A disproportionate number of impoverished and minority children suffer from asthma. Many of these children who should receive preventive asthma medications are not receiving them. In our prior work, we found that providers frequently misclassify asthma severity, and this misclassification leads to inadequate prescription of preventive medications. Further, once preventive medications are prescribed, many children continue to have poor asthma control. Importantly, most clinicians do not systematically screen for asthma symptoms at office visits. The goal of this project is to evaluate whether a multifaceted prompting intervention, administered in urban primary care offices, reduces morbidity among urban children with asthma. This study builds on our experience with a pilot randomized trial in 2 urban clinics, in which we found that prompting clinicians about asthma severity and care guidelines at the time of an office visit resulted in improved preventive care delivery. We propose a full scale cluster randomized trial with 510 children ages 2-12 years in 12 different practices from our Clinical and Translational Science Institute's practice-based research network. Practices will be matched into 6 pairs and then randomly assigned to either the Multifaceted Prompting Intervention (MPI) or usual care. For enrolled intervention subjects, the MPI will include a prompt for the health care provider and a simplified prompt for the caregiver, designed for use during the office visit and prepared in the waiting room on a Tablet Personal Computer by a trained research associate. These prompts are designed to stimulate communication between the caregiver and provider and will include information regarding the patient's asthma severity or level of control as well as individualized guideline-based recommendations for care. Intervention practices also will receive practice- level supports, including interactive seminars, access to educational programs and resource guides, and bi- annual feedback on their performance for the primary outcomes. We will assess the effectiveness of the intervention in reducing asthma morbidity (including symptom-free days as the primary outcome, as well as additional clinical and functional outcomes) and will assess the extent and nature of preventive care delivery (defined by the occurrence of guideline-based corrective actions at the index visit) for children in MPI and usual care practices. At study completion, the effectiveness of office-based prompting will be better defined as a sustainable means to reduce morbidity among high-risk asthmatic children. This type of intervention is widely applicable for asthma care in practices nationwide, and for management of other chronic diseases.

Public Health Relevance

NARRATIVE -

Public Health Relevance

This project may have a profound impact on public health because it presents a practical system change to promote adherence to effective asthma care guidelines. Should it prove successful in reducing symptoms and improving the health of urban children with asthma, it has the potential to serve as a model for improved asthma care in urban communities.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL091835-05
Application #
8402577
Study Section
Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
Program Officer
Freemer, Michelle M,
Project Start
2009-01-01
Project End
2014-12-31
Budget Start
2013-01-01
Budget End
2014-12-31
Support Year
5
Fiscal Year
2013
Total Cost
$702,271
Indirect Cost
$227,982
Name
University of Rochester
Department
Pediatrics
Type
Schools of Dentistry
DUNS #
041294109
City
Rochester
State
NY
Country
United States
Zip Code
14627
Halterman, Jill S; Fagnano, Maria; Tremblay, Paul J et al. (2014) Prompting asthma intervention in Rochester-uniting parents and providers (PAIR-UP): a randomized trial. JAMA Pediatr 168:e141983
GutiƩrrez, Susana J; Fagnano, Maria; Wiesenthal, Elise et al. (2014) Discrepancies between medical record data and parent reported use of preventive asthma medications. J Asthma 51:446-50
Carlin, Courtney; Yee, Alison B; Fagnano, Maria et al. (2014) The influence of Hispanic ethnicity on parent-provider communication about asthma. Clin Pediatr (Phila) 53:380-6
Lewis, Porschea; Fagnano, Maria; Koehler, Alana et al. (2014) Racial disparities at the point of care for urban children with persistent asthma. J Community Health 39:706-11
Yee, Alison B; Fagnano, Maria; Halterman, Jill S (2013) Preventive asthma care delivery in the primary care office: missed opportunities for children with persistent asthma symptoms. Acad Pediatr 13:98-104