Asthma in a Decentralized Patient Population: Is Traditional Disease Management Enough?
Condition: Asthma
MeSH terms: Asthma
Study type: Interventional

Summary: 
      This is a health services demonstration project that evaluates three methods of health care
      delivery for the management of individuals with symptoms of asthma. This study will evaluate
      the impact of a telephonic asthma disease management process, with and without a home
      intervention program, on preventing asthma-related morbidity through patient/family asthma
      education.

      The investigators' central thesis is that comprehensive clinical disease management protocols
      for the management of asthma will improve clinical outcomes; reduce fiscal resource
      consumption; and improve both patient satisfaction and patient quality of life. Additionally,
      individualized, in-home patient education and environmental assessment, when added to the
      telephonic protocol, will further improve these measures. However, incremental improvement
      will vary according to the population's access to care.
    

Detailed description: 
      This trial addresses the real-world concerns of asthma management through a disease
      management approach that will assist both the patient and the primary care physician by
      providing education, additional outpatient resources and additional access to health care
      personnel. This approach will stress empowering the patient to participate in his or her own
      health care at a higher level, which, in the case of asthma, is critical to wellness.

      In a cooperative network of San Antonio medical centers, civilian and military, with a
      collective mission to care for military beneficiaries and the underserved patients of South
      Texas, this trial will evaluate the clinical benefits, as well as the cost savings, of a
      chronic disease management intervention in asthma. This study will fill a conspicuous gap in
      the medical literature by addressing the effectiveness of disease management through a large,
      decentralized, randomized, controlled trial.

      DISEASE MANAGEMENT INTERVENTION

      The project will use asthma disease management protocols and educational materials developed
      by the National Jewish Medical and Research Center. The program will be fully available in
      both English and Spanish, allowing a direct test of its impact on the State's vulnerable
      Hispanic population. Based on the principles of comprehensive disease management, National
      Jewish Medical and Research Center has developed a disease management program for asthma
      (DMP: Asthma) which addresses continuity of care by integrating traditional treatment methods
      with a program that focuses on creating a stronger partnership between the patient and the
      healthcare team, as well as greater patient empowerment. The primary program goal is
      empowering patients with the tools and resources they need for better self management of
      their prescribed treatment regimens and control of their environment. The program
      incorporates practice guidelines outlined by the National Heart, Lung, and Blood Institute
      (NHLBI) at the National Institutes of Health (NIH).

      HOME VISIT INTERVENTION

      In addition, the demonstration will evaluate the addition of a home-based disease management
      protocol focusing on patient education, to test for incremental improvement. Patients will be
      taught about their disease (symptoms, treatment, appropriate action plans), as well as about
      the healthcare system (how and when to access it). Based on the principles of comprehensive
      disease management and the unique needs of South Texas residents, the South Texas Asthma
      Management Program (STAMP) is designed for a diverse, mobile, underserved patient population.
      The protocol delivers up-front home-based education and environmental assessment, with
      follow-up visits focused on reinforcement of the earlier messages. The program ensures access
      to a primary care provider for patients who lack this critical member of the healthcare team.
      It also provides multiple resources for social services and guidance in appropriately
      accessing the healthcare system. The goal of the program is to equip patients, who have
      barriers to access due to a number of factors (lack of phone, language, remote location,
      etc), to navigate the healthcare system and effectively receive the care they need.
    

Intervention name(s): Disease Management; Disease Management + Educational Home Visits
Intervention type(s): Behavioral; Behavioral
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single