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.

Final Research Report

View this project's final research report.

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.

Conflict of Interest Disclosures

Project Information

Andrea J. Apter, MD, MA, MSc
University of Pennsylvania
$2,014,419
10.25302/06.2020.AS.130705218
Using Information Technology to Improve Access, Communication and Asthma in African American and Hispanic /Latino Adults

Key Dates

December 2013
October 2019
2013
2019

Study Registration Information

Tags

Has Results
Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: April 22, 2024