The Breathewell Program to Improve Asthma Outcomes

改善哮喘结果的呼吸计划

• 批准号: 9334284
• 负责人: Bruce George Bender
• 金额: $ 80.36万
• 依托单位: NATIONAL JEWISH HEALTH
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-15 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9334284
• 关键词: Address; Adherence; Agonist; American; Asthma; Behavioral; Caring; Chronic; Clinic; Clinical; Clinical effectiveness; Collaborations; Colorado; Communication; Cost Analysis; Cost Savings; Data; Decision Making; Development; Effectiveness; Electronic Health Record; Emergency department visit; Enrollment; Evaluation; Exhibits; Fatigue; Guidelines; Health system; Healthcare Systems; Healthy People 2020; Home environment; Hospitalization; Informatics; Inhalators; Intervention; Knowledge; Lead; Measures; Mediating; Mediator of activation protein; Medical center; Modeling; Monitor; Morbidity - disease rate; Nurses; Oral; Outcome; Patients; Pharmaceutical Preparations; Physicians; Pragmatic clinical trial; Primary Health Care; Provider; Quality of life; Randomized; Reporting; Research; Research Priority; Risk; Smoke; Smoking; Speed; Steroids; Symptoms; System; Technology; Therapeutic; Time; Translations; United States National Institutes of Health; Visit; asthma inhaler; asthmatic patient; base; behavior change; clinical care; cost; cost effectiveness; evidence base; experience; group intervention; health care service organization; high risk; implementation science; impression; improved; improved outcome; innovation; intervention effect; medication compliance; patient oriented; pragmatic trial; prevent; programs; public health relevance; safety net; smoking cessation; support tools; treatment as usual; trial design; urgent care

 DESCRIPTION (provided by applicant): Despite established, evidence-based therapies, major gaps exist in asthma treatment, increasing the risk of asthma-related emergency department visits, hospitalizations, and oral steroid bursts. Provider (therapeutic inertia, insufficient time, patient (poor adherence, smoking), and system barriers (challenges with data, monitoring, communication, and medication refill) contribute to these gaps. The application of Electronic Health Records (EHRs) has the potential to lower these barriers leading to better asthma control and fewer exacerbations. The objective of this study is to conduct a large pragmatic trial to assess the effectiveness, cost-effectiveness, and implementation of the Breathewell intervention, which combines an evidence-based EHR intervention and team-based care to improve asthma outcomes. Breathewell employs EpicCare, the most widely used commercial EHR in the U.S, to identify poor medication adherence or unaddressed smoking and automatically enroll patients in a medication refill or smoking cessation program. For patients with asthma exacerbations or B-agonist inhaler overuse, the EHR sends the patients a decision support tool and notifies a nurse who uses an EHR-generated report to engage the patient in a shared-decision discussion, leading to development of an asthma care plan. EHR templated notes and order sets facilitate care plan execution. The study will be conducted in 26 primary care clinics of Kaiser Permanente Colorado using a cluster- randomized pragmatic clinical trial design. More than 10,400 asthma patients will be assigned to Breathewell or Usual Care based on their clinic. The evaluation assesses clinical effectiveness (asthma exacerbations, quality of life, and cost) and implementation (mediators and moderators of intervention effect, intervention barriers and facilitators, patient and provider impressions and RE-AIM framework translational measures). This study is significant because it could substantially reduce morbidity by addressing gaps in evidence-based asthma care. This research is innovative because it 1) uses the EHR to simultaneously addresses provider, patient, and system barriers to evidence-based care; 2) facilitates patient-centered decision making; 3) integrates evidence-based EHR and interactive behavioral change technologies; 4) is conducted as part of routine clinical care; and 5) is delivered in English and Spanish. Our results are likely to impact the field by speeding the translation of asthma care knowledge into practice. Successful deployment of Breathewell could serve as an implementation model for using EHRs to improve care for many chronic conditions, an NIH research priority and an objective of Healthy People 2020.

 描述（由申请人提供）：尽管已有基于证据的治疗方法，但哮喘治疗仍存在重大差距，增加了哮喘相关急诊就诊、住院和口服类固醇爆发的风险。提供者（治疗惰性、时间不足、患者（依从性差、吸烟）和系统障碍（数据、监测、沟通和药物补充方面的挑战）造成了这些差距。电子健康记录 (EHR) 的应用有可能降低这些障碍，从而更好地控制哮喘并减少病情恶化。这项研究的目的是进行一项大型务实试验来评估有效性， 成本效益，以及实施 Breathewell 干预措施，该干预措施结合了基于证据的 EHR 干预措施和基于团队的护理，以改善哮喘结果。 Breathewell 采用美国最广泛使用的商业 EHR EpicCare 来识别药物依从性差或未解决的吸烟情况，并自动将患者纳入药物补充或戒烟计划。对于哮喘急性发作或服用 B 激动剂的患者 吸入器过度使用时，EHR 会向患者发送决策支持工具，并通知护士，护士使用 EHR 生成的报告让患者参与共同决策讨论，从而制定哮喘护理计划。 EHR 模板笔记和订单集有助于护理计划的执行。该研究将采用整群随机实用临床试验设计，在科罗拉多州 Kaiser Permanente 的 26 个初级保健诊所进行。 超过 10,400 名哮喘患者将根据其诊所被分配到 Breathewell 或常规护理中心。该评估评估临床有效性（哮喘加重、生活质量和成本）和实施情况（干预效果的中介因素和调节因素、干预障碍和促进因素、患者和提供者印象以及 RE-AIM 框架转化措施）。这项研究意义重大，因为它可以通过解决以下方面的差距来大幅降低发病率： 循证哮喘护理。这项研究具有创新性，因为它 1) 使用 EHR 同时解决提供者、患者和系统对循证护理的障碍； 2）促进以患者为中心的决策； 3）整合基于证据的电子病历和交互式行为改变技术； 4) 作为常规临床护理的一部分进行； 5) 以英语和西班牙语提供。我们的研究结果可能会加速哮喘护理知识转化为实践，从而对该领域产生影响。 Breathewell 的成功部署可以作为使用 EHR 改善许多慢性病护理的实施模型，这是 NIH 的研究重点和 Healthy People 2020 的目标。