RANDOMIZED TRIAL--COMPUTERIZED ASTHMA MANAGEMENT SYSTEM

在儿科护理中，实践差异是普遍存在的。哮喘一直是许多质量改进努力的目标。然而，大多数尝试都代价高昂，或者受到改变提供商行为的挑战的阻碍。这项随机对照试验旨在测试实时计算机干预的能力，以符合成本效益的方式改善对哮喘儿童的护理。计算机化哮喘管理系统(CAMS)旨在通过在护理点提供循证指南和哮喘管理工具来改变初级保健提供者的处方行为和慢性病管理。CAMS与其他哮喘干预措施在三个方面不同。首先，它保留了临床医生的自主权。其次，建议是由患者特定的数据驱动的。第三，CAMS更容易使用，而不是被忽视。因为它是自动化的，所以它涉及的成本可能比其他质量改进工作低得多。我们将随机将三个不同儿科诊所的提供者随机分配到CAMS或常规护理。我们假设，CAMS将在随机接受它的提供者中导致改善护理。具体地说，我们假设CAMS提供者在适当的时候更有可能开控制器药物处方，并准备书面的哮喘护理计划；接受CAMS提供者护理的哮喘儿童出现症状的天数将更少。我们进一步假设，CAMS将不会导致供应商的净成本增加。我们将从750名患者/父母的电脑数据和电话访问中，前瞻性地收集药物使用、家庭护理、症状天数、健康状况、使用情况和满意度等数据，以评估CAMS的有效性。

Practice variation is widespread in pediatric care. Asthma has been the target of many quality improvement efforts. However, most attempts have been costly or hampered by the challenges of changing provider behavior. This randomized controlled trial aims to test the ability of a real-time computerized intervention to improve care for children with asthma in a cost-effective manner. The computerized asthma management system (CAMS) aims to change primary care providers' prescribing behavior and chronic disease management by delivering evidence-based guidelines and asthma management tools at the point of care. CAMS differs from other asthma interventions in three ways. First, it preserves clinician autonomy. Second, recommendations are driven by patient-specific data. Third, CAMS is easier to use than to ignore. Because it is automated, it involves potentially much lower costs than other quality improvement efforts. We will randomize providers in three diverse pediatric clinics to CAMS or usual care. We hypothesize that CAMS will result in improved care among providers randomized to receive it. Specifically, we hypothesize that CAMS providers will be more likely to prescribe controller medication when appropriate and to prepare written asthma care plans; and that children with asthma receiving care from CAMS providers will experience fewer symptom days. We further hypothesize that CAMS will result in no net cost increases to providers. We will assess the effectiveness of CAMS by prospectively collecting data on medication use, home care, symptom days, health status, utilization and satisfaction from computerized data and telephone interviews of 750 patients/parents.