Supporting the Use of a Treatment Approach in Health Systems to Improve Outcomes for Adults with Moderate to Severe Asthma

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 making a treatment approach for asthma, shown to reduce asthma attacks and improve asthma control, part of regular care in in four health systems across the country.
Asthma is a health problem that can make it hard to breathe. People with uncontrolled asthma may have to go to the emergency room or hospital when asthma attacks occur. Asthma attacks can also make doing normal activities like going to work or school difficult.

What is the goal of this implementation project?

As part of usual care for asthma, people with asthma often use a reliever inhaler with fast-acting medicine or a nebulizer to ease symptoms like wheezing. They also use an inhaled corticosteroid, or ICS, every day to help control their asthma and prevent asthma attacks.

A PCORI-funded research study with Black and Hispanic adults found that, compared with usual care alone, a treatment approach called Patient Activated Reliever-Triggered Inhaled CorticoSteroids, or PARTICS, reduced asthma attacks and improved asthma control. It also led to fewer missed days of work, school and doing usual activities. With PARTICS, people take a puff of ICS each time they need to take a puff of a rescue inhaler and five puffs of ICS each time they use a nebulizer.

This project is making PARTICS part of regular care at health systems in four states to improve outcomes for adult patients with moderate to severe asthma.

What will this project do?

The project team is working with four health systems in California, Colorado, Ohio, and Tennessee. These health systems serve diverse communities. Three of the health systems mainly serve patients who are Black, Hispanic, or without health insurance.

To make PARTICS part of regular asthma care for adults, the project team is:

Preparing and working with a clinician champion to promote use of PARTICS at each site
Promoting awareness of PARTICS to clinicians through regular meetings, emails, newsletters, and self-teaching materials
Adapting electronic health record, or EHR, systems to identify eligible patients and alert clinicians before and during visits that patients may benefit from PARTICS
Supporting prescribing through EHR systems at three of the four sites
Informing patients about PARTICS through letters, texts, or messages in their patient portal
Updating after-visit summaries for patients to include information about how to use PARTICS as well as links to educational videos
Providing reports every three to six months on the use of PARTICS by patients at each site

What is the expected impact of this project?

The project will demonstrate what’s required to make PARTICS part of regular care in health systems. These systems vary in size and serve diverse patients. More than 1,600 clinicians will learn about PARTICS. About 14,900 patients with asthma will receive PARTICS. The project evaluation will confirm that PARTICS is working as intended to improve outcomes for adult patients with asthma.

More about this implementation project:

Stakeholders Involved in This Project

American Academy of Allergy, Asthma, and Immunology
American Academy of Pediatrics
Allergy and Asthma Network
American College of Osteopathic Family Physicians
American Lung Association
Asthma and Allergy Foundation of America
Local implementation teams at each site, including patient partners, frontline clinicians, EHR programmers, and a local clinician champion

Implementation Strategies

Adapt sites’ EHR systems, working with EHR personnel, to include clinical decision supports, such as pop-up alerts and smartsets to alert providers when a patient would benefit from PARTICS
Adapt materials used in the original study, PREPARE, to meet each site’s needs
Provide sites with tools to support implementation, including EHR-integrated patient eligibility queries, prescribing modules, and patient instruction sheets
Support implementation teams at sites
Promote patient awareness of PARTICS through letters, text messages, and patient portal, working with each site’s patient advisors
Identify and prepare a physician champion at each site to lead clinician awareness through staff meetings, educational meetings, emails, and newsletters
Provide clinics with audit and feedback reports on the number of PARTICS prescriptions that are distributed and refused
Offer continuing medical education credits

Evaluation Outcomes

To document implementation:

Number and proportion of eligible patients prescribed PARTICS
Number and proportion of patients prescribed PARTICS who fill at least one prescription
Number and proportion of EHR alerts that clinicians acted on
Adoption (i.e., number and proportion of clinicians who started at least one patient on PARTICS)
Fidelity to treatment approach
Maintenance of intervention components by site and patients

To assess healthcare and health outcomes:

Asthma exacerbation rates from EHR and claims data
Decreased emergency department visits and hospitalizations if available through EHR

Project Information

Principal Investigator Principal Investigator The lead researcher and primary contact for the project. View Glossary:

Elliot Israel, M.D.

Organization Organization The institution/organization in which the project originates, or the primary institution or organization that received funding for the project. View Glossary:

Brigham and Women's Hospital

Project Budget:

$2,067,804 *

Project Title Project Title The original title of the project supplied by the principal investigator or project lead/team. View Glossary:

Implementation of Patient Activated Reliever-Triggered Inhaled Corticosteroids in Adults with Moderate to Severe Asthma

Key Dates

Project Period:

36 months *

Approval Date Approval Date The date of approval to fund by PCORI. The actual project start dates vary as the negotiation of project milestones must be completed before the contract can be fully executed. View Glossary:

March 2023

Year Awarded Year Awarded The year that funding for the project was approved, or the year the proposal received a notice of award. View Glossary:

2023

Initial PCORI-Funded Research Study

This implementation project focuses on putting findings into practice from this PCORI-funded research study: Comparing Asthma Treatments: A Study Focusing on African-American, Hispanic, and Latino Adults -- The PREPARE Study for PeRson EmPowered Asthma Relief

*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.

About

Research

Impact

Highlights of PCORI-Funded Research Results

Topics

Engagement

Funding Opportunities

Applicant and Awardee Resources

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