Evaluation of the Colorado Asthma Toolkit Program in Primary Care using SAFTINEt

描述（由申请人提供）：哮喘是最常见的慢性健康状况之一，通常可以通过适当的监测和管理得到很好的控制，然而许多初级保健提供者没有遵循NHLBI的哮喘管理指南，导致哮喘预后不佳。为了提高初级保健中哮喘指南的一致性，研究人员建议使用联邦转化查询网络（SAFTINet）的可扩展架构（一个基于实践的分布式研究网络）进行二次数据分析，以衡量科罗拉多哮喘工具包计划（CATP）对哮喘结果的影响。CATP是由国家犹太健康研究人员使用利益相关者参与方法设计的多成分指南传播干预，已在100个科罗拉多州初级保健安全网实践中实施，包括Metro社区提供者网络（MCPN）的提供者，这是一个为整个丹佛大都市的安全网人口服务的实践网络。SAFTINet，包括MCPN实践，精确地设计用于测量安全网实践中的疾病结果，是拟议研究的理想数据源，因为它包括临床EHR数据和医疗补助索赔数据，这些数据是实施标准哮喘结果测量所必需的。目前提案的研究小组汇集了国家犹太健康，MCPN和SAFTINet的研究人员，使用SAFTINet的数据，对MCPN实践中与CAPT实施相关的哮喘过程和结果措施进行了中学前后数据分析。研究人员的长期目标是通过实用的临床试验，在实践中传播和实施有效的基于指南的流程，为安全网患者提供服务，从而提高哮喘的预后。当前提案的目标是展示CATP的价值，并为CATP的务实试验奠定基础。研究人员将在3个具体目标中追求这一目标：目标1：测量CATP实施对哮喘患者评估、监测和管理相关哮喘护理过程指南一致性的影响。目的2：测量CATP实施对哮喘控制结果测量的影响：恶化、医疗保健利用、哮喘严重程度评分和肺生理学。目标3：进行可行性评估和探索性分析，为比较两个版本的CATP进行严格的、适合上下文的实用集群随机试验奠定基础。拟议的工作与NHLBI的使命相关，因为它促进了该机构的哮喘指南向最需要改进指南一致性护理的患者的传播，并证明了改进指南一致性在提高哮喘患者健康结果方面的价值。

DESCRIPTION (provided by applicant): Asthma is one of the most common chronic health conditions and can generally be well controlled through appropriate monitoring and management, yet many primary care providers do not follow NHLBI's asthma management guideline, resulting in poor asthma outcomes. To improve asthma guideline-concordance in primary care, the investigators propose a secondary data analysis using the Scalable Architecture for Federated Translational Inquiries Network (SAFTINet), a practice-based distributed research network, to measure the impact of the Colorado Asthma Toolkit Program (CATP) on asthma outcomes. The CATP, a multicomponent guideline dissemination intervention designed by researchers at National Jewish Health using stakeholder engagement methods, has been implemented in 100 Colorado primary care safety-net practices, including providers at the Metro Community Provider Network (MCPN), a network of practices serving safety-net populations throughout metropolitan Denver. SAFTINet, which includes MCPN practices, designed precisely for measuring disease outcomes in safety-net practices and is the ideal data source for the proposed study as it includes both the clinical EHR data and Medicaid claims data necessary for operationalizing standard asthma outcome measures. The research team for the current proposal brings together National Jewish Health, MCPN and SAFTINet investigators to perform a pre-post-secondary data analysis of asthma process and outcome measures associated with CAPT implementation at MCPN practices, using data from SAFTINet. The investigators' long-term goal is to advance asthma outcomes via pragmatic clinical trials of the dissemination and implementation of effective guideline-based processes in practices serving safety-net patients. The objectives of the current proposal are to demonstrate the value of the CATP and lay the groundwork for a pragmatic trial of the CATP. The investigators will pursue this objective in 3 Specific Aims: Aim 1: Measure the impact of CATP implementation on the guideline concordance of asthma care processes related to the assessment, monitoring and management of patients with asthma. Aim 2: Measure the impact of CATP implementation on outcome measures of asthma control: exacerbations, healthcare utilization, asthma severity scores, and pulmonary physiology. Aim 3: Perform a feasibility assessment and exploratory analyses to lay the groundwork for a rigorous, contextually-appropriate pragmatic cluster-randomized trial comparing two versions of the CATP. The proposed work is relevant to NHLBI's mission because it promotes dissemination of the agency's asthma guideline to patients in greatest need of improved delivery of guideline-concordant care, and demonstrates the value of improved guideline-concordance in enhancing the health outcomes of patients with asthma.