Guidelines to Practice: Reducing Asthma Health Disparities Through Guideline Implementation (G2P)
8 de mayo de 2015 actualizado por: Public Health - Seattle and King County
The primary hypothesis the investigators will test is that that improving asthma guideline implementation and providing patients with a unified asthma management plan using a multi-component and multilevel intervention will improve patient-centered asthma outcomes compared to health plan case management, passive guideline dissemination and provider education.
Descripción general del estudio
Estado
Desconocido
Condiciones
Descripción detallada
The study will use a factorial randomized controlled design to assess the comparative effectiveness of the following interventions among 8 community health centers and 550 patients with:
- Health plan enhanced intervention plus traditional provider education: Health plans will enhance case management support, monitor medication fills, and increase passive guideline dissemination. Traditional provider education will consist of implementation of the PACE asthma education program. Note that all participants and clinics will receive this intervention. In effect, this will be the base active comparator arm of the study.
- Home visit intervention: Community health workers will provide in-home tailored asthma support: assess asthma self-management knowledge and skills, conduct a home environmental assessment focused on asthma triggers, and conduct follow-up visits to support patient actions to improve asthma control based on unified asthma management plan.
- Enhanced clinic intervention with system integration: Clinics will implement a multi-component intervention that includes decision support, audit and feedback, provider and staff education, team-based care, and training and feedback in implementing office spirometry and allergy testing. EHR enhancements and clinic systems redesign will support this work. The EHR will also provide a platform for sharing a common asthma management plan and enhancing communications among care team members (clinicians, CHWs, plan case managers).
All four intervention groups will receive enhanced health plan intervention + provider education. The four study arms will receive the following additional different interventions: (a) usual clinic care; (b) a + home visit, (c) enhanced clinic care + system integration, and (d) c + home visit.
Tipo de estudio
Intervencionista
Inscripción (Anticipado)
550
Fase
- No aplica
Contactos y Ubicaciones
Esta sección proporciona los datos de contacto de quienes realizan el estudio e información sobre dónde se lleva a cabo este estudio.
Ubicaciones de estudio
-
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Washington
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Seattle, Washington, Estados Unidos, 98104
- Public Health -- Seattle & King County
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-
Criterios de participación
Los investigadores buscan personas que se ajusten a una determinada descripción, denominada criterio de elegibilidad. Algunos ejemplos de estos criterios son el estado de salud general de una persona o tratamientos previos.
Criterio de elegibilidad
Edades elegibles para estudiar
5 años a 75 años (Niño, Adulto, Adulto Mayor)
Acepta Voluntarios Saludables
No
Géneros elegibles para el estudio
Todos
Descripción
Inclusion Criteria:
- Age 5-75
- Provider-verified diagnosis of asthma
- Have uncontrolled asthma
- Primary language of English,Spanish or Vietnamese
- Patient of Neighborcare or HealthPoint Health
- Insured by Molina Healthcare or Community Health Plan of Washington
Exclusion Criteria:
- Patient planning to leave Neighborcare or Healthpoint Health within the next 12 months
- Household appearing to be unsafe for a visit by a community health worker
- Co-existing medical conditions that make asthma control a low priority for patient management or that confound outcome measurement or that preclude participation in self-management
- Participation in another asthma research study
Plan de estudios
Esta sección proporciona detalles del plan de estudio, incluido cómo está diseñado el estudio y qué mide el estudio.
¿Cómo está diseñado el estudio?
Detalles de diseño
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación factorial
- Enmascaramiento: Ninguno (etiqueta abierta)
Armas e Intervenciones
Grupo de participantes/brazo |
Intervención / Tratamiento |
|---|---|
|
Comparador activo: Enhanced Clinic+ Unified Management Plan
Patients in study arm will receive:
|
Otros nombres:
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Comparador activo: CHW Home Visit Only
Patients in study arm will receive:
|
-Home visit intervention: Community health workers will provide in-home tailored asthma support: assess asthma self-management knowledge and skills, conduct a home environmental assessment focused on asthma triggers, and conduct follow-up visits to support patient actions to improve asthma control based on unified asthma management plan.
Otros nombres:
|
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Comparador activo: Enhanced Clinic+ Unified Plan+ CHW
Patients in study arm will receive:
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Otros nombres:
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Sin intervención: Usual Care
-Usual clinic care with enhanced healthplan
|
¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
|
Symptom free days
Periodo de tiempo: 12 Months
|
Measured by questionnaire: Days without cough, wheeze, chest tightness, shortness of breath, nocturnal wakening from symptoms or activity limitation due to asthma in past 2 weeks.
|
12 Months
|
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Asthma control
Periodo de tiempo: 12 Months
|
Measured by questionnaire and spirometry.
Asthma Control Adults: Asthma Control Test and EPR3 categories Asthma Control Children: cACT and EPR3 categories
|
12 Months
|
|
Asthma-related Quality of Life
Periodo de tiempo: 12 Months
|
Measured by questionnaire. Adults:
Children 7-17:
Children 5-6:
|
12 Months
|
Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
|
Nocturnal wakening
Periodo de tiempo: 12 Months
|
Measured by questionnaire: Nights wakened in the past two weeks due to asthma.
|
12 Months
|
|
Asthma exacerbations
Periodo de tiempo: 12 Months
|
Measured by questionnaire: Need for oral steroids (3+ day course), hospitalization, ED visit or unscheduled clinic visit for worsening asthma in past 12 months
|
12 Months
|
|
Pulmonary function
Periodo de tiempo: 12 Months
|
Measured by spirometry: Post-bronchodilator FEV1 and FEV1 /FVC and change in pre-post bronchodilator FEV1 and FEV1 /FVC182 using EasyOne Diagnostic spirometer
|
12 Months
|
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FeNO (Fractional exhaled Nitric Oxide)
Periodo de tiempo: 12 Months
|
Measured by portable handheld device: Online measurement of ppb in exhaled breath at 50 L/s (<25 ppb indicates normal value.)
|
12 Months
|
|
Beta-agonist use
Periodo de tiempo: 12 Months
|
Measured by questionnaire and claims data: Days using Beta-agonist medication in past 2 weeks
|
12 Months
|
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Oral steroid use
Periodo de tiempo: 12 Months
|
Measured by questionnaire and claims data: Courses of steroids (3+ day course) in past 12 months
|
12 Months
|
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Controller use
Periodo de tiempo: 12 Months
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Measured by claims data: Controller to total asthma medication ratio > 0.5
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12 Months
|
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Asthma-related urgent health services utilization
Periodo de tiempo: 12 Month
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Measured by questionnaire and administrative data: Urgent clinic visits, emergency department visits, and hospitalizations during past three months and past year
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12 Month
|
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Missed work or school days
Periodo de tiempo: 12 Months
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Measured by questionnaire: Number of school or work days missed in past two weeks.
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12 Months
|
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General Health Status
Periodo de tiempo: 12 Months
|
Measured by questionnaire: Adults: SF-12 Health Survey Children: SF -10 Health Survey |
12 Months
|
Colaboradores e Investigadores
Aquí es donde encontrará personas y organizaciones involucradas en este estudio.
Patrocinador
Colaboradores
Investigadores
- Investigador principal: James Stout, MD, University of Washington
Fechas de registro del estudio
Estas fechas rastrean el progreso del registro del estudio y los envíos de resultados resumidos a ClinicalTrials.gov. Los registros del estudio y los resultados informados son revisados por la Biblioteca Nacional de Medicina (NLM) para asegurarse de que cumplan con los estándares de control de calidad específicos antes de publicarlos en el sitio web público.
Fechas importantes del estudio
Inicio del estudio
1 de diciembre de 2014
Finalización primaria (Anticipado)
1 de octubre de 2016
Finalización del estudio (Anticipado)
1 de octubre de 2016
Fechas de registro del estudio
Enviado por primera vez
11 de julio de 2014
Primero enviado que cumplió con los criterios de control de calidad
14 de julio de 2014
Publicado por primera vez (Estimar)
15 de julio de 2014
Actualizaciones de registros de estudio
Última actualización publicada (Estimar)
12 de mayo de 2015
Última actualización enviada que cumplió con los criterios de control de calidad
8 de mayo de 2015
Última verificación
1 de julio de 2014
Más información
Términos relacionados con este estudio
Palabras clave
Términos MeSH relevantes adicionales
Otros números de identificación del estudio
- AS1307-05498
Esta información se obtuvo directamente del sitio web clinicaltrials.gov sin cambios. Si tiene alguna solicitud para cambiar, eliminar o actualizar los detalles de su estudio, comuníquese con register@clinicaltrials.gov. Tan pronto como se implemente un cambio en clinicaltrials.gov, también se actualizará automáticamente en nuestro sitio web. .