Results Summary
What was the research about?
Asthma is a common illness in adults that can make it hard to breathe. Patients with uncontrolled asthma may end up in the emergency room, or ER, or in the hospital. People who have low incomes and who are African American or Hispanic are more likely to have asthma than other adults.
Patient portals may help patients with asthma manage their symptoms. Patient portals are secure websites where patients can view their health records, see test results, send messages to their doctors, and ask for prescription refills. Community health workers, or CHWs, may also help patients—especially those with low incomes—manage asthma. CHWs are trained to teach people about health and link them with health and social services in their community.
In this study, the research team wanted to learn whether African-American and Hispanic patients who had patient portal training plus visits from CHWs improved control of asthma symptoms more than patients who had patient portal training alone. The team also looked at
- Asthma-related quality of life
- Number of visits to an ER
- Number of hospital stays
What were the results?
After one year, patients in the two groups didn’t differ in how much asthma symptoms improved. Patients in both groups improved their control of asthma symptoms.
Compared with patients who had patient portal training alone, patients who also had visits from CHWs reported fewer hospital stays. The groups didn’t differ in quality of life or the number of trips to the ER.
Who was in the study?
The study included 301 adults with moderate to severe asthma in Philadelphia. Of these, 75 percent were African American, 22 percent were Hispanic or Latino, 1 percent were white, and 1 percent were other races. The average age was 49, 90 percent were women, and 79 percent had incomes less than $30,000 per year.
What did the research team do?
The research team assigned patients by chance to one of two groups. In both groups, patients had training to use a patient portal. In the second group, patients also had up to four home visits from CHWs over six months. During these visits, CHWs created or reviewed an action plan for asthma care. They also helped patients use the portal on a computer to send messages to their doctors and make appointments.
Patients completed a survey before the training and again one year later.
Patients with asthma, their families, and clinicians helped design the study.
What were the limits of the study?
Many patients didn’t have a computer at home and could only access the patient portal at a school or library. CHWs also had trouble scheduling home visits with patients. These problems may have led to lower use of the patient portal and fewer than four CHW visits.
Future research could look at other programs for asthma control that don’t rely on a computer.
How can people use the results?
Doctors can use the results when considering ways to help people with low incomes manage asthma.
| How this project fits under PCORI’s Research Priorities PCORI identified asthma in African American and Hispanic/Latino populations as an important research topic. Patients, clinicians, and others wanted to learn how to encourage care that follows national asthma guidelines and improves patient-centered outcomes for African American and Hispanic/Latino populations. In 2013, PCORI launched an initiative on Treatment Options for African Americans and Hispanics/Latinos with Uncontrolled Asthma. The initiative funded this research project and others. |
Professional Abstract
Objective
To compare the effectiveness of patient portal training plus home visits from community health workers (CHWs) versus patient portal training alone in controlling asthma symptoms in African-American and Hispanic patients with low incomes
Study Design
| Design Elements | Description |
|---|---|
| Design | Randomized controlled trial |
| Population | 301 adults from low-income Philadelphia neighborhoods who have moderate to severe asthma |
| Interventions/ Comparators |
|
| Outcomes |
Primary: control of asthma symptoms Secondary: asthma-related quality of life, number of ED visits, number of hospitalizations |
| Timeframe | 1-year follow-up for primary outcome |
This randomized controlled trial compared the effectiveness of patient portal training plus home visits from CHWs versus patient portal training alone in controlling asthma symptoms, improving asthma-related quality of life, and reducing emergency department (ED) visits and hospitalizations in African-American and Hispanic adults. Asthma disproportionately affects people with low incomes and particularly African American and Hispanic people.
The research team randomly assigned patients to one of two groups. In both groups, patients received training on using a patient portal to locate laboratory test results, schedule appointments, request refills for prescriptions, and send messages to their doctors. Patients in the second group had home visits with CHWs in addition to the portal training. During the home visits, CHWs helped patients create an action plan for asthma care and use the patient portal to communicate with their doctors. The patients in this group received four home visits over a six-month period.
The study included 301 adults with moderate to severe asthma in Philadelphia. Of these, 75% were African American, 22% were Hispanic or Latino, 1% were white, and 1% were other races. The average age was 49, 90% were female, and 79% made less than $30,000 per year.
At baseline and one year later, patients completed surveys on asthma symptoms, asthma-related quality life, and the number of visits to the hospital or ED in the past year.
Patients with asthma, their families, and clinicians helped design the study.
Results
After one year, the two groups did not differ significantly in their control of asthma symptoms. Patients in both groups reported statistically significant improvements in control of asthma symptoms (-0.21; 95% confidence interval [CI]: -7.2, -2.7).
Compared with patients who had patient portal training alone, patients who also had visits from CHWs reported significantly fewer hospitalizations (-0.53; CI: -1.08, -0.024). The two groups did not differ in improvement in other outcomes.
Limitations
Many patients did not have a computer at home and could only access the patient portal at a school or library. The CHWs had difficulty scheduling home visits with patients. These factors may have limited patients’ benefits from the patient portal as well as the number of CHW visits.
Conclusions and Relevance
In this study, patients who had patient portal training plus home visits from CHWs and patients who had patient portal training alone did not differ in the amount of improvement in most asthma-related outcomes.
Future Research Needs
Future research could explore other interventions for asthma control that consider patient living situations and patient computer or internet access.
| How this project fits under PCORI’s Research Priorities PCORI identified asthma in African American and Hispanic/Latino populations as an important research topic. Patients, clinicians, and others wanted to learn how to encourage care that follows national asthma guidelines and improves patient-centered outcomes for African American and Hispanic/Latino populations. In 2013, PCORI launched an initiative on Treatment Options for African Americans and Hispanics/Latinos with Uncontrolled Asthma. The initiative funded this research project and others. |
Final Research Report
View this project's final research report.
Journal Citations
Results of This Project
Related Journal Citations
Peer-Review Summary
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:
- The reviewers asked for clarification on how many data collection points occurred outside planned timeframes and how this was accounted for in analyses. The researchers said they planned consistent data collection times for each patient but said that actually collecting data at specified times is practically impossible in patient-centered research. In weekly project meetings, the researchers discussed the challenges of contacting patients and the consequences of delay. They decided to collect data as soon as they could contact patients, even if late, so as to retain as many patients as possible in the study. The researchers accounted for the differences in data collection times by modeling time flexibly as a continuous variable in their analyses. They reported the actual versus preplanned data collection times graphically and explained their decisions in detail in an appendix.
- The reviewers asked about the qualitative results presented in the report, given the absence of any qualitative methods presented. The reviewers asked whether the researchers collected this information on the community health worker (CHW) experience through formal qualitative methods or through informal observations. The researchers explained that CHWs provided their impressions and experiences at weekly project meetings. The researchers documented these for later reporting. Since this was not done as part of a formal qualitative protocol, the researchers renamed the section describing these experiences t CHW Experiences and Observations.
- The reviewers asked if the researchers blinded the data collectors to which category of intervention patients were assigned. The researchers responded that they did not and could not blind the data collectors, as these were the four CHWs involved in the project who acted as research coordinators, data collectors, and home visitors. The researchers noted the lack of CHWs’ blinding as a study limitation. The researchers added that they blinded the principal investigators to participant assignments.