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Guidelines to Practice: Reducing Asthma Health Disparities Through Guideline Implementation (G2P)

8. mai 2015 oppdatert av: 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.

Studieoversikt

Status

Ukjent

Forhold

Intervensjon / Behandling

Detaljert beskrivelse

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.

Studietype

Intervensjonell

Registrering (Forventet)

550

Fase

  • Ikke aktuelt

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiesteder

  • Forente stater
    • Washington
      • Seattle, Washington, Forente stater, 98104
        • Public Health -- Seattle & King County

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

5 år til 75 år (Barn, Voksen, Eldre voksen)

Tar imot friske frivillige

Nei

Kjønn som er kvalifisert for studier

Alle

Beskrivelse

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

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

  • Tildeling: Randomisert
  • Intervensjonsmodell: Faktoriell oppgave
  • Masking: Ingen (Open Label)

Våpen og intervensjoner

Deltakergruppe / Arm
Intervensjon / Behandling
Aktiv komparator: Enhanced Clinic+ Unified Management Plan

Patients in study arm will receive:

  • Enhanced Clinic Intervention
  • Enhanced Health Plan
  • Unified Management Plan
Atferdsmessig: Enhanced Clinic+ Unified Management Plan
  • Unified asthma management plan and asthma support team coordination: A support team (clinicians, CHWs and plan care managers) will partner with each patient to develop a single asthma management plan. An EMR will provide a web-based platform for sharing the unified asthma management plan and enhancing communications among care team.
  • Enhanced clinic intervention: Intervention clinics will implement a multicomponent intervention that will include decision support, audit and feedback, provider and staff education, asthma champions, team-based care, and spirometry, all supported by EMR enhancements and clinic systems redesign.
Andre navn:
  • -Unified Management Plan
  • -Enhanced Clinic Intervention
Aktiv komparator: CHW Home Visit Only

Patients in study arm will receive:

  • CHW Home Visit
  • Usual clinic care with enhanced health plan
Atferdsmessig: CHW Home Visit Only
-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.
Andre navn:
  • -CHW Home Visit Intervention
Aktiv komparator: Enhanced Clinic+ Unified Plan+ CHW

Patients in study arm will receive:

  • CHW Home Visit
  • Enhanced Clinic intervention
  • Enhanced health plan
  • Unified asthma management plan
Atferdsmessig: Enhanced Clinic+ Unified Plan + CHW
  • Unified asthma management plan and asthma support team coordination: A support team will partner with each patient to develop a single asthma management plan. An EMR will provide a web-based platform for sharing the unified asthma management plan.
  • Home visit intervention: Community health workers will provide in-home tailored asthma support and conduct follow-up to support patient actions to improve asthma control based on unified asthma management plan.
  • Enhanced clinic intervention: Intervention clinics will implement a multicomponent intervention that will include decision support, audit and feedback, provider and staff education, asthma champions, team-based care, and spirometry, all supported by EMR enhancements and clinic systems redesign.
Andre navn:
  • -Enhanced Clinic
  • -CHW Home Visits
  • -Unified Management plan
Ingen inngripen: Usual Care
-Usual clinic care with enhanced healthplan

Hva måler studien?

Primære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Symptom free days
Tidsramme: 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
Asthma control
Tidsramme: 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
Tidsramme: 12 Months

Measured by questionnaire.

Adults:

  • Mini Asthma Quality of Life Questionnaire

Children 7-17:

  • Pediatric Asthma Quality of Life Questionnaire

Children 5-6:

  • Pediatric Asthma Caregiver Quality of Life Scale
12 Months

Sekundære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Nocturnal wakening
Tidsramme: 12 Months
Measured by questionnaire: Nights wakened in the past two weeks due to asthma.
12 Months
Asthma exacerbations
Tidsramme: 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
Tidsramme: 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
FeNO (Fractional exhaled Nitric Oxide)
Tidsramme: 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
Tidsramme: 12 Months
Measured by questionnaire and claims data: Days using Beta-agonist medication in past 2 weeks
12 Months
Oral steroid use
Tidsramme: 12 Months
Measured by questionnaire and claims data: Courses of steroids (3+ day course) in past 12 months
12 Months
Controller use
Tidsramme: 12 Months
Measured by claims data: Controller to total asthma medication ratio > 0.5
12 Months
Asthma-related urgent health services utilization
Tidsramme: 12 Month
Measured by questionnaire and administrative data: Urgent clinic visits, emergency department visits, and hospitalizations during past three months and past year
12 Month
Missed work or school days
Tidsramme: 12 Months
Measured by questionnaire: Number of school or work days missed in past two weeks.
12 Months
General Health Status
Tidsramme: 12 Months

Measured by questionnaire:

Adults: SF-12 Health Survey Children: SF -10 Health Survey
12 Months

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Sponsor

Public Health - Seattle and King County

Samarbeidspartnere

Patient-Centered Outcomes Research Institute

Etterforskere

  • Hovedetterforsker: James Stout, MD, University of Washington

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart

1. desember 2014

Primær fullføring (Forventet)

1. oktober 2016

Studiet fullført (Forventet)

1. oktober 2016

Datoer for studieregistrering

Først innsendt

11. juli 2014

Først innsendt som oppfylte QC-kriteriene

14. juli 2014

Først lagt ut (Anslag)

15. juli 2014

Oppdateringer av studieposter

Sist oppdatering lagt ut (Anslag)

12. mai 2015

Siste oppdatering sendt inn som oppfylte QC-kriteriene

8. mai 2015

Sist bekreftet

1. juli 2014

Mer informasjon

Begreper knyttet til denne studien

Nøkkelord

Ytterligere relevante MeSH-vilkår

Andre studie-ID-numre

  • AS1307-05498

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