Asthma is a highly prevalent disease with a significant morbidity leading to emergency room visits, hospitalizations and absenteeism from work and school. Two major factors contributing to asthma morbidity (and mortality) are failure to detect asthma decompensation and use of inappropriate treatment strategies. Asthma severity can be assessed by clinical symptoms and peak flow measurements. There are internationally accepted guidelines for asthma management. However, rapid translation of asthma symptoms into a change in therapy is frequently impeded by the patient's inability to understand self management, reluctance to contact the health care provider, or delays in feedback from the provider to the patient. The objective of the proposal is to develop and clinically evaluate a new Automated System for Telephonic Home Management of Asthma. We describe the design and alpha testing of a dynamic relational database (DRdb) suitable for use either in a isolated PC or in a distributed computer system to support daily reporting and facilitate all provider monitoring. The resulting DRdb accepts information about the patient, their specific diagnoses and treatment regimens. Each DRdb is accessible on-line, linked through LAN or WAN and captures the patient's symptoms and measurements at the moment when they are reported. Because the patient's history is electronically available, the DRdb can dynamically support the health professional to relay instructions immediately. Generally these instructions are pre-defined by the patient's doctor for the reported symptom set. Automation of these procedures may be possible. Specifically, we are developing a custom telephone interface, conducting a clinical trial in both adult and pediatric populations in which asthma management is under constant physician direction and where asthma intervention is (I) computer-assisted, (II) computer-mediated, or (III) according to conventional methods (Control Group). We measure end-points relevant to disease managers(costs), to health care providers(time) and to asthmatic patients(respiratory outcomes). The goals of the Asthma system described in this proposal are to save time (efficacy), and increase patient and health care provider satisfaction (attractiveness).
The commercial application of this grant may be attractive to Health Maintenance Organizations, Medicare and Medicaid as well as those who see the need for cost containment.
