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

描述(申请人提供)：哮喘是最常见的慢性健康状况之一，通过适当的监测和管理通常可以很好地控制，但许多初级保健提供者没有遵循NHLBI的哮喘管理指南，导致哮喘结果很差。为了改善初级保健中哮喘指南的一致性，研究人员建议使用联邦转换查询网络(SAFTINet)的可扩展架构(SAFTINet)进行二次数据分析，这是一个基于实践的分布式研究网络，以衡量科罗拉多州哮喘工具包计划(CATP)对哮喘结果的影响。CATP是由国家犹太人健康研究所的研究人员使用利益相关者参与方法设计的一种多成分指南传播干预措施，已在100家科罗拉多州初级保健安全网实践中实施，其中包括Metro社区提供者网络(MCPN)的提供者，MCPN是一个服务于整个丹佛市安全网人口的实践网络。SAFTINet包括MCPN实践，专为衡量安全网实践中的疾病结果而设计，是拟议研究的理想数据来源，因为它包括实施标准哮喘结果衡量标准所需的临床EHR数据和医疗补助索赔数据。当前提案的研究小组将国家犹太人健康、MCPN和SAFTINet调查人员聚集在一起，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中级前数据分析。研究人员的长期目标是通过在服务于安全网患者的实践中传播和实施有效的基于指南的过程的务实临床试验来改善哮喘结果。目前建议的目的是证明《禁止酷刑公约》的价值，并为对《禁止酷刑公约》进行务实的试验奠定基础。研究人员将在3个具体目标中追求这一目标：目标1：衡量CATP实施对与哮喘患者评估、监测和管理相关的哮喘护理流程指南一致性的影响。目的2：测量CAPP实施对哮喘控制结果指标的影响：加重、医疗利用、哮喘严重程度评分和肺生理学。目的3：进行可行性评估和探索性分析，为严格的、与语境相适应的语用类群随机试验比较CATP的两个版本奠定基础。拟议的工作与NHLBI的使命相关，因为它促进了向最需要改善指南一致性护理交付的患者传播该机构的哮喘指南，并证明了改善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.