The proposed parallel arm, clustered randomized controlled trial will evaluate the effectiveness of a novel model for pulmonary specialist-health coach (PuSHCon) with respect to access to specialist recommendations and the provision of evidence-based care for patients with chronic obstructive pulmonary disease (COPD) and/or asthma receiving care at federally qualified health centers (FQHCs). The PuSHCon model was developed in partnership between patients, investigators, primary care clinicians, specialists, and FQHCs within the San Francisco Health Care Network during a randomized controlled trial of health coaching for patients with moderate to severe COPD. In the PuSHCon model, a trained, non-professional (unliscenced) health worker, meets with the patient at the patient?s own clinic to gather extensive information needed by the pulmonary specialist to make an assessment and recommendation for evidence-based care for COPD and/or asthma. The health coach then meets with the hospital-based pulmonary specialist who can assess the patient and make evidence-based recommendations without requiring the patient to be seen. These recommendations are communicated electronically to the patient?s primary care provider (PCP). The health coach communicates with the PCP and meets with the patient to explain the recommendations and support their implementation. The proposed study will be conducted in the San Francisco Health Network, at 10 clinic sites that share an electronic medical record and a single electronic referral process (eReferral).
The specific aims of the study are to compare the use of evidence-based care and of patient reported 16 weeks after the referral. In addition, the study will evaluate the number of patients seen under each model and the cost per patient in each model. The PuSHCon model combines desirable attributes of patient-centered care, team-based care, and coordinated specialty consultation to improve guideline-based care for at-risk patients with COPD and/or asthma. This model has been specifically developed to function within a safety-net system. It is designed to be practical and adaptable to other FQHCs and FQHC networks, and to be effective despite financial, technological, and resource constraints. If the proposed study shows that the PuSHCon model increases the use of evidence-based care, it can be widely implemented to increase guideline concordant, evidence-based care not just for patients with COPD or asthma, but also for patients with other chronic conditions that would benefit from specialist consultation.
Chronic obstructive pulmonary disease (COPD) and asthma together affect over 30 million Americans, costing tens of billions of dollars annually in lost productivity and direct medical costs and significantly lowering the quality of life for millions of people. Evidence-based care for both COPD and asthma can substantially reduce disease burden, improve quality of life, and prevent emergency visits and hospitalizations, but is widely underutilized, especially in primary care for vulnerable populations. The proposed study will test an innovative model in which a trained health coach increase patients' access to consultations with a pulmonary specialist, who will provide recommendations for evidence-based care, and supports the implementation of those recommendations by working with the patient and the patient's primary care provider.
