Redesigning Ambulatory Care Delivery to Enhance Asthma Control in Children
Condition: Asthma
MeSH terms: Asthma
Study type: Interventional

Summary: 
      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.
    

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
    

Intervention name(s): Experimental: Standard vs Intensive e-AT Intervention
Intervention type(s): Other
Intervention description(s): 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.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: Self-Management; Asthma