Project Summary

This implementation project is complete.

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 expanded the use of an electronic asthma tracker, or e-AT, which improves asthma control in children.

Asthma is a common chronic illness in children that can make it hard to breathe. Asthma attacks can cause children to miss school and their parents to miss work. Being aware of asthma symptoms and changing treatments early before symptoms get worse can help prevent severe asthma attacks.

What was the goal of this implementation project?

Being aware of asthma symptoms and changing treatments when asthma gets worse can help children and their families prevent severe attacks. A PCORI-funded study found that children who used an electronic asthma tracker, or e-AT, had improved asthma control and quality of life compared with those who didn’t use e-AT. Also, children who used the e-AT had fewer missed school days, asthma attacks, emergency room, or ER, visits, and hospital visits. Parents also missed work less often. 

This project expanded use of the e-AT for children with asthma in Utah.

What did this project do?

The project team expanded use of the e-AT to diverse sites in Utah, including:

  • 33 Intermountain Health, or IH, clinics
  • 2 community health centers, or CHCs
  • 23 clinics serving University of Utah Health Plan, or UUHP, members 

Patients who received care at these sites included those with low incomes and those who speak Spanish.

Children or their families using the e-AT  could record asthma symptoms on the e-AT website using a computer or smart phone once a week, either in English or Spanish. The e-AT then produced an asthma control score. The e-AT tracked changes in the score over time and sent users advice for follow-up care. If symptoms got worse, the e-AT sent alerts to parents and to the children’s clinics.

Clinics used different staffing approaches for putting the e-AT in place.  At IH clinics and CHCs, asthma care coordinators or centralized asthma care managers coordinated all e-AT activities. These activities included patient outreach, training, enrollment, monitoring, coordinating care, and patient follow-up. Centralized care managers worked with clinic staff to coordinate patient care and follow-up activities; care coordinators managed care and patient follow-up activities directly. At UUHP clinics, centralized asthma care managers employed by the health plan took on all these activities. They also worked with clinic staff to coordinate care and follow up with patients.

The project team trained at least 134 asthma care coordinators and asthma care managers in:

  • The benefits of using the e-AT
  • How to identify families who could benefit 
  • How to enroll patients in person or remotely
  • How to use a web-based dashboard at each site to help care managers and clinic staff track family use of the e-AT
  • How to track children’s asthma control and respond to alerts when children’s symptoms get worse suddenly or over time

Throughout the project, the project team provided support to care managers and clinic staff. Support included monthly virtual meetings and calls, site visits, in-person meetings, and monthly patient user reports.

What was the impact of this project?

Based on the first 333 patients enrolled in the e-AT across all clinics, 74% began using it following their enrollment; the remaining patients didn’t.  Of the patients who began using it, about 45% used it regularly or every week as intended.

The IH clinics enrolled the largest number of patients; 374 children enrolled at these clinics. Among these children, 67% started using the e-AT. After one year, compared with the one-year period prior to launch, patients at IH clinics who used the e-AT program had:

  • Fewer asthma-related ER visits or hospital stays (p<0.0001)
  • Fewer non-asthma-related ER visits or hospital stays (p<0.0001)
  • Decreases in the use of a rescue medicine (p=0.0056) 
  • Decreases in the use of oral corticosteroids, or OCS (p=0.0034)
  • No difference in use of asthma controller medicine. This kind of medicine prevents asthma symptoms when used regularly.

At IH clinics, patients in the e-AT program had greater reductions in asthma-related ER visits or hospital stays compared with matched controls (p=0.0093). The two groups didn’t differ in controller use, rescue medicine use, or OCS use.

UUHP and the CHCs launched the e-AT program but reached fewer children. Of the 73 patients enrolled, 53 were patients at UUHP clinics and 20 were patients at CHCs. After one year, compared with the one-year period prior to launch, the 60 patients from UUHP and CHCs who used the e-AT program had fewer asthma-related ER visits or hospital stays (p<0.0001). Use of asthma controller medicine, rescue medicine, and oral steroids didn't differ significantly over time for these patients.

Several challenges limited the project team’s ability to reach as many patients as intended. Many clinics had limited resources to support the uptake of the e-AT. For example, clinics had few care coordinators with limited time to devote to patient enrollment. For this reason, clinics decided to offer the program only to their highest risk patients. Further, workload and workforce challenges related to the COVID-19 pandemic and changes in clinic priorities led a few clinics to halt use of the program.

More about this implementation project:

Stakeholders Involved in This Project

  • Utah Pediatric Partnership to Improve Healthcare Quality (UPIQ)

  • Utah Asthma Program (UAP) at the Utah Department of Health

  • University of Utah Health Plans
  • Intermountain Health

Publicly Accessible Project Materials

  • An implementation toolkit that includes:

    • Training and educational materials for clinic staff, including slides and informational guides.
    • Resources for clinics to guide delivery of the e-AT (e.g., how to identify, enroll, monitor, and follow up with patients) and support its consistent use—for example, a playbook for care managers, communication scripts for care coordinators, monthly clinic- and system-level performance report templates, and patient invitation letters and welcome packets.
    • Resources to support ongoing clinic (e.g., flyers, posters) and family (e.g., newsletters) engagement.
    • Testimonials and success stories, including videos for clinic staff and families.

For more information about these materials, please contact the project team at flory.nkoy@hsc.utah.edu.

The project team developed these materials, which may be available for free or require a fee to access. Please note that the materials do not necessarily represent the views of PCORI and that PCORI cannot guarantee their accuracy or reliability.

Project Achievements

  • Trained 134 staff to deliver the intervention.

  • Reached 447 children with asthma.

  • Created implementation resources for future sites interested in implementing the intervention.

Implementation Strategies

  • Used an electronic system, e-AT, that includes clinical decision support—including real-time results interpretation and recommendations.

  • Adapted the e-AT program to work with sites’ existing resources and workflows.

  • Provided sites with Information Technology tools to support implementation, including alerts, reminders, and dashboards to support use by families and clinic staff.

  • Provided educational materials to patients, including written materials and videos.

  • Trained care managers and clinic staff to use the program in person and via written materials and videos.

  • Used a phased implementation approach, launching the program in three waves.

  • Identified and prepared physician champions and systems leaders at sites.

  • Conducted site visits.

  • Provided technical assistance to sites, including practice facilitation and consultation.

Evaluation Measures

To document implementation:

  • Number of care managers and clinic staff trained and using e-AT

  • Number of patients using e-AT

  • Additional measures of acceptability, fidelity of program delivery and use, and maintenance

  • Implementation barriers and facilitators

To assess healthcare and health outcomes:

  • Number of ER visits and hospital admissions

  • Oral corticosteroid use

  • Asthma medication ratio

  • Asthma control

Project Information

Flory Nkoy, MD, MS, MPH
University of Utah
$1,061,330
Expanding the Use of an Electronic Tracker to Support Successful Asthma Self-Management Among Children

Key Dates

November 2019
August 2023
2019

Study Registration Information

Initial PCORI-Funded Research Study

This implementation project focuses on putting findings into practice from this completed PCORI-funded research study: Does an Advanced Electronic Tracker Help Families Manage Children's Asthma Symptoms Better Than a Standard Electronic Tracker?

Tags

Project Status
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
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
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Last updated: March 14, 2024