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Results from a pragmatic prospective cohort study: Shared decision making improves outcomes for children with asthma
Hazel Tapp1, Lindsay Shade1, Rohan Mahabaleshwarkar2
1a Department of Family Medicine , Carolinas HealthCare System , Charlotte , NC , USA.
Insights
Shared decision making (SDM) improved asthma control in pediatric patients, reducing exacerbations. However, the SDM intervention did not significantly impact outcomes for adult asthma patients in this real-world study.
Area of Science:
- Clinical Medicine
- Public Health
- Health Services Research
Background:
- Shared decision making (SDM) is recognized for improving patient outcomes in asthma management.
- Implementing evidence-based SDM toolkits in real-world clinical settings requires evaluation.
- Asthma exacerbations, including emergency department visits, hospitalizations, and oral steroid use, represent significant burdens on patients and healthcare systems.
Purpose of the Study:
- To evaluate the impact of an evidence-based SDM toolkit on asthma outcomes in a real-world setting.
- To determine if SDM reduces emergency department visits, hospitalizations, and oral steroid use in pediatric and adult asthma patients.
- To test the hypothesis that SDM improves asthma control in a pragmatic clinical trial setting.
Main Methods:
- A pragmatic clinical trial was conducted across six primary care practices serving vulnerable populations.
- Patients with asthma (746 children, 718 adults) were identified, and propensity scores were used to match intervention and control groups (200 children, 206 adults).
- Asthma exacerbations (ED visits, hospitalizations, oral steroid prescriptions) were monitored at 3, 6, and 12 months post-intervention and compared between groups.
Main Results:
- Pediatric patients receiving the SDM intervention showed a significantly lower proportion of exacerbations (33% vs. 47%, p = 0.023) compared to controls over 12 months.
- Adult patients did not demonstrate a significant association between the SDM intervention and improved asthma outcomes.
- The study observed differential effects of the SDM intervention based on patient age group.
Conclusions:
- An evidence-based SDM intervention was associated with improved asthma outcomes in pediatric patients within a real-world clinical setting.
- The SDM intervention did not yield significant improvements in asthma outcomes for adult patients.
- Findings suggest that SDM may be a valuable tool for improving pediatric asthma management, but further research is needed for adult populations.
Objective:
Patient/provider shared decision making (SDM) improves asthma control in a pragmatic clinical trial setting. This study evaluated the impact of an evidence-based SDM toolkit on outcomes for patients with asthma implemented by providers in a real world setting. We hypothesized that these patients with asthma would demonstrate improved outcomes such as reduced emergency department (ED) visits, hospitalizations, and oral steroid use in the 12 months following a SDM visit compared to those who did not receive the intervention.
Methods:
Patients with asthma were identified within six primary care practices that serve vulnerable populations in Charlotte, NC (746 children; 718 adult patients). Propensity scores were used to match 200 children and 206 adults for analysis. The primary outcome variable was asthma exacerbation defined as an ED visit or hospitalization for asthma or outpatient prescription of an oral steroid. Patients were monitored at 3, 6, and 12 months after the intervention date. The outcome variables of ED visits, hospitalizations, and oral steroids were compared between intervention and matched control patients.
Results:
The proportion of pediatric patients with one or more exacerbations was significantly lower in the SDM intervention group compared to controls during 12 months after exposure to the intervention (33% vs. 47%, p = 0.023). For adults, there was not a strong association between use of the SDM intervention and outcomes improvement.
Conclusions:
The evidence-based SDM intervention implemented in this study was associated with improved asthma outcomes for pediatric patients but not adult patients in a real world clinical setting.
