TAC ABSTRACT Reducing asthma morbidity is a public health priority. Despite National guidelines that recommend collaboration with the parent for effective asthma care, most primary care providers (PCPs) do not provide on- going self-management education or support, and effective interventions to improve maintenance care are difficult to disseminate into office practice. Our prior NHLBI-funded work focused on reducing asthma-related morbidity and healthcare use in children from low-income, urban neighborhoods. We have demonstrated that a lay asthma coach can improve self-management behaviors and reduce asthma hospitalizations, and can improve rates of follow-up with a PCP after an emergency department visit. In this competitive renewal application we will extend our successful theory-based coaching model into the general asthma population, and integrate coaching into office-based care with the Telephone Asthma Coaching program (TAC). We will conduct a randomized controlled trial to evaluate the TAC program. The coaching intervention will occur at the level of the parent, but to minimize contamination, randomization will occur at the level of the physician. Using a stratified cluster design, we will randomize 24 community pediatricians to the intervention or usual care control group. All participating physicians (intervention and control groups) will receive a summary of the most recent NAEPP guidelines, patient education materials and a registry of their asthma patients. Physicians in the intervention group will participate in two brief meetings to introduce coaching and to tailor implementation of the intervention to their practice. Parents of asthmatic children they care for will be invited to participate in the TAC program and work with an off site asthma coach to facilitate effective self-management and a collaborative partnership with the PCP. We will evaluate this pragmatic intervention in the community, and develop educational materials for PCPs, coaches and parents to facilitate widespread program dissemination. Our hypothesis is that the intervention will reduce asthma morbidity among children by improving maintenance care provided by the parent and the PCP, and these changes will be maintained. The target population is asthmatic children who are 5 to 12 years old and had >1 urgent care episode in the prior 12 months. All outcomes will be measured by parent interviews and chart audits at 12 and 24 months. The measurement cohort will average 40 patients/PCP (total 1000 patients). We will determine if the intervention: reduces asthma impairment measured as improved asthma control and asthma-related quality of life;reduces asthma risk measured by urgent care episodes among the target population in 12-months;and improves adherence to National guidelines for asthma care by the PCP. We will assess cost effectiveness from the perspective of the payor and society. Collaboration between key players in community-based asthma care resulted in development of the TAC program, and affords an opportunity to evaluate this model to translate research into office-based practice. Final Project Narrative. Reducing asthma morbidity is a public health priority. This project will evaluate if a telephone asthma coaching program that is integrated into office practice will reduce asthma morbidity among children by improving maintenance care provided by the parent and the PCP, and if the program is cost-effective.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Application #
Study Section
Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
Program Officer
Freemer, Michelle M,
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Washington University
Schools of Medicine
Saint Louis
United States
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Sumner 2nd, Walton; Walker, Mark S; Highstein, Gabrielle R et al. (2016) A randomized controlled trial of directive and nondirective smoking cessation coaching through an employee quitline. BMC Public Health 16:550
Garbutt, Jane M; Yan, Yan; Strunk, Robert C (2016) Practice Variation in Management of Childhood Asthma Is Associated with Outcome Differences. J Allergy Clin Immunol Pract 4:474-80
Garbutt, Jane M; Yan, Yan; Highstein, Gabrielle et al. (2015) A cluster-randomized trial shows telephone peer coaching for parents reduces children's asthma morbidity. J Allergy Clin Immunol 135:1163-70.e1-2
Garbutt, Jane M; Sylvia, Susan; Rook, Shannon et al. (2015) Peer training to improve parenting and childhood asthma management skills: a pilot study. Ann Allergy Asthma Immunol 114:148-9
Yan, Yan; Wu, Wei; Strunk, Robert C et al. (2014) Use of factor analysis models to evaluate measurement invariance property of the Asthma Control Questionnaire (ACQ). Qual Life Res 23:509-13
Nelson, Kyle A; Garbutt, Jane M; Wallendorf, Michael J et al. (2014) Primary care visits for asthma monitoring over time and association with acute asthma visits for urban Medicaid-insured children. J Asthma 51:907-12
Nelson, Kyle A; Highstein, Gabriele; Garbutt, Jane et al. (2012) Factors associated with attaining coaching goals during an intervention to improve child asthma care. Contemp Clin Trials 33:912-9
Garbutt, Jane M; Highstein, Gabrielle; Yan, Yan et al. (2012) Partner randomized controlled trial: study protocol and coaching intervention. BMC Pediatr 12:42
Nelson, Kyle A; Highstein, Gabriele R; Garbutt, Jane et al. (2011) A randomized controlled trial of parental asthma coaching to improve outcomes among urban minority children. Arch Pediatr Adolesc Med 165:520-6
Nelson, Kyle A; Lee, Pearlene; Trinkaus, Kathryn et al. (2011) Exhaled nitric oxide levels during treatment of pediatric acute asthma exacerbations and association with the need for hospitalization. Pediatr Emerg Care 27:249-55

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