Effect of a web-based chronic disease management system on asthma control and health-related quality of life: study protocol for a randomized controlled trial

Ahmed, Sara; Bartlett, Susan J.; Ernst, Pierre; Paré, Guy; Kanter, Maria; Perreault, Robert; Grad, Roland; Taylor, Laurel; Tamblyn, Robyn

doi:10.1186/1745-6215-12-260

Cited by 25 publications

(21 citation statements)

References 113 publications

(100 reference statements)

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“…The research assistant obtained informed patient consent. The detailed protocol is available elsewhere [15]. …”

Section: Methodsmentioning

confidence: 99%

The Effectiveness of Web-Based Asthma Self-Management System, My Asthma Portal (MAP): A Pilot Randomized Controlled Trial

Ahmed¹,

Ernst²,

Bartlett³

et al. 2016

J Med Internet Res

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BackgroundWhether Web-based technologies can improve disease self-management is uncertain. My Asthma Portal (MAP) is a Web-based self-management support system that couples evidence-based behavioral change components (self-monitoring of symptoms, physical activity, and medication adherence) with real-time monitoring, feedback, and support from a nurse case manager.ObjectiveThe aim of this study was to compare the impact of access to a Web-based asthma self-management patient portal linked to a case-management system (MAP) over 6 months compared with usual care on asthma control and quality of life.MethodsA multicenter, parallel, 2-arm, pilot, randomized controlled trial was conducted with 100 adults with confirmed diagnosis of asthma from 2 specialty clinics. Asthma control was measured using an algorithm based on overuse of fast-acting bronchodilators and emergency department visits, and asthma-related quality of life was assessed using the Mini-Asthma Quality of Life Questionnaire (MAQLQ). Secondary mediating outcomes included asthma symptoms, depressive symptoms, self-efficacy, and beliefs about medication. Process evaluations were also included.ResultsA total of 49 individuals were randomized to MAP and 51 to usual care. Compared with usual care, participants in the intervention group reported significantly higher asthma quality of life (mean change 0.61, 95% CI 0.03 to 1.19), and the change in asthma quality of life for the intervention group between baseline and 3 months (mean change 0.66, 95% CI 0.35 to 0.98) was not seen in the control group. No significant differences in asthma quality of life were found between the intervention and control groups at 6 (mean change 0.46, 95% CI –0.12 to 1.05) and 9 months (mean change 0.39, 95% CI –0.2 to 0.98). For poor control status, there was no significant effect of group, time, or group by time. For all self-reported measures, the intervention group had a significantly higher proportion of individuals, demonstrating a minimal clinically meaningful improvement compared with the usual care group.ConclusionsThis study supported the use of MAP to enhance asthma quality of life but not asthma control as measured by an administrative database. Implementation of MAP beyond 6 months with tailored protocols for monitoring symptoms and health behaviors as individuals’ knowledge and self-management skills improve may result in long-term gains in asthma control.ClinicalTrialInternational Standard Randomized Controlled Trial Number (ISRCTN): 34326236; http://www.isrctn.com/ISRCTN34326236 (Archived by Webcite at http://www.webcitation.org/6mGxoI1R7).

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“…The research assistant obtained informed patient consent. The detailed protocol is available elsewhere [15]. …”

Section: Methodsmentioning

confidence: 99%

The Effectiveness of Web-Based Asthma Self-Management System, My Asthma Portal (MAP): A Pilot Randomized Controlled Trial

Ahmed¹,

Ernst²,

Bartlett³

et al. 2016

J Med Internet Res

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“…19,20 Similarly, primary care providers (PCPs) often lack the tools, incentives, time, and resources to adequately monitor their patients outside clinical encounters. 21 Several tools for assessing asthma control have been developed, but few have been validated for ongoing monitoring, and studies have reported significant limitations in children. [22][23][24][25][26][27] We have developed a new tool, the Asthma Symptom Tracker (AST) or Asthma…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Validation of a Tool for Asthma Self-Monitoring

2013

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: To prevent asthma exacerbations, asthma guidelines recommend ongoing monitoring of patients' asthma symptoms to promote timely adjustments of therapy to achieve and maintain optimal control. Existing tools, validated for ongoing monitoring, have significant limitations in children.WHAT THIS STUDY ADDS: Our study established longitudinal validation of the Asthma Symptom Tracker, a novel tool designed for use by children or their parents to facilitate ongoing monitoring of patients' asthma symptoms and proactive medical decision-making to prevent acute exacerbations. abstract OBJECTIVES: To establish longitudinal validation of a new tool, the Asthma Symptom Tracker (AST). AST combines weekly use of the Asthma Control Test with a color-coded graph for visual trending.METHODS: Prospective cohort study of children age 2 to 18 years admitted for asthma. Parents or children (n = 210) completed baseline AST assessments during hospitalization, then over 6 months after discharge. Concurrent with the first 5 AST assessments, the Asthma Control Questionnaire (ACQ) was administered for comparison.RESULTS: Test-retest reliability (intraclass correlation) was moderate, with a small longitudinal variation of AST measurements within subjects during follow-ups. Internal consistency was strong at baseline (Cronbach' s a 0.70) and during follow-ups (Cronbach' s a 0.82-0.90). Criterion validity demonstrated a significant correlation between AST and ACQ scores at baseline (r = 20.80, P , .01) and during follow-ups (r = 20.64, 20.72, 20.63, and 20.69). The AST was responsive to change over time; an increased ACQ score by 1 point was associated with a decreased AST score by 2.65 points (P , .01) at baseline and 3.11 points (P , .01) during follow-ups. Discriminant validity demonstrated a strong association between decreased AST scores and increased oral corticosteroid use (odds ratio 1.13, 95% confidence interval, 1.10-1.16, P , .01) and increased unscheduled acute asthma visits (odds ratio 1.23, 95% confidence interval, 1.18-1.28, P , .01). CONCLUSIONS:The AST is reliable, valid, and responsive to change over time, and can facilitate ongoing monitoring of asthma control and proactive medical decision-making in children. Pediatrics 2013;132:e1554-e1561 AUTHORS:

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“…These confluent events yield an unprecedented opportunity to use clinical data and functions in novel ways. [15][16][17][18][19][20] Although some clinics already engage in health insurance outreach activities and insurance coverage discussions with patients, these efforts are not usually supported by HIT or HIE. We anticipate that many health care organizations will embrace having enhanced capacity to help their patients obtain and keep coverage because of the benefits to be gained from having stably insured patients.…”

Section: Policy Relevancementioning

confidence: 99%

“…This reminder would prompt front desk staff to talk with patients about their health insurance expiration date and/or facilitate referrals to appropriate resources within (eg, enrollment specialists or clinic staff who specialize in coverage assistance) or outside (eg, state or federal websites and local agencies available to assist patient with health insurance enrollment) the clinic. 9,[15][16][17][18][19][20] For clinics that ask about health insurance information before a visit, tools could be tailored to identify scheduled patients without coverage and facilitate communication between the enrollment specialist and patient regarding their potential options to gain insurance. In addition, EHR tools could create customized messages about potential insurance plans available to the patient (if uninsured), or enrollment expiration dates (if insured), to be included with the after-visit summary.…”

Section: Enrollment Specialistmentioning

confidence: 99%

Health Information Technology: An Untapped Resource to Help Keep Patients Insured

DeVoe

Angier

Burdick

et al. 2014

The Annals of Family Medicine

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The recent confluence of: (1) changing state and national insurance-related policies, and (2) the rapid growth in electronic health record (EHR) use, yields an unprecedented opportunity for patient-centered medical homes (PCMHs) and other primary care practices or care settings to use health information technology (HIT) and health information exchange (HIE) in novel ways to impact patient health. We propose that HIT is an untapped resource for supporting clinic-based efforts to help eligible patients obtain and maintain insurance coverage. This commentary presents a conceptual model and guiding principles for this idea. Additionally, it describes insurance support tools that could be used to conduct 'inreach' and 'outreach' with patients around health insurance, similar to how HIT is used to manage chronic disease and panels of patients, and to improve population health outcomes. 2014;12:568-572. doi: 10.1370/afm.1721. Ann Fam Med INTRODUCTIONE xpansions in health insurance are concurrent with increasing implementation and adoption of electronic health records (EHRs) and other health information technology (HIT). Such changes present a unique opportunity for patient-centered medical homes (PCMHs) and other primary care practices or care settings to use HIT to maximize coverage among eligible patients.1,2 We propose that insurance coverage gaps are often preventable, [3][4][5] and that HIT is an untapped resource for closing these gaps. Since even short gaps in health insurance can negatively impact patient outcomes, 6-8 these opportunities for increased coverage have the potential to improve health.In a previous essay, we discussed how PCMHs could view uninsurance as a chronic illness and apply tenets and tools of the Chronic Care Model to treat it. 9 In follow-up, this commentary: (1) provides guiding principles for HIT infrastructure development to support health insurance enrollment and re-enrollment, and (2) describes how HIT and health information exchange (HIE) could be used to organize and communicate this information to patients. Guiding Principles For the Use of HIT and HIE to Help Keep Patients InsuredPatients are usually affiliated with multiple organizations which impact their health. For example, a patient may simultaneously: (1) be enrolled in an insurance program (eg, Medicaid); (2) receive medical services; and (3) receive educational and social services from local, county, or state facilities. Historically, information relevant to a patient's health has not been integrated or coordinated across multiple organizations; in particular, data from insurance payers were rarely made available to medical care teams. Though As HIT and HIE capabilities have grown, the potential to share diverse data across organizations in ways that could benefit patients' health has also improved. For example, HIT is being used in some health care settings to improve communication between patients and care teams and to address federal priorities to improve the 'Meaningful Use' of EHRs. 13 Our guiding principles...

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Effect of a web-based chronic disease management system on asthma control and health-related quality of life: study protocol for a randomized controlled trial

Cited by 25 publications

References 113 publications

The Effectiveness of Web-Based Asthma Self-Management System, My Asthma Portal (MAP): A Pilot Randomized Controlled Trial

The Effectiveness of Web-Based Asthma Self-Management System, My Asthma Portal (MAP): A Pilot Randomized Controlled Trial

Longitudinal Validation of a Tool for Asthma Self-Monitoring

Health Information Technology: An Untapped Resource to Help Keep Patients Insured

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