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Protocol for the asthma tools study: a pragmatic practice-based research network trial
Barbara P Yawn1, Susan Bertram1, Margary Kurland1
1Department of Research, Olmsted Medical Center, Rochester, MN.
Insights
Implementing the Asthma APGAR tool in primary care improves asthma control and quality of life for patients. This evidence-based approach links assessment with management, enhancing patient outcomes.
Area of Science:
- Pulmonary Medicine
- Clinical Practice Guidelines
- Healthcare Implementation Science
Background:
- Asthma management frequently deviates from evidence-based guidelines, particularly in primary care settings.
- While asthma control assessments exist, they often lack integration with actionable next steps in patient care.
- The Asthma APGAR tool bridges this gap by combining control assessment with identification of common control issues and linking to a care algorithm.
Purpose of the Study:
- To evaluate the impact of implementing the Asthma APGAR tool on patient asthma outcomes within primary care practices.
- To assess if linking asthma control assessment with a management algorithm improves patient-level outcomes.
Main Methods:
- A pragmatic, randomized trial involving 1400 patients (aged 5-60) with asthma across 20 practice-based research network (PBRN) practices.
- Intervention group received the Asthma APGAR tool integrated into care; control group received usual care.
- Primary outcomes measured over 18-24 months include changes in self-reported asthma control, quality of life, and documented exacerbation rates. Medical records were reviewed for process measures and qualitative data.
Main Results:
- The study aims to demonstrate improved patient-reported asthma control and quality of life.
- Reduced rates of asthma exacerbations are anticipated as a key outcome.
- The implementation process and barriers/facilitators will be assessed through medical record review and qualitative methods.
Conclusions:
- Linking asthma assessment tools with management algorithms is crucial for improving patient outcomes in primary care.
- This pragmatic trial's findings in real-world settings will be generalizable to a broad range of primary care providers and clinics.
- The study underscores the importance of integrated tools for effective asthma management.
Background:
Asthma is common among children, adolescents, and adults. However, management of asthma often fails to follow evidence-based guidelines. Control assessments have been developed, validated against expert opinion, and disseminated. However, in primary care, assessment of control is only one step in asthma management. To facilitate integration of the evidence-based guidelines into practice, tools should also guide the next steps in care. The Asthma APGAR tools do just that, incorporating a control assessment as well as assessment of the most common reasons for inadequate and poor control. The Asthma APGAR tool is also linked to a care algorithm based on the 2007 National Heart, Lung, and Blood Institute asthma guidelines. The objective of this study is to assess the impact of implementation of the Asthma APGAR on patient asthma outcomes in primary care practices.
Methods:
A total of 1400 patients aged 5-60 years with physician-diagnosed asthma are enrolled in 20 practice-based research network (PBRN) practices randomized to intervention or usual care. The primary outcomes are changes in patient self-reported asthma control, asthma-related quality of life, and rates of exacerbations documented in medical records over the 18-24 months of enrollment. Process measures related to implementation of the Asthma APGAR system into daily care will also be assessed using review of medical records. Qualitative assessments will be used to explore barriers to and facilitators for integrating the Asthma APGAR tools into daily practice in primary care.
Discussion:
Data from this pivotal pragmatic study are intended to demonstrate the importance of linking assessment of asthma and management tools to improve asthma-related patient outcomes. The study is an effectiveness trial done in real-world PBRN practices using patient-oriented outcome measures, making it generalizable to the largest possible group of asthma care providers and primary care clinics.
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