A Web-Based Module for Asthma Management in Primary Care

描述（申请人提供）：随着人们对疾病管理和预防性筛查活动的要求越来越高，初级保健医生发现自己缺乏具有成本效益的资源来提高他们为慢性病患者提供的医疗服务质量。例如，国家质量保证委员会（NCQA）已经开始推广一种全面的病人护理模式，即以病人为中心的医疗之家（PCMH）。在资源稀缺的时代，为了满足成为PCMH的疾病管理要求，医生需要具有成本效益的工具来自动化功能，包括与患者接触、准确评估疾病状态、向患者反馈结果，以及在健康记录中有效地记录这些结果。拟议的SBIR奖的目的是开发一个基于网络的哮喘管理模块，该模块可以无缝集成到采用电子健康记录或纸质图表的社区初级保健实践的办公室工作流程中。我们将设计一个在线工具，用于通过电子邮件联系患者，邀请他们在研究网站上完成哮喘控制测试（ACT），这是一种简短的哮喘控制自我报告测量。ACT评分显示哮喘控制不佳的患者将得到更多的重症监护，而那些得分表明控制良好的患者将得到较少的接触，从而有助于根据患者的需要进行优先排序。与在线ACT一起，我们将共同管理经过验证的措施，以评估与不良哮喘结局相关的显著行为和心理共病，包括药物依从性、吸烟状况和心理困扰水平。患者和临床医生将收到在线评估的结果以及对这些结果的简要解释。患者还可以使用在线自我管理工具，包括每日高峰流量记录模块和电子哮喘行动计划。在拟议的单组设计试点研究中，我们将采用混合定性和定量方法，与临床医生和患者进行焦点小组讨论，并招募50名成年哮喘患者参与为期六个月的基于网络的疾病管理模块使用纵向评估。这项试点研究的目的是：1)检查使用基于web的应用程序的可接受性和可行性，2)建立干预在改善肺功能客观测量（办公室肺活量测定）方面的效果大小，最终目标是为该产品的大规模随机对照试验提供动力。我们相信该产品具有巨大的临床和商业成功的潜力，随着报销结构的发展，包括对初级保健医生提供高质量、全面和以患者为中心的医疗服务的更多激励。

DESCRIPTION (provided by applicant): With the increasing requirements for assuming prominent disease management and preventive screening activities, primary care physicians find themselves lacking cost-effective resources to improve the quality of medical care they provide to patients with chronic medical conditions. For example, the National Committee for Quality Assurance (NCQA) has begun promoting a model of comprehensive patient care referred to as Patient-Centered Medical Home (PCMH). To meet the disease management requirements for becoming a PCMH in an era of scarce resources, physicians need cost-effective tools to automate functions including contact with patients, accurate assessment of disease status, feedback to patients regarding results, and efficient documentation of those results in the health record. The purpose of the proposed SBIR award is to develop a web based asthma management module that can be integrated seamlessly into the office workflow of community primary care practices that employ either electronic health records or paper charts. We will design an online tool that will be used to contact patients via email inviting them to complete the Asthma Control Test (ACT), a brief self-report measure of asthma control, at the study website. Patients whose ACT scores reveal poor asthma control will receive more intensive care, while those with scores indicating adequate control will receive less frequent contact, thus helping practices prioritize according to patient needs. Along with the online ACT, we will co-administer validated measures to assess salient behavioral and psychological comorbities that have been associated with poor asthma outcomes, including medication adherence, smoking status, and level of psychological distress. Patients and clinicians will receive results of the online assessments along with brief interpretation of those findings. Patients will also have access to online self management tools including a daily peak flow recording module and an electronic Asthma Action Plan. In the proposed pilot study of single group design, we will use mixed qualitative and quantitative methodology by conducting focus groups with clinicians and patients as well as recruiting 50 adult patients with asthma to participate in a six-month longitudinal assessment of their use of the web-based disease management module. The aims of this pilot study are: 1) to examine the acceptability and feasibility of use of the web-base application, and 2) to establish the effect size of the intervention in improving objective measures of lung function (office spirometry), with the ultimate goal of powering a large-scale, randomized controlled trial of the product. We believe this product has strong potential for clinical and commercial success as reimbursement structures evolve to include more incentives for primary care physicians to provide quality, comprehensive, and patient-centered medical care. PUBLIC HEALTH RELEVANCE: With a growing shortage of primary care physicians, new tools are needed to help improve the quality of care for the more than 20 million Americans with asthma without adding additional time burden or costs for these doctors. Developing an efficient, low-cost, online disease management system that integrates with the established workflow and charting in primary care offices may indeed represent a sustainable new method for improving patient asthma care.