With the increasing requirements for assuming prominent disease management and preventive screening activities, primary care physicians find themselves lacking cost-effective resources to improve the quality of medical care they provide to patients with chronic medical conditions. For example, the National Committee for Quality Assurance (NCQA) has begun promoting a model of comprehensive patient care referred to as Patient-Centered Medical Home (PCMH). To meet the disease management requirements for becoming a PCMH in an era of scarce resources, physicians need cost-effective tools to automate functions including contact with patients, accurate assessment of disease status, feedback to patients regarding results, and efficient documentation of those results in the health record. The purpose of the proposed SBIR award is to develop a web based asthma management module that can be integrated seamlessly into the office workflow of community primary care practices that employ either electronic health records or paper charts. We will design an online tool that will be used to contact patients via email inviting them to complete the Asthma Control Test (ACT), a brief self-report measure of asthma control, at the study website. Patients whose ACT scores reveal poor asthma control will receive more intensive care, while those with scores indicating adequate control will receive less frequent contact, thus helping practices prioritize according to patient needs. Along with the online ACT, we will co-administer validated measures to assess salient behavioral and psychological comorbities that have been associated with poor asthma outcomes, including medication adherence, smoking status, and level of psychological distress. Patients and clinicians will receive results of the online assessments along with brief interpretation of those findings. Patients will also have access to online self management tools including a daily peak flow recording module and an electronic Asthma Action Plan. In the proposed pilot study of single group design, we will use mixed qualitative and quantitative methodology by conducting focus groups with clinicians and patients as well as recruiting 50 adult patients with asthma to participate in a six-month longitudinal assessment of their use of the web-based disease management module.
The aims of this pilot study are: 1) to examine the acceptability and feasibility of use of the web-base application, and 2) to establish the effect size of the intervention in improving objective measures of lung function (office spirometry), with the ultimate goal of powering a large-scale, randomized controlled trial of the product. We believe this product has strong potential for clinical and commercial success as reimbursement structures evolve to include more incentives for primary care physicians to provide quality, comprehensive, and patient-centered medical care.
With a growing shortage of primary care physicians, new tools are needed to help improve the quality of care for the more than 20 million Americans with asthma without adding additional time burden or costs for these doctors. Developing an efficient, low-cost, online disease management system that integrates with the established workflow and charting in primary care offices may indeed represent a sustainable new method for improving patient asthma care.
