Using IT to improve access, communication, and asthma in African American and Hispanic/Latino Adults: Rationale, design, and methods of a randomized controlled trial

Apter, Andrea J.; Morales, Knashawn H.; Wan, Fei; Hardy, Sharmaine; Reed-Wells, Shakira; Domı́nguez, M.A.; Gonzalez, Rodalyn; Mak, NaDea; Nardi, Alyssa; Park, Hami; Howell, John T.; Localio, Russell

doi:10.1016/j.cct.2015.08.001

Cited by 21 publications

(10 citation statements)

References 32 publications

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“…Informed by patient focus groups 24 and piloting studies, 17,22,25 HVs were intended to link the patient to the medical practice, empowering patients to communicate with their clinicians through the portal, reconcile medications, facilitate appointment scheduling, 21 and ultimately improve asthma control. 26 HVs were conducted by CHWs, high school graduates who had lived in lowincome neighborhoods, were familiar with asthma, and had at least 3 years' work experience.…”

Section: Hvs: Designed and Pilotedmentioning

confidence: 99%

“…Each HV had 2 parts: (1) care coordination and promotion of portal use and (2) improving familiarity with health information technology. 21 For care coordination, the patient completed a needs assessment, identified goals for asthma management with the CHW, drafted an asthma care plan for review/revision/ approval by the patient's asthma clinician, and advised a visit to discuss the plan with the clinician. The scheduling was done, if possible, through the portal.…”

Section: Hvs: Designed and Pilotedmentioning

confidence: 99%

“…Responses were captured in a secure, encrypted, Web-based database: Research Electronic Data Capture (REDCap). 21,43…”

Section: Enrollment and Baseline Data Collectionmentioning

confidence: 99%

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Home visits for uncontrolled asthma among low-income adults with patient portal access

Apter

Localio

Morales

et al. 2019

Journal of Allergy and Clinical Immunology

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Background: Asthma disproportionately affects low-income and minority adults. In an era of electronic records and Internetbased digital devices, it is unknown whether portals for patientprovider communication can improve asthma outcomes. Objective: We sought to estimate the effect on asthma outcomes of an intervention using home visits (HVs) by community health workers (CHWs) plus training in patient portals compared with usual care and portal training only. Methods: Three hundred one predominantly African American and Hispanic/Latino adults with uncontrolled asthma were recruited from primary care and asthma specialty practices serving low-income urban neighborhoods, directed to Internet access, and given portal training. Half were randomized to HVs over 6 months by CHWs to facilitate competency in portal use and promote care coordination. Results: One hundred seventy (56%) patients used the portal independently. Rates of portal activity did not differ between randomized groups. Asthma control and asthma-related quality of life improved in both groups over 1 year. Differences in improvements over time were greater for the HV group for all outcomes but reached conventional levels of statistical significance only for the yearly hospitalization rate (20.53; 95% CI, 21.08 to 20.024). Poor neighborhoods and living conditions plus limited Internet access were barriers for patients to complete the protocol and for CHWs to make HVs. Conclusion: For low-income adults with uncontrolled asthma, portal access and CHWs produced small incremental benefits. HVs with emphasis on self-management education might be necessary to facilitate patient-clinician communication and to improve asthma outcomes. (J Allergy Clin Immunol 2019;144:846-53.)

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Section: Hvs: Designed and Pilotedmentioning

confidence: 99%

Section: Hvs: Designed and Pilotedmentioning

confidence: 99%

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Home visits for uncontrolled asthma among low-income adults with patient portal access

Apter

Localio

Morales

et al. 2019

Journal of Allergy and Clinical Immunology

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“…The patient portal includes web-based communication with providers and practices and has the potential to improve communication and access. In a study of adults with asthma, Apter et al [23] will examine asthma outcomes in adults with asthma randomized to receive either portalbased communication or portal-based communication with support from a community health worker (CHW).…”

Section: Information Technologymentioning

confidence: 99%

Asthma management programs for primary care providers

Cloutier¹

2016

Current Opinion in Allergy &Amp; Clinical Immunology

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“…The Using Information Technology to Improve Access, Communication and Asthma in African American and Hispanic/Latino Adults study compares home visits by CHWs to train patients in use of a patient portal (Table II, study reference letter A). 34 The patient portal offers patients Web-based access to clinicians and practices and allows them to make appointments, refill medications, and communicate directly with clinicians. This study links patient education and an existing health system tool (ie, patient portals).…”

Section: Patient Education In the Home: Use Of Community Health Workersmentioning

confidence: 99%

Patient-centered outcomes research to improve asthma outcomes

Anise

Hasnain‐Wynia

2016

Journal of Allergy and Clinical Immunology

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The Patient-Centered Outcomes Research Institute is funding 8 comparative effectiveness research projects to improve patient-centered outcomes for African American and Hispanic/Latino patients with uncontrolled asthma. These projects aim to compare multilevel interventions with known efficacy at the community, home, and health system levels to enhance patient and clinician uptake of the National Heart, Lung, and Blood Institute's National Asthma Education Prevention Program guidelines and improve outcomes. The National Asthma Education Prevention Program guidelines provide clinicians with a range of acceptable approaches for the diagnosis and management of asthma and define general practices that meet the needs of most patients. Yet disparities in asthma care and outcomes remain pervasive for African Americans and Hispanics/Latinos. The National Heart, Lung, and Blood Institute AsthmaNet consortium has identified several top research priorities for pediatric and adult populations, including a recommendation to examine tailored approaches based on race/ethnicity. In addition, the guidelines emphasize the need for studies that focus on multicomponent interventions recognizing that single interventions are generally ineffective. This article will describe the Patient-Centered Outcomes Research Institute-funded asthma projects and how they are individually and collectively addressing evidence gaps in asthma care by focusing on multicomponent and tailored approaches for improving outcomes and reducing disparities for African American and Hispanic/Latino patients.

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Using IT to improve access, communication, and asthma in African American and Hispanic/Latino Adults: Rationale, design, and methods of a randomized controlled trial

Cited by 21 publications

References 32 publications

Home visits for uncontrolled asthma among low-income adults with patient portal access

Home visits for uncontrolled asthma among low-income adults with patient portal access

Asthma management programs for primary care providers

Patient-centered outcomes research to improve asthma outcomes

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