Project Summary

PCORI implementation projects promote the use of findings from PCORI-funded studies in real-world healthcare and other settings. These projects build toward broad use of evidence to inform healthcare decisions.

This PCORI-funded implementation project is using a virtual iPad program to help children with asthma and their parents and clinicians make shared decisions about treatment to improve their care in the emergency room, or ER, and reduce return visits.

Asthma is a chronic lung disease that affects more than 26 million Americans, including 6.2 million children. When asthma is not well-controlled, it can lead to hospitalizations and even death. Each year there are 2 million ER visits and 3,600 deaths due to asthma among US children.

What is the goal of this implementation project?

In shared decision making, or SDM, patients work with their doctors to select treatments or medical tests based on what is most important to them. A PCORI-funded research study found that primary care practices that used an SDM training program for clinicians had more patients with asthma who said they shared equally in treatment decisions. But many children who have trouble managing asthma go to the ER for treatment instead of a clinic.

This project adapted the SDM training program to help children with asthma who visit the ER make choices with their clinicians and parents about the treatment they will have after they go home.

What will this project do?

After their study, the research team adapted their SDM program to a virtual iPad format called Coach McLungs. Coach McLungs uses an animated computer character to help gather information from children and parents on asthma symptoms, goals, and preferences. It also provides education about asthma.

The project team is working with two children’s ERs to help them use Coach McLungs as part of routine care. The ERs are part of two health systems in Charlotte, North Carolina, and Atlanta, Georgia. Children and their parents are using Coach McLungs in the ER before seeing a doctor.

The project team is working with the ERs to:

  • Add training on SDM to the standard education that doctors and nurses receive on asthma
  • Train nurses and doctors in how to use Coach McLungs with children who have asthma and their parents
  • Help doctors and nurses work with families to make asthma treatment decisions based on summary reports from Coach McLungs

The project team is updating Coach McLungs to work better in the ER. For example, reminders about follow-up visits can be sent by email. The updated version is also available in Spanish.

What is the expected impact of this project?

The project is demonstrating what’s required for routine use of Coach McLungs in the ER. The project evaluation will confirm that the program is working as intended to improve the quality of asthma care that children receive in the ER and to reduce return visits.

More than 2,400 children who have asthma, including patients without a regular source of care, will receive the program. The project paves the way for the program’s further expansion to other ERs within the participating health systems and for its planned expansion to pediatric primary care and family medicine settings.

More about this implementation project:

Stakeholders Involved in This Project

  • Wellstar Health System
  • UNC Health
  • Atrium Health
  • Medicaid’s Community Care of North Carolina
  • Asthma and Allergy Foundation of America
  • Mecklenburg County Asthma Coalition

Implementation Strategies

  • Promote shared decision making. 
  • Adapt a shared decision making training for clinicians to a virtual program, called Coach McLungs, that families and clinicians use together. 
  • Adapt Coach McLungs to work on an IPad in the emergency room, to generate summary reports for families and clinicians, to send families reminders about follow-up visits, and by translating into Spanish. 
  • Adapt existing asthma education for emergency room doctors and nurses to include training on shared decision making. 
  • Provide sites with tools to support implementation, including job aides, and refresher training materials. 
  • Provide educational materials to patients, as part of Coach McLungs. 
  • Train emergency room staff and providers, including attendings, fellows, residents, and nurses, to use Coach McLungs and to promote shared decision making. 
  • Conduct cyclical small tests of change. 
  • Identify and prepare nursing asthma champions at sites. 
  • Provide technical assistance to sites, including coaching and consultation.

Evaluation Outcomes

To document implementation:

  • Number of children with asthma visiting the ER
  • Number of children with asthma receiving the intervention
  • Fidelity of SDM intervention delivery
  • Implementation barriers, facilitators, and resource needs

To assess healthcare and health outcomes:

  • Changes in emergency department visits and hospitalizations
  • Satisfaction with care
  • Utilization of primary care
  • Use of asthma medicines
  • Child and parent knowledge about asthma, self-efficacy for asthma self-care, and decisional conflict about asthma treatment decisions

Project Information

Hazel Tapp, PhD
Carolinas Medical Center
Evaluation of a Shared Decision Making Intervention for Patients with Asthma in the ED

Key Dates

November 2023

Study Registration Information

Initial PCORI-Funded Research Study

This implementation project focuses on putting findings into practice from this completed PCORI-funded research study: Training Staff at Doctors' Offices to Use Shared Decision Making with Patients Choosing Asthma Treatments



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
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Last updated: September 26, 2023