RANDOMIZED TRIAL--COMPUTERIZED ASTHMA MANAGEMENT SYSTEM

实践变化是普遍的儿科护理。哮喘已经成为许多质量改进工作的目标。然而，大多数尝试都是昂贵的，或者受到改变提供者行为的挑战的阻碍。本随机对照试验旨在测试实时计算机化干预以经济有效的方式改善哮喘儿童护理的能力。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疾病管理。CAMS在三个方面不同于其他哮喘干预措施。首先，它保留了临床医生的自主权。其次，建议是由患者特定数据驱动的。第三，CAMS使用起来比忽视起来更容易。因为它是自动化的，它所涉及的潜在成本比其他质量改进工作要低得多。我们将在三个不同的儿科诊所随机选择CAMS或常规护理的提供者。我们假设CAMS将导致随机接受它的提供者的护理得到改善。具体来说，我们假设CAMS提供者更有可能在适当的时候开具控制药物，并准备书面的哮喘护理计划；并且接受CAMS提供者护理的哮喘儿童将经历更少的症状天数。我们进一步假设，CAMS不会导致供应商的净成本增加。我们将通过对750名患者/家长的计算机数据和电话访谈，前瞻性地收集药物使用、家庭护理、症状天数、健康状况、使用率和满意度等数据，来评估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.