Better Pediatric Asthma Outcomes Through Chronic Care

Study Overview
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Brief Summary
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This 3-year, multi-site study focuses on the translation of cost-effective methods to bring a chronic care model to the care of poor, minority, inner-city children with asthma, at risk of the worst outcomes for the leading chronic disease of children. The specific aims are to: Develop a computer support system to deliver peer-driven, patient-linked Guideline prompts at the point of care using affordable information technology; Evaluate the effect of the Guideline prompt system on the process and outcomes (symptom control, health-related-quality-of-life, ED and hospitalizations) of asthma care; and Evaluate the added effect on outcomes of family-focused, supportive education delivered by a community health worker. The key product of the computer support system is a guideline prompt that serves as the mechanism for integrating patient specific data with standards of care. 548 children, ages 5-18, with physician diagnosed asthma, enrolled in one Medicaid Managed Care Organization in CT, and receiving care at one of four Federally Qualified Community Health Centers will be recruited. All sites will have access to the computer support system and the to-be-developed, Guideline-Driven Clinical Standards of Asthma Care. In Phase I (12 months), the effect of prompts delivered at the point of care on patient outcomes will be compared to the effect of no-prompt care. In Phase II (6 months), the effect of family-focused, supportive education will be assessed in combination with prompted care compared to no-prompt care and compared to no education. All patients will receive standard screening and outreach to keep appointments. Data will be obtained from medical records, medical and pharmacy claims data as well as patient and parent interviews at baseline and quarterly for 18 months.

Official Title
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Better Pediatric Asthma Outcomes Through Chronic Care

Conditions
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Asthma

Intervention / Treatment
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* Behavioral: electronic (computer based) provider feedback tool


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: determined by provider to be asthmatic member of Medical Managed Care Organization partner group Exclusion Criteria: -

Ages Eligible for Study
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Minimum Age: 5 Years
Maximum Age: 17 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Non-Randomized
Intervention Model: Factorial Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 1<br>Received the Basic Pediatric Chronic Care Model AND the Medication Assessment Prompt AND family education | Behavioral: electronic (computer based) provider feedback tool<br>* All sites received a Basic Pediatric Chronic Care Model; 2x2 factorial design allocated the additional Medication Assessment Prompt and family education across the four sites as well.<br>* Other names: Medication Assessment Prompt (MAP);|
| Experimental: 2<br>Received the Basic Pediatric Chronic Care Model AND the Medication Assessment Prompt but NOT family education | Behavioral: electronic (computer based) provider feedback tool<br>* All sites received a Basic Pediatric Chronic Care Model; 2x2 factorial design allocated the additional Medication Assessment Prompt and family education across the four sites as well.<br>* Other names: Medication Assessment Prompt (MAP);|
| Experimental: 3<br>Received the Basic Pediatric Chronic Care Model AND family education but NOT the Medication Assessment Prompt | Behavioral: electronic (computer based) provider feedback tool<br>* All sites received a Basic Pediatric Chronic Care Model; 2x2 factorial design allocated the additional Medication Assessment Prompt and family education across the four sites as well.<br>* Other names: Medication Assessment Prompt (MAP);|
| Placebo Comparator: 4<br>Received the Basic Pediatric Chronic Care Model only (NO Medication Assessment Prompt and NO family education) | Behavioral: electronic (computer based) provider feedback tool<br>* All sites received a Basic Pediatric Chronic Care Model; 2x2 factorial design allocated the additional Medication Assessment Prompt and family education across the four sites as well.<br>* Other names: Medication Assessment Prompt (MAP);|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| asthma control |  | assessed at all 5 study visits | 
| guideline appropriate medicating by providers |  | assessed at all 5 study visits | 
| patient knowledge |  | assessed at all 5 study visits | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| self efficacy |  | assessed at all 5 study visits | 
| social support |  | assessed at all 5 study visits | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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pediatric, asthma, translational research, health information technology