Protocol for the asthma tools study: a pragmatic practice-based research network trial

Yawn, Barbara P.; Bertram, Susan; Kurland, Margary; Wollan, Peter C.; Graham, Deborah; Littlefield, Dawn; Smail, Craig; Pace, Wilson D.

doi:10.2147/por.s43161

Cited by 8 publications

(6 citation statements)

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“…Both reported limited guideline adherence. 21,22 To expand our knowledge base, we use baseline data from a large multi-centered US pragmatic randomized trial of primary care asthma management 23 to assess rates of guideline adherence across family medicine and pediatric practices in children, adolescents, and adults. We also report the association of assessed guideline adherence with patient and practice characteristics.…”

mentioning

confidence: 99%

“…We use retrospective and patient reported data from the pre-trial period of the Asthma Tools Study 23 to report rates of adherence with elements of the 2007 NAEPP guidelines. This collection of pre-trial medical record data and patient report of baseline data was a planned part of the Asthma Tools Study used to provide information for assessing differences in rates of improvement in the control and intervention practices and so assess the comparability of the patients in the two study arms in the year prior to study initiation.…”

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confidence: 99%

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Adherence to Asthma Guidelines in Children, Tweens, and Adults in Primary Care Settings

Yawn

Rank

Cabana

et al. 2016

Mayo Clinic Proceedings

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confidence: 99%

mentioning

confidence: 99%

Adherence to Asthma Guidelines in Children, Tweens, and Adults in Primary Care Settings

Yawn

Rank

Cabana

et al. 2016

Mayo Clinic Proceedings

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“…The study methods have been published previously. 46 Of the 22 practices enrolled, 18 practices (9 intervention and 9 usual care randomized by practice size, practice type, and being a residency training site) completed the study. Three practices were lost before enrolling any patients (2 were sold and 1 became an urgent care site), and a 4th practice enrolled only 10 patients before being destroyed in a tornado.…”

Section: Methodsmentioning

confidence: 99%

Use of Asthma APGAR Tools in Primary Care Practices: A Cluster-Randomized Controlled Trial

et al. 2018

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PURPOSE The purpose of this study was to assess patient and practice outcomes after introducing the Asthma APGAR (Activities, Persistent, triGGers, Asthma medications, Response to therapy) tools into primary care practices. METHODSWe used a pragmatic cluster-randomized controlled design in 18 US family medicine and pediatric practices to compare outcomes in patients with persistent asthma aged 5 to 45 years after introduction of the Asthma APGAR tools vs usual care. Patient outcomes included asthma control, quality of life, and emergency department (ED), urgent care, and inpatient hospital visits. The practice outcome was adherence to asthma guidelines. RESULTSWe enrolled 1,066 patients: 245 children, 174 adolescents, and 647 adults. Sixty-five percent (692 patients) completed both baseline and 12-month questionnaires, allowing analysis for patient-reported outcomes. Electronic health record data were available for 1,063 patients (99.7%) for practice outcomes. The proportion of patients reporting an asthma-related ED, urgent care, or hospital visit in the final 6 months of the study was lower in the APGAR practices vs usual care practices (10.6% vs 20.9%, P = .004). The percentage of patients with "in control" asthma increased more between baseline and 1 year in the APGAR group vs usual care group (13.5% vs 3.4%, P =.0001 vs P =.86) with a trend toward better control scores and asthma-related quality of life in the former at 1 year (P ≤.06 and P = .06, respectively). APGAR practices improved their adherence to 3 or more guideline elements compared with usual care practices (20.7% increase vs 1.9% decrease, P = .001).CONCLUSIONS Introduction of the Asthma APGAR tools improves rates of asthma control; reduces asthma-related ED, urgent care, and hospital visits; and increases practices' adherence to asthma management guidelines. Ann Fam Med 2018;16:100-110. https://doi.org/10.1370/afm.2179. INTRODUCTIONA sthma is a common chronic condition, [1][2][3] and primary care is the site of most asthma diagnoses and management.2-5 Implementation of asthma guidelines has been challenging, and the burden of asthma remains high with little improvement from 1990 to 2010. [6][7][8][9][10][11][12][13] Use of a metric for assessing asthma control has been suggested for improving asthma care, and several asthma control scores have been developed and validated against allergists' assessments.14-25 But use of these tools remains limited and has not significantly improved asthma outcomes. 23,[26][27][28][29][30][31][32][33][34][35][36] The Asthma APGAR (Activities, Persistent, triGGers, Asthma medications, Response to therapy) (Figure 1) tools were developed not only to provide a score for asthma control, but also to guide further evaluation of inadequate control with a link to a care algorithm (Supplemental Figure 1, available at http://www.annfammed.org/content/16/2/100/suppl/ DC1/). In a small pilot study, use of the Asthma APGAR tools was associated with enhanced asthma guidelines adherence, and focus groups of patients an...

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“…Despite the variety of topics and varying study designs, many of the same implementation strategies and support techniques proved to be useful across studies. Each of the studies introduced a practice change: using spirometry to evaluate patients with asthma and chronic obstructive pulmonary disorder 20 ; introducing screening, diagnosis, and management support for postpartum depression [21][22][23][24] ; using new asthma tools (asthma APGAR tools) in managing children and adults with asthma 25 ; and assessing the effect of 2 classes of long-acting bronchodilators on exacerbation rates in black adults with asthma.…”

Section: Methodsmentioning

confidence: 99%

Preventing the Voltage Drop: Keeping Practice-based Research Network (PBRN) Practices Engaged in Studies

Yawn

Dietrich

Graham³

et al. 2014

The Journal of the American Board of Family Medicine

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Introduction: Practice-based research continues to evolve and has become a major methodology for many pragmatic studies. While early practice-based network projects were usually short term, current studies often introduce or compare practice innovations that require long-term evaluation. That change requires that practice sites remain engaged in research work for up to 5 years, a time that can allow for a significant "voltage drop," or decline in active participation.Methods: Over the past 15 years we have developed and adapted several strategies to facilitate and encourage the continued active engagement of practices in practice-based research network studies of up to 5 years' duration. The concepts, details, evaluation, and results (when available) of the strategies are described.Results: Eight strategies that enhance practice sites' attention to enrollment, data collection and continued use of the implemented practice change are described. Practice-based research network (PBRN) research has become a valuable method of identifying and answering questions relevant to primary care patients and practices. As PBRN research has matured, studies have evolved from simple, short-term observational studies to longer-duration interventional studies that involve all members of the practice and enrolled patients.

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Protocol for the asthma tools study: a pragmatic practice-based research network trial

Cited by 8 publications

References 64 publications

Adherence to Asthma Guidelines in Children, Tweens, and Adults in Primary Care Settings

Adherence to Asthma Guidelines in Children, Tweens, and Adults in Primary Care Settings

Use of Asthma APGAR Tools in Primary Care Practices: A Cluster-Randomized Controlled Trial

Preventing the Voltage Drop: Keeping Practice-based Research Network (PBRN) Practices Engaged in Studies

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