Improving the Quality of Asthma Care Using the Internet

描述（由申请人提供）：哮喘是美国发病率和生产力损失的最重要的潜在原因之一。尽管越来越多的美国哮喘患者服用了控制药物，但只有不到一半的成年人的哮喘得到了控制。为了提高美国哮喘护理的质量，提供者必须按照NAEPP指南继续加强治疗（例如，增加额外的控制药物），直到哮喘症状得到控制，并始终应用循证指南中的其他建议。促使患者要求医生进行检查和治疗可以改善预防性护理，但其对哮喘管理的影响尚未得到研究。我们开发了一个互动网站，供哮喘患者在就诊前后使用。该项目询问患者有关哮喘症状和药物的问题。根据对这些问题的回答和决策规则，给予患者个性化的反馈。反馈包括患者在下次看医生时应该考虑问的问题，以及他们为什么应该问每个问题的外行解释，以及链接到知名网站（例如NHLBI）以进一步阅读每个主题。由于患者倾向于接受他们要求医生提供的检查和治疗，该网站旨在激发患者提出问题，从而更好地治疗哮喘。该研究的主要目的是测试提供访问交互式网站哮喘模块的功效。我们将随机抽取408名患有哮喘的成人，他们是Highmark的会员，使用该网站的哮喘（IC）或预防服务模块12个月。我们假设，在使用该网站12个月后，70%的IC患者将控制哮喘，而CC患者的这一比例为55%。未控制的哮喘是对公众健康和美国劳动力生产力的最大威胁之一。由于现在有四分之三的美国人可以上网，正在测试的干预措施，如这个互动网站，对改善哮喘护理和通过提高其他常见慢性疾病的护理质量来改善公众健康有着巨大的希望。公共卫生相关性：本研究将测试哮喘患者在与哮喘护理提供者就诊之间和之前使用的网站的有效性。患者输入有关其症状和药物的信息，这些信息与循证指南的决策规则相结合，为患者提供个性化反馈。这些反馈的目的是帮助患者知道在看医生时该问什么，以便更好地控制他们的哮喘。

DESCRIPTION (provided by applicant): Asthma is one of the most important underlying causes of morbidity and lost productivity in the US. Though more US adults with asthma have controller medicines, fewer than half of adults have their asthma controlled. To improve the quality of asthma care in the US it is essential for providers to continue to intensify treatments (e.g., adding additional controller medications), in keeping with the NAEPP Guidelines, until asthma symptoms are controlled, as well as to consistently apply other recommendations from evidence-based guidelines. Prompting patients to ask doctors for tests and treatments improves preventive care, but its effect on asthma management has not been studied. We have developed an interactive website to be used by patients with asthma between and before doctor visits. The program asks patients questions about their asthma symptoms and medications. Based on responses to these questions and decision rules, patients are given personalized feedback. The feedback includes questions that the patient should consider asking during their next doctor visit, along with a lay explanation of why they should ask each question and links to reputable websites (e.g., NHLBI) for further reading on each topic. As patients tend to get tests and treatments that they ask their physicians for, the website is designed to activate patients to ask questions that lead to better asthma care. The main aim of the study is to test the efficacy of providing access to the asthma module of the interactive website. We will randomize 408 adults with asthma, who are members of Highmark, to use the asthma (IC) or preventive services module of the website for 12 months. We hypothesize that, after 12 months of using the website, 70% of patients in the IC will have controlled asthma, compared to 55% of patients in the CC. Uncontrolled asthma is one of the greatest threats to the public's health and the productivity of the US workforce. As three in four Americans now have access to the Internet, interventions being tested such as this interactive website hold great promise for improving asthma care and for improving the public's health by improving the quality of care for other common, chronic illnesses. PUBLIC HEALTH RELEVANCE: This study will test the efficacy of a website to be used by patients with asthma between and before visits with their asthma care provider. Patients enter information about their symptoms and medications, which is combined with decision rules from evidence-based guidelines to provide patients with personalized feedback. The feedback is designed to help patients know what to ask during doctor visits, in order to better control their asthma.