1. What were the results from the original PCORI-funded research study?
With help of parent stakeholders and their children, the project team created a tool to help parents manage their children’s asthma better. The tool is called the electronic-AsthmaTracker (e-AT). With the e-AT, parents and children work with their doctor to track asthma symptoms regularly, recognize early when they are getting worse, and act before an asthma attack happens. After 325 patients used the e-AT at 11 clinics, the team found the following:
- Children who used the e-AT had an improvement in their overall health (quality of life) and asthma control.
- Children who used the e-AT had fewer missed school days, fewer asthma attacks, and fewer emergency room visits and hospital admissions. The team also found that their parents missed work less.
- The team did not see any change in 603 children (control group) from clinics that did not use the e-AT.
2. Why is this research finding important?
- Children with asthma have too many asthma attacks, leading to poor quality of life, missed school and work, and emergency room or hospital visits. Guidelines suggest children with asthma and parents should learn to manage asthma between doctor visits. Recognizing worsening asthma symptoms early helps parents and doctors make changes to avoid attacks. But it is difficult to recognize when asthma starts worsening; this needs to be easier.
- Tracking symptoms with the e-AT provides an early warning for parents and doctors to prevent an asthma attack.
- Results show the e-AT is effective, and if it is widely disseminated in practice, it will improve care and outcomes of many children with asthma.
3. What is the goal of this project?
Actively disseminate the e-AT to children with asthma at three different healthcare systems, including: Intermountain Healthcare (IH), a regional system with 22 hospitals and 185 clinics and urgent care sites in Utah and southeastern Idaho, providing care to 1,680,000 patients; federally qualified community health centers (CHCs), providing care to low-income populations; the team will work with six CHCs and the Utah Pediatric Partnership to Improve Healthcare Quality (UPIQ), an organization that leads care improvement projects for CHCs in Utah; and University of Utah Health Plans (UUHP), an insurance provider to 220,000 clients, 42,939 children, and 2,634 children with asthma. The team has three goals:
- Spread the e-AT to more children with asthma through clinics and insurers. The team will do this in two phases: take the e-AT to 50 children through five clinics and 50 children through UUHP to determine how best to spread the e-AT in the two environments, and solve problems; disseminate the e-AT to at least 1,870 children in 36 clinics and UUHP.
- Determine the impact of the e-AT on children and parents after it is disseminated to many more children.
- Determine the best ways to help clinics and health insurance plans use the e-AT with their asthma patients.
4. What is the project team doing?
- The team will disseminate the e-AT to 1,080 children with asthma from 36 clinics (30 IH clinics and six CHCs) and 790 children enrolled through UUHP, which insures patients in four states (Utah, Idaho, Montana, and Nevada).
- The team will use facilitation and provide education/training and ongoing support to clinic representatives and health plan representatives who will, in turn, lead the effort to utilize the e-AT in clinics and the health plan.
- This project will help the team learn what works and doesn’t work when spreading the e-AT to clinics and insurers, how to effectively get doctors to use it, and ensure that the patients benefit.
5. How is the team evaluating this project?
- Using an approach called RE-AIM: Reach (how many patients use the e-AT), Effectiveness (impact on patient and parent outcomes), Adoption (number of physicians using the e-AT), Implementation (e-AT acceptance, how clinics and UUHP use it, and challenges and solutions faced using it), and Maintenance (ensuring e-AT use and benefits continue). The team will also assess the fidelity and feasibility of the e-AT intervention.
- The team will see if children using the e-AT have fewer ED and hospital visits and asthma attacks; improved asthma control and asthma self-management skills; fewer missed school and work days; and sustained parent satisfaction.
6. How is the team involving patients and others in making sure the findings reach people who can use them?
- In addition to parent, physician, public health, and health system leader stakeholders who helped design this, the project team has engaged teenage children with asthma and other key stakeholders from participating health systems, including IH, CHCs, UPIQ, and UUHP. Other key stakeholders include local program managers, asthma care coordinators, care managers, and physician champions who will help with spreading use of the e-AT locally.
- Teen stakeholders will help expand use to independent users of the e-AT, and help determine how to meet the needs of teens to ensure success.
- UPIQ stakeholders are experienced in spreading improvements to clinics using tools such as webinars, electronic approaches, and face-to-face training. They have strong connections to CHC clinics and will help share the e-AT to minority and Native American populations, thus benefiting this project and future efforts to spread the e-AT.
- UUHP stakeholders need to meet a quality improvement benchmark, which will allow the team to measure the e-AT’s effectiveness in meeting this. They are providing a new way to spread the e-AT through a payer (rather than the individual clinic model the team has used) and have committed four case managers to the project. They have also agreed to share information about the impact of the e-AT on payments for health care, and help explore the possibility of insurers providing incentives to their clinics/providers and their insured patients to continue using the e-AT.
- Clinics will use a physician champion and an asthma care manager. The team will explore with them approaches to using the e-AT in clinics and their day-to-day use in a clinic setting to improve use now and in the future.
7. How will this project help ensure future uptake and use of findings from patient-centered outcomes research?
- Participating health systems will review data of the project and compare resource use of those who used and those who did not use the e-AT. Results will help develop new training and incentive mechanisms for clinics and patients to use the e-AT consistently, then use those to disseminate the e-AT to remaining IH clinics and UUHP members.
- The team will present results at regional and national meetings, and summarize them in a final project report. The team will publish and distribute results to other health systems and payers to spread use of the e-AT as a model to improve asthma care and outcomes.
Related PCORI-funded Research Project
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.