Asthma is one of the most common chronic health conditions and can generally be well controlled through appropriate monitoring and management, yet many primary care providers do not follow NHLBI's asthma management guideline, resulting in poor asthma outcomes. To improve asthma guideline-concordance in primary care, the investigators propose a secondary data analysis using the Scalable Architecture for Federated Translational Inquiries Network (SAFTINet), a practice-based distributed research network, to measure the impact of the Colorado Asthma Toolkit Program (CATP) on asthma outcomes. The CATP, a multicomponent guideline dissemination intervention designed by researchers at National Jewish Health using stakeholder engagement methods, has been implemented in 100 Colorado primary care safety-net practices, including providers at the Metro Community Provider Network (MCPN), a network of practices serving safety-net populations throughout metropolitan Denver. SAFTINet, which includes MCPN practices, designed precisely for measuring disease outcomes in safety-net practices and is the ideal data source for the proposed study as it includes both the clinical EHR data and Medicaid claims data necessary for operationalizing standard asthma outcome measures. The research team for the current proposal brings together National Jewish Health, MCPN and SAFTINet investigators to perform a pre-post-secondary data analysis of asthma process and outcome measures associated with CAPT implementation at MCPN practices, using data from SAFTINet. The investigators'long-term goal is to advance asthma outcomes via pragmatic clinical trials of the dissemination and implementation of effective guideline-based processes in practices serving safety-net patients. The objectives of the current proposal are to demonstrate the value of the CATP and lay the groundwork for a pragmatic trial of the CATP. The investigators will pursue this objective in 3 Specific Aims:
Aim 1 : Measure the impact of CATP implementation on the guideline concordance of asthma care processes related to the assessment, monitoring and management of patients with asthma.
Aim 2 : Measure the impact of CATP implementation on outcome measures of asthma control: exacerbations, healthcare utilization, asthma severity scores, and pulmonary physiology.
Aim 3 : Perform a feasibility assessment and exploratory analyses to lay the groundwork for a rigorous, contextually-appropriate pragmatic cluster-randomized trial comparing two versions of the CATP. The proposed work is relevant to NHLBI's mission because it promotes dissemination of the agency's asthma guideline to patients in greatest need of improved delivery of guideline-concordant care, and demonstrates the value of improved guideline-concordance in enhancing the health outcomes of patients with asthma.

Public Health Relevance

Asthma is one of the most common chronic health conditions and can generally be well controlled through appropriate monitoring and management, yet many primary care providers do not follow NHLBI's asthma management guideline, resulting in poor asthma outcomes. This project will study asthma outcomes in primary care practices that participated in a program designed to give providers working with poor and minority patients the tools to follow guidelines for asthma care. By helping us to understand how to improve asthma care for patients in greatest need, this project can help to promote better health outcomes for patients with asthma.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Exploratory/Developmental Grants (R21)
Project #
1R21HL123589-01
Application #
8753748
Study Section
Special Emphasis Panel (ZRG1-PSE-Q (56))
Program Officer
Freemer, Michelle M
Project Start
2014-08-15
Project End
2016-07-31
Budget Start
2014-08-15
Budget End
2015-07-31
Support Year
1
Fiscal Year
2014
Total Cost
$116,250
Indirect Cost
$41,250
Name
University of Colorado Denver
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
041096314
City
Aurora
State
CO
Country
United States
Zip Code
80045