This project has results

Comparing Enhanced Clinical Care with and without Home Visits to Help African-American Adults Manage Asthma -- The HIITBAC Study

Results Summary and Professional Abstract

Results Summary

What was the research about?

Asthma is a health problem that can make it hard to breathe. In Harris County, Texas, African-American adults with asthma die at twice the rate of white adults with asthma. Reducing asthma triggers at home, such as dust and chemical odors, can help patients manage asthma symptoms.

In this study, the research team wanted to learn if enhanced care with or without home visits helped African-American patients manage their asthma. Enhanced care included a doctor’s visit at a clinic to test for allergies, information on asthma triggers, and an asthma care plan. For patients who had home visits, a home visit team checked for asthma triggers. Then this team created a specific plan to improve asthma control, such as use of special pillow covers or safer pest control products. The research team compared patients who had home visits with those who didn’t have them.

What were the results?

After one year, patients with home visits had a greater reduction in emergency room, or ER, trips than patients without home visits. Patients with and without home visits didn’t differ in asthma control, quality of life, number of symptom-free days, or hospital stays for asthma.

Compared with the start of the study, after one year, patients with and without home visits

Had improved asthma control and quality of life and more symptom-free days
Were less likely to have ER visits or be hospitalized for asthma

Who was in the study?

The study included 263 African-American adults who had poorly controlled asthma. All lived in Harris County, which includes most of Houston. The average age was 50, and 75 percent were women.

What did the research team do?

The research team assigned patients to one of two groups by chance. Patients in both groups received enhanced clinical care. Patients in one group also received five home visits. The home visit team included an environmental home assessor, a nurse practitioner, and a community health worker, or CHW. The CHWs worked with the patients to implement the individual asthma control plan developed based on the first home visit. Patients who had home visits also received information about how to manage their asthma.

Patients completed surveys when they joined the study and again 6 and 12 months later.

Patients with asthma, a social worker, a doctor, and advocacy groups gave input during the study.

What were the limits of the study?

Fewer patients with home visits completed the study than patients without home visits. Results may have differed if more patients with home visits had completed the study. The study didn’t look at how well enhanced clinical care worked compared with usual asthma care. As a result, the team doesn’t know if the changes were because of enhanced clinical care or something else.

Future research could continue to look at ways to help African-American adults manage their asthma.

How can people use the results?

Clinics can use these results when considering ways to help African-American patients manage asthma.

Professional Abstract

Objective

To compare the effectiveness of enhanced clinical care with and without home visits on improving asthma-related outcomes among African-American adults

Study Design

Design Element	Description
Study Design	Randomized controlled trial
Population	263 African-American adults with poorly controlled asthma, defined as an Asthma Control Test™ score of 19 or lower; one or more ED visits or hospitalizations for asthma in the preceding year; and/or meeting the definition of very poorly controlled asthma from NIH and the National Asthma Education and Prevention Program’s Guidelines for the Diagnosis and Management of Asthma
Interventions/ Comparators	Enhanced clinical care plus home visits Enhanced clinical care
Outcomes	Primary: asthma control, asthma-related QOL, ED visits Secondary: hospitalizations for asthma, symptom-free days, spirometry
Timeframe	1-year follow-up for primary outcomes

This randomized pragmatic trial compared the effectiveness of enhanced clinical care with and without home visits on improving asthma control and asthma-related quality of life (QOL) and reducing emergency department (ED) visits among African Americans who had poorly controlled asthma. In Harris County, Texas, African-American adults with asthma die at twice the rate of white adults with asthma.

All patients received an enhanced clinical care visit with an asthma assessment, customized education, and pulmonary and allergy testing. Patients received test results and developed an asthma action plan with a healthcare provider.

After the baseline clinical visit, researchers randomized patients to receive five home visits or none. A home environmental assessor conducted the first home visit. Based on clinical and home-visit findings, the patient, a nurse practitioner, and community health worker (CHW) created a comprehensive asthma action plan. For subsequent visits at 2, 5, 8, and 12 months, the CHW implemented the plan and provided education and supplies to reduce indoor allergens and irritants.

The study included 263 African-American adults with poorly controlled asthma from Harris County, which includes most of Houston. The average age was 50, and 75% were female.

All patients completed baseline and 12-month surveys in the clinic and a 6-month survey over the phone on study outcomes.

An advisory board consisting of patients; a health system manager; a social worker; a physician; a CHW; a community faith leader; and advocates from clean air, asthma, and mental health groups gave input on the study.

Results

After one year, participants who received home visits had a greater reduction in ED visits than people who received enhanced care alone (p=0.045), but the two groups did not differ significantly in other study outcomes.

In both groups, participants had clinically meaningful improvements in asthma control and asthma-related QOL after one year (both p<0.001). Compared with baseline,

Participants in both groups were less likely to have ED visits (enhanced care only odds ratio [OR]=0.4; 95% confidence interval [CI]: 0.25, 0.59; home visits OR=0.2; 95% CI: 0.12, 0.32) and had more symptom-free days (enhanced care only 2.23 days; home visits 2.49 days; both p<0.001).
Participants who received home visits were less likely to be hospitalized for asthma (OR=0.45; 95% CI: 0.26, 0.78).
Neither group had a statistically significant improvement in spirometry.

Limitations

Fewer participants who received home visits completed the study than participants who received enhanced care alone. Results may differ if more participants who received home visits completed the study. Without a usual care comparison, this study cannot establish with certainty that the improvements seen before and after care were the result of enhanced clinical care.

Conclusions and Relevance

In this study, enhanced clinical care with and without home visits was similarly effective in improving asthma control and asthma-related QOL.

Future Research Needs

Future research could continue to assess ways to improve care delivery for African-American adults with asthma.

This project's final research report is expected to be available by January 2021.

Journal Articles

The Journal of Allergy and Clinical Immunology

Enrolling African-American and Latino Patients with Asthma in Comparative Effectiveness Research: Lessons Learned From Eight Patient-Centered Studies

Peer-Review Summary

The Peer-Review Summary for this project will be posted here soon.

Conflict of Interest Disclosures

The Conflict of Interest Disclosures for this project will be posted here soon.

Project Details

Principal Investigator

Winifred J. Hamilton, MS, PhD

Project Status

Completed; PCORI Public and Professional Abstracts Posted

Project Title

The Houston Home-based Integrated Intervention Targeting Better Asthma Control (HIIT-BAC) for African Americans

Board Approval Date

December 2013

Project End Date

March 2020

Organization

Baylor College of Medicine

Year Awarded

2013

State

Texas

Year Completed

2020

Project Type

Research Project

Health Conditions

Allergies and Immune Disorders

Cardiovascular Diseases

Hypertension

Nutritional and Metabolic Disorders

Diabetes

Obesity

Respiratory Diseases

Asthma

Chronic Obstructive Pulmonary Disease

Toxins

Intervention Strategies

Other Clinical Interventions
Other Health Services Interventions
Policy Interventions
Technology Interventions
Training and Education Interventions

Populations

Low Income
Older Adults
Racial/Ethnic Minorities
Urban

Funding Announcement

Asthma Treatment Options for African Americans and Hispanics/Latinos

Project Budget

$2,316,750

Study Registration Information

HSRP20143426

NCT02253433

Page Last Updated:

April 14, 2020