Uncontrolled asthma seriously affects a person's quality of life and disproportionately impacts low-income people and people of color. Although guidelines that show how to control asthma are available, they are not consistently implemented. We will implement three different approaches to improving guideline use. The first is deploying community health workers to make home visits to help people improve how they manage their asthma. The second is making clinic improvements so it is easier for clinic staff to know about and use the guidelines by using computers to remind them of the guidelines when they are seeing patients, giving them feedback on how well they are using the guidelines, creating teams of doctors and nurses and other clinic staff who can work together to implement the guidelines, reorganizing clinic processes, and teaching them how to measure the effect asthma is having on patients' lungs and how to do allergy tests. The third is helping health plans (insurers) enhance case management, monitor medications, notify providers of patient ED visits and hospitalizations, and increase guideline distribution to provider as well as making sure all providers receive basic asthma education. We will enroll 380 black, Hispanic1 and other low-income patients with uncontrolled asthma aged 5-75 years receiving care at six community health centers in Seattle, Washington in the study. We will divide the study participants into four groups so we can compare the relative benefits of each of these approaches. The four groups are:
- home visits + clinic improvement + health plan improvement/provider education;
- home visits + health plan intervention + provider education;
- enhanced clinic intervention + health plan intervention + provider education; and
- health plan intervention + provider education.
We will follow 95 patients in each of these groups for a year to compare how measures of asthma control change. We will also compare how study patients do relative to patients receiving usual care. The measures of asthma outcomes will be the following: Asthma control
- Asthma control
- Asthma-related quality of life
- Lung function
- Lung inflammation
- Hospitalizations and ED visits for asthma
- Patient-provider communication
- Patient satisfaction with care
The following groups will work together to conduct the study:
- Patients — Provide patient perspective through Patient Advisory Group and as members of research team
- Public Health — Seattle & King County — Study coordination, home visits, asthma and evaluation expertise
- Community Health Plan and Molina Healthcare (Medicaid health plans) — Case management
- Neighborcare — Community health center system clinic site
- University of Washington and Group Health Research Institute — Expertise in asthma, clinic systems design, evaluation
- Qualis Health — Expertise in health information technology, quality improvement
- PTSO — Expertise in health information technology
 We use the term Hispanic to denote people of Hispanic or Latino ethnicity.
Related PCORI Dissemination and Implementation Project
^James W. Krieger, MD, MPH, was the original principal investigator for this project.