Title: Comparative Effectiveness of Asthma Interventions Within an AHRQ PBRN
19 de abril de 2022 atualizado por: Wake Forest University Health Sciences
Accelerating Implementation of Comparative Effectiveness Findings on Clinical and Delivery Systems by Leveraging AHRQ Networks
The overall goal is to identify best practices for improving health outcomes for patients with asthma using comparative effectiveness research within an Agency for Healthcare Research and Quality (AHRQ) Practice-Based Research Network (PBRN).
This goal will be achieved by completing the following aims: (1) Create a centralized database for comparative effectiveness research on asthma by combining clinical and billing data from one of the largest healthcare systems in the country (Carolinas Healthcare System) with data from the school system, Medicaid, and patient and community-level datasets; (2) Deploy a fully developed integrated approach to asthma management based on the Chronic Care Model; (3) Develop and implement a "shared decision making" approach for asthmatic patients from disadvantaged backgrounds; (4) Implement an electronic data collection system for an existing CDC funded school-based asthma intervention that will allow program evaluation and link school nurses with providers; (5) Evaluate and compare the effectiveness of these three asthma management strategies on: overall healthcare consumption and medical costs; quality of life, school absenteeism and performance; asthma clinical measures; and medication utilization; and (6) Disseminate findings across the state via the statewide PBRN and other network partners.
This project has the potential to impact over 30,000 asthma patients across the Carolinas including many patients from disadvantaged backgrounds.
Visão geral do estudo
Status
Concluído
Condições
Tipo de estudo
Intervencional
Inscrição (Real)
1040
Estágio
- Não aplicável
Contactos e Locais
Esta seção fornece os detalhes de contato para aqueles que conduzem o estudo e informações sobre onde este estudo está sendo realizado.
Locais de estudo
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North Carolina
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Charlotte, North Carolina, Estados Unidos, 28207
- Department of Family Medicine
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Charlotte, North Carolina, Estados Unidos, 28207
- CMC Elizabeth Family Medicine
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Critérios de participação
Os pesquisadores procuram pessoas que se encaixem em uma determinada descrição, chamada de critérios de elegibilidade. Alguns exemplos desses critérios são a condição geral de saúde de uma pessoa ou tratamentos anteriores.
Critérios de elegibilidade
Idades elegíveis para estudo
- Filho
- Adulto
- Adulto mais velho
Aceita Voluntários Saudáveis
Sim
Gêneros Elegíveis para o Estudo
Tudo
Descrição
Inclusion Criteria:
all with asthma diagnosis
Exclusion Criteria:
none
Plano de estudo
Esta seção fornece detalhes do plano de estudo, incluindo como o estudo é projetado e o que o estudo está medindo.
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Pesquisa de serviços de saúde
- Alocação: Não randomizado
- Modelo Intervencional: Atribuição cruzada
- Mascaramento: Nenhum (rótulo aberto)
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
|---|---|
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Comparador de Placebo: Group A - Usual Care Controls
Group A will consist of 20 primary care clinics who are part of the Carolinas Healthcare System network but have not yet adopted the Electronic Medical Record System.
These practices do use the same billing databases as the remaining clinics, allowing easy identification of asthma patients and their health services utilization patterns.
Data from the billing systems will be used to retrospectively populate a database for these clinics from January 2009 forward.
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No EMR
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Comparador Ativo: Group B - EMR Control Practices
There are currently 65 primary care practices within the Carolinas Healthcare System network that have electronic medical record with decision support (EAP)access at baseline.
These practices will serve as a second level of control for comparison with the intervention groups.
Each of these practices is currently using Cerner PowerChart and at the start of the study and will have access to the asthma decision support tools; an electronically generated Asthma Action Plan (AAP); and a built-in system of population management reports which will be pushed to the practices on an on-going basis to help in patient recall and management.
The EAP approach to care has been developed with input from clinicians, hospital administrators, hospital information services personnel, and Cerner consultants.
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Decision Support, Asthma Action Plans, and Population Management Reporting (EAP)
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Comparador Ativo: C Integrated Approach to Care
There are 10 practices within the Carolinas Healthcare System (CHS) network that have already received additional training for improving outcomes for patients with chronic diseases termed the Integrated Approach to Care (IAC).
This IAC approach developed by CHS is based on the Chronic Care Model (CCM).
The IAC approach includes a heavy emphasis on the use of health information technology that practices receive during the initial EAP rollout.
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Patients within the IAC group will also receive their own copy of an asthma action plan to allow for some degree of self-management support.
In addition, IAC practices receive assistance from a practice coach trained in practice redesign and rapid cycle process improvement.
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Comparador Ativo: Group D - Shared Decision Making (SDM)
This approach has great potential for improved patient outcomes and provides an additional step in the successful implementation of patient self-management.
The research team will develop the SDM intervention during the first 6 months of the study.
In particular, the Shared decision making (SDM) intervention will be designed to be deployed within the 4 large clinics that care for the majority of the community's underserved and disadvantaged patients.
The SDM intervention development will be overseen by the study advisory board and actively recruit providers from within the clinics for feedback about the intervention.
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The research team will develop the SDM intervention during the first 6 months of the study.
The team will model this intervention on the randomized control trial performed by Dr. Sandra Wilson and colleagues within the Kaiser Permanente Clinics in California and Oregon
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Comparador Ativo: School Based Care (SBC)
Activities included: spending individual time with students to assess, treat, and monitor and to educate students in proper asthma management; facilitate access to health care and medicine; and communicate with parents.
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the research team will start an electronic data capture system linking school data and the clinical EMR (Cerner Power Chart) that will be implemented over the first year.
Flow of data between schools and the hospital system will allow the children who have a regular source of care as well as those without a medical home to be treated with a unified asthma program by the school nurse and the hospital system.
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O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Reducing Hospitalizations and Emergency Department Visits
Prazo: 2011-2013
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Quality goals will be measured by the percentage of patients who reach the goal out of all patients identified with the disease through healthcare system data.
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2011-2013
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Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Improving Adherence to Medication
Prazo: 2011-2013
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Quality goals will be measured by the percentage of patients who reach the goal out of all patients identified with the disease.
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2011-2013
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Improve Quality of Life
Prazo: 2011-2013
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Measured via Survey
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2011-2013
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Reduced School Absenteeism
Prazo: 2011-2013
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measured with school absenteeism data
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2011-2013
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Improved Self-Efficacy
Prazo: 2011-2013
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survey
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2011-2013
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Improved School Performance
Prazo: 2011-2013
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measured by yearly end of grade results
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2011-2013
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Colaboradores e Investigadores
É aqui que você encontrará pessoas e organizações envolvidas com este estudo.
Patrocinador
Investigadores
- Investigador principal: Michael F Dulin, MD, PhD, Wake Forest University Health Sciences
Datas de registro do estudo
Essas datas acompanham o progresso do registro do estudo e os envios de resumo dos resultados para ClinicalTrials.gov. Os registros do estudo e os resultados relatados são revisados pela National Library of Medicine (NLM) para garantir que atendam aos padrões específicos de controle de qualidade antes de serem publicados no site público.
Datas Principais do Estudo
Início do estudo
1 de março de 2011
Conclusão Primária (Real)
1 de agosto de 2017
Conclusão do estudo (Real)
1 de agosto de 2017
Datas de inscrição no estudo
Enviado pela primeira vez
19 de janeiro de 2011
Enviado pela primeira vez que atendeu aos critérios de CQ
19 de janeiro de 2011
Primeira postagem (Estimativa)
20 de janeiro de 2011
Atualizações de registro de estudo
Última Atualização Postada (Real)
25 de abril de 2022
Última atualização enviada que atendeu aos critérios de controle de qualidade
19 de abril de 2022
Última verificação
1 de fevereiro de 2018
Mais Informações
Termos relacionados a este estudo
Termos MeSH relevantes adicionais
Outros números de identificação do estudo
- HS10-014
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