu X. Asthma prevalence, health care use, and mortality: United States, 2005-2009. Natl Health Stat Report. 2011 Jan 12;(32):1-14.
• CDC. Healthy Youth! Health Topics, Asthma2009.
• Wessel L, Spain J. The Chronic Care Model: A Collaborative Approach to Preventing and Treating Asthma in Infants and Young Children. January 2005. EJ847179
• Association AL. Asthma & Children Fact Sheet 2012. http://www.lung.org/lung-disease/asthma/resources/facts-and-figures/asthma-children-fact-sheet.html
• Farber HJ. Risk of readmission to hospital for pediatric asthma. J Asthma. 1998;35(1):95-9. doi: 10.3109/02770909809055410.
• Minkovitz CS, Andrews JS, Serwint JR. Rehospitalization of children with asthma. Arch Pediatr Adolesc Med. 1999 Jul;153(7):727-30. doi: 10.1001/archpedi.153.7.727.
• Lieu TA, Quesenberry CP, Sorel ME, Mendoza GR, Leong AB. Computer-based models to identify high-risk children with asthma. Am J Respir Crit Care Med. 1998 Apr;157(4 Pt 1):1173-80. doi: 10.1164/ajrccm.157.4.9708124.
• Rea HH, Scragg R, Jackson R, Beaglehole R, Fenwick J, Sutherland DC. A case-control study of deaths from asthma. Thorax. 1986 Nov;41(11):833-9. doi: 10.1136/thx.41.11.833.
• Weiss KB, Gergen PJ, Hodgson TA. An economic evaluation of asthma in the United States. N Engl J Med. 1992 Mar 26;326(13):862-6. doi: 10.1056/NEJM199203263261304.
• Bloomberg GR, Trinkaus KM, Fisher EB Jr, Musick JR, Strunk RC. Hospital readmissions for childhood asthma: a 10-year metropolitan study. Am J Respir Crit Care Med. 2003 Apr 15;167(8):1068-76. doi: 10.1164/rccm.2201015.
• Crane J, Pearce N, Burgess C, Woodman K, Robson B, Beasley R. Markers of risk of asthma death or readmission in the 12 months following a hospital admission for asthma. Int J Epidemiol. 1992 Aug;21(4):737-44. doi: 10.1093/ije/21.4.737.
• Li D, German D, Lulla S, Thomas RG, Wilson SR. Prospective study of hospitalization for asthma. A preliminary risk factor model. Am J Respir Crit Care Med. 1995 Mar;151(3 Pt 1):647-55. doi: 10.1164/ajrccm.151.3.7881651.
• To T, Dick P, Feldman W, Hernandez R. A cohort study on childhood asthma admissions and readmissions. Pediatrics. 1996 Aug;98(2 Pt 1):191-5.
• Centers for Disease Control and Prevention (CDC). Asthma hospitalizations and readmissions among children and young adults--Wisconsin, 1991-1995. MMWR Morb Mortal Wkly Rep. 1997 Aug 8;46(31):726-9.
• Mitchell EA, Bland JM, Thompson JM. Risk factors for readmission to hospital for asthma in childhood. Thorax. 1994 Jan;49(1):33-6. doi: 10.1136/thx.49.1.33.
• Vargas PA, Perry TT, Robles E, Jo CH, Simpson PM, Magee JM, Feild CR, Hakkak R, Carroll PA, Jones SM. Relationship of body mass index with asthma indicators in head start children. Ann Allergy Asthma Immunol. 2007 Jul;99(1):22-8. doi: 10.1016/S1081-1206(10)60616-3.
• Barnes PJ. Achieving asthma control. Curr Med Res Opin. 2005;21 Suppl 4:S5-9. doi: 10.1185/030079905X61730.
• Bloomberg GR, Banister C, Sterkel R, Epstein J, Bruns J, Swerczek L, Wells S, Yan Y, Garbutt JM. Socioeconomic, family, and pediatric practice factors that affect level of asthma control. Pediatrics. 2009 Mar;123(3):829-35. doi: 10.1542/peds.2008-0504.
• Bateman ED, Frith LF, Braunstein GL. Achieving guideline-based asthma control: does the patient benefit? Eur Respir J. 2002 Sep;20(3):588-95. doi: 10.1183/09031936.02.00294702.
• Rabe KF, Adachi M, Lai CK, Soriano JB, Vermeire PA, Weiss KB, Weiss ST. Worldwide severity and control of asthma in children and adults: the global asthma insights and reality surveys. J Allergy Clin Immunol. 2004 Jul;114(1):40-7. doi: 10.1016/j.jaci.2004.04.042.
• Stempel DA, McLaughin TP, Stanford RH, Fuhlbrigge AL. Patterns of asthma control: a 3-year analysis of patient claims. J Allergy Clin Immunol. 2005 May;115(5):935-9. doi: 10.1016/j.jaci.2005.01.054.
• Williams SG, Schmidt DK, Redd SC, Storms W; National Asthma Education and Prevention Program. Key clinical activities for quality asthma care. Recommendations of the National Asthma Education and Prevention Program. MMWR Recomm Rep. 2003 Mar 28;52(RR-6):1-8.
• Glauber JH, Farber HJ, Homer CJ. Asthma clinical pathways: toward what end? Pediatrics. 2001 Mar;107(3):590-2. doi: 10.1542/peds.107.3.590. No abstract available.
• Ressel GW; Centers for Disease Control and Prevention; National Asthma Education and Prevention Program. NAEPP updates guidelines for the diagnosis and management of asthma. Am Fam Physician. 2003 Jul 1;68(1):169-70. No abstract available.
• Clark DO, Frankel RM, Morgan DL, Ricketts G, Bair MJ, Nyland KA, Callahan CM. The meaning and significance of self-management among socioeconomically vulnerable older adults. J Gerontol B Psychol Sci Soc Sci. 2008 Sep;63(5):S312-9. doi: 10.1093/geronb/63.5.s312.
• McGowan P. Self-Managment: A Background Paper. Centre on Aging New Perspectives: International Conference on Patient Self-Management 2006:1-10.
• Adams WG, Fuhlbrigge AL, Miller CW, Panek CG, Gi Y, Loane KC, Madden NE, Plunkett AM, Friedman RH. TLC-Asthma: an integrated information system for patient-centered monitoring, case management, and point-of-care decision support. AMIA Annu Symp Proc. 2003;2003:1-5.
• Cruz-Correia R, Fonseca J, Lima L, Araujo L, Delgado L, Castel-Branco MG, Costa-Pereira A. Web-based or paper-based self-management tools for asthma--patients' opinions and quality of data in a randomized crossover study. Stud Health Technol Inform. 2007;127:178-89.
• Finkelstein J, Cabrera MR, Hripcsak G. Internet-based home asthma telemonitoring: can patients handle the technology? Chest. 2000 Jan;117(1):148-55. doi: 10.1378/chest.117.1.148.
• Janson SL, McGrath KW, Covington JK, Cheng SC, Boushey HA. Individualized asthma self-management improves medication adherence and markers of asthma control. J Allergy Clin Immunol. 2009 Apr;123(4):840-6. doi: 10.1016/j.jaci.2009.01.053.
• Joshi A, Amelung P, Arora M, Finkelstein J. Clinical impact of home automated telemanagement in asthma. AMIA Annu Symp Proc. 2005;2005:1000.
• Ostojic V, Cvoriscec B, Ostojic SB, Reznikoff D, Stipic-Markovic A, Tudjman Z. Improving asthma control through telemedicine: a study of short-message service. Telemed J E Health. 2005 Feb;11(1):28-35. doi: 10.1089/tmj.2005.11.28.
• van der Meer V, van Stel HF, Bakker MJ, Roldaan AC, Assendelft WJ, Sterk PJ, Rabe KF, Sont JK; SMASHING (Self-Management of Asthma Supported by Hospitals, ICT, Nurses and General practitioners) Study Group. Weekly self-monitoring and treatment adjustment benefit patients with partly controlled and uncontrolled asthma: an analysis of the SMASHING study. Respir Res. 2010 Jun 10;11(1):74. doi: 10.1186/1465-9921-11-74.
• Ahmad E, Grimes DE. The effects of self-management education for school-age children on asthma morbidity: a systematic review. J Sch Nurs. 2011 Aug;27(4):282-92. doi: 10.1177/1059840511403003. Epub 2011 Apr 8.
• Bonner S, Zimmerman BJ, Evans D, Irigoyen M, Resnick D, Mellins RB. An individualized intervention to improve asthma management among urban Latino and African-American families. J Asthma. 2002 Apr;39(2):167-79. doi: 10.1081/jas-120002198.
• Perneger TV, Sudre P, Muntner P, Uldry C, Courteheuse C, Naef AF, Jacquemet S, Nicod L, Rochat T, Assal JP. Effect of patient education on self-management skills and health status in patients with asthma: a randomized trial. Am J Med. 2002 Jul;113(1):7-14. doi: 10.1016/s0002-9343(02)01136-1.
• Rhee H, Belyea MJ, Hunt JF, Brasch J. Effects of a peer-led asthma self-management program for adolescents. Arch Pediatr Adolesc Med. 2011 Jun;165(6):513-9. doi: 10.1001/archpediatrics.2011.79.
• Guendelman S, Meade K, Benson M, Chen YQ, Samuels S. Improving asthma outcomes and self-management behaviors of inner-city children: a randomized trial of the Health Buddy interactive device and an asthma diary. Arch Pediatr Adolesc Med. 2002 Feb;156(2):114-20. doi: 10.1001/archpedi.156.2.114.
• Bheekie A, Syce JA, Weinberg EG. Peak expiratory flow rate and symptom self-monitoring of asthma initiated from community pharmacies. J Clin Pharm Ther. 2001 Aug;26(4):287-96. doi: 10.1046/j.1365-2710.2001.00361.x.
• Thompson R, Delfino RJ, Tjoa T, Nussbaum E, Cooper D. Evaluation of daily home spirometry for school children with asthma: new insights. Pediatr Pulmonol. 2006 Sep;41(9):819-28. doi: 10.1002/ppul.20449.
• Chan DS, Callahan CW, Hatch-Pigott VB, Lawless A, Proffitt HL, Manning NE, Schweikert M, Malone FJ. Internet-based home monitoring and education of children with asthma is comparable to ideal office-based care: results of a 1-year asthma in-home monitoring trial. Pediatrics. 2007 Mar;119(3):569-78. doi: 10.1542/peds.2006-1884.
• de Jongste JC, Carraro S, Hop WC; CHARISM Study Group; Baraldi E. Daily telemonitoring of exhaled nitric oxide and symptoms in the treatment of childhood asthma. Am J Respir Crit Care Med. 2009 Jan 15;179(2):93-7. doi: 10.1164/rccm.200807-1010OC. Epub 2008 Oct 17.
• McPherson AC, Glazebrook C, Forster D, James C, Smyth A. A randomized, controlled trial of an interactive educational computer package for children with asthma. Pediatrics. 2006 Apr;117(4):1046-54. doi: 10.1542/peds.2005-0666.
• Willems DC, Joore MA, Hendriks JJ, Nieman FH, Severens JL, Wouters EF. The effectiveness of nurse-led telemonitoring of asthma: results of a randomized controlled trial. J Eval Clin Pract. 2008 Aug;14(4):600-9. doi: 10.1111/j.1365-2753.2007.00936.x. Epub 2008 Jul 9.
• Jan RL, Wang JY, Huang MC, Tseng SM, Su HJ, Liu LF. An internet-based interactive telemonitoring system for improving childhood asthma outcomes in Taiwan. Telemed J E Health. 2007 Jun;13(3):257-68. doi: 10.1089/tmj.2006.0053.
• NHLBI. So You Have Asthma. 2007(NIH Publication No. 07-5248). https://www.nhlbi.nih.gov/files/docs/public/lung/have_asthma.pdf.
• Cuijpers CE, Wesseling GJ, Swaen GM, Sturmans F, Wouters EF. Asthma-related symptoms and lung function in primary school children. J Asthma. 1994;31(4):301-12. doi: 10.3109/02770909409089477.
• Davis KJ, Disantostefano R, Peden DB. Is Johnny wheezing? Parent-child agreement in the Childhood Asthma in America survey. Pediatr Allergy Immunol. 2011 Feb;22(1 Pt 1):31-5. doi: 10.1111/j.1399-3038.2010.01016.x. Epub 2010 Sep 9.
• Halterman JS, Yoos HL, Kitzman H, Anson E, Sidora-Arcoleo K, McMullen A. Symptom reporting in childhood asthma: a comparison of assessment methods. Arch Dis Child. 2006 Sep;91(9):766-70. doi: 10.1136/adc.2006.096123. Epub 2006 May 16.
• McQuaid EL, Koinis Mitchell D, Walders N, Nassau JH, Kopel SJ, Klein RB, Wamboldt MZ, Fritz GK. Pediatric asthma morbidity: the importance of symptom perception and family response to symptoms. J Pediatr Psychol. 2007 Mar;32(2):167-77. doi: 10.1093/jpepsy/jsj112. Epub 2006 May 22.
• Hagmolen Of Ten Have W, van den Berg NJ, van der Palen J, van Aalderen WM, Bindels PJ. Limitations of questioning asthma to assess asthma control in general practice. Respir Med. 2008 Aug;102(8):1153-8. doi: 10.1016/j.rmed.2008.03.008. Epub 2008 Jun 24.
• Bridge PD, McKenzie SA. Bronchodilator responsiveness testing in young children. Arch Dis Child. 2001 Jun;84(6):525. doi: 10.1136/adc.84.6.525n. No abstract available.
• NHLBI-EPR-3. Guidelines for the diagnosis ane management of asthma. Periodic Assessment and Monitoring: Essential for Asthma Management. 2007. http://www.nhlbi.nih.gov/files/docs/guidelines/asthsumm.pdf
• Tirimanna PR, Den Otter JJ, Van Schayck CP, Van Herwaarden CL, Folgering H, Van Weel C. Evaluation of the suitability of weekly peak expiratory flow rate measurements in monitoring annual decline in lung function among patients with asthma and chronic bronchitis. Br J Gen Pract. 1996 Jan;46(402):15-8.
• Frischer T, Meinert R, Urbanek R, Kuehr J. Variability of peak expiratory flow rate in children: short and long term reproducibility. Thorax. 1995 Jan;50(1):35-9. doi: 10.1136/thx.50.1.35.
• Goldberg S, Springer C, Avital A, Godfrey S, Bar-Yishay E. Can peak expiratory flow measurements estimate small airway function in asthmatic children? Chest. 2001 Aug;120(2):482-8. doi: 10.1378/chest.120.2.482.
• McGrath AM, Gardner DM, McCormack J. Is home peak expiratory flow monitoring effective for controlling asthma symptoms? J Clin Pharm Ther. 2001 Oct;26(5):311-7. doi: 10.1046/j.1365-2710.2001.00374.x.
• Juniper EF, Gruffydd-Jones K, Ward S, Svensson K. Asthma Control Questionnaire in children: validation, measurement properties, interpretation. Eur Respir J. 2010 Dec;36(6):1410-6. doi: 10.1183/09031936.00117509. Epub 2010 Jun 7.
• Kattan M. Quality of inpatient care for asthma: challenges and opportunities. Pediatrics. 2008 Dec;122(6):1369-70. doi: 10.1542/peds.2008-2787. No abstract available.

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2013
• Primary Completion (Actual): December 31, 2016
• Study Completion (Actual): December 31, 2016

Study Registration Dates

• First Submitted: March 25, 2015
• First Submitted That Met QC Criteria: March 31, 2015
• First Posted (Estimate): April 6, 2015

Study Record Updates

• Last Update Posted (Actual): February 5, 2020
• Last Update Submitted That Met QC Criteria: January 24, 2020
• Last Verified: January 1, 2020

More Information

Terms related to this study

• Keywords: Asthma; Self-Management
• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Immune System Diseases; Lung Diseases; Hypersensitivity, Immediate; Bronchial Diseases; Lung Diseases, Obstructive; Respiratory Hypersensitivity; Hypersensitivity; Asthma
• Other Study ID Numbers: 51002874

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: We can only share completely de-identified data. Request can be sent to my email: flory.nkoy@hsc.utah.edu