Improving the Quality of Asthma Care Using the Internet

描述（由申请人提供）：哮喘是美国发病率和生产力损失的最重要的根本原因之一。虽然更多的美国成年哮喘患者有控制药物，但只有不到一半的成年人的哮喘得到控制。为了提高美国哮喘护理的质量，提供者必须继续加强治疗（例如，添加额外的控制药物），与NAEPP指南保持一致，直到哮喘症状得到控制，以及始终如一地应用循证指南的其他建议。允许患者要求医生进行测试和治疗可以改善预防性护理，但其对哮喘管理的影响尚未研究。我们已经开发了一个互动网站，供哮喘患者在医生就诊之前和就诊之间使用。该计划询问患者有关哮喘症状和药物的问题。根据对这些问题的回答和决策规则，患者得到个性化的反馈。反馈包括患者在他们下一次看医生时应该考虑问的问题，沿着他们为什么应该问每个问题的通俗解释和到信誉良好的网站的链接（例如，NHLBI），以进一步阅读每个主题。由于患者倾向于接受他们向医生要求的测试和治疗，该网站旨在激发患者提出问题，从而获得更好的哮喘护理。这项研究的主要目的是测试提供访问哮喘模块的互动网站的功效。我们将随机抽取408名成人哮喘患者，他们是Highmark的成员，使用网站的哮喘（IC）或预防服务模块12个月。我们假设，在使用该网站12个月后，70%的IC患者的哮喘得到控制，而CC患者的这一比例为55%。不受控制的哮喘是对公众健康和美国劳动力生产力的最大威胁之一。由于四分之三的美国人现在可以访问互联网，正在测试的干预措施，如这个互动网站，对改善哮喘护理和通过改善其他常见慢性疾病的护理质量来改善公众健康大有希望。公共卫生相关性：这项研究将测试哮喘患者在与哮喘护理提供者就诊之间和之前使用的网站的有效性。患者输入有关其症状和药物的信息，这些信息与循证指南中的决策规则相结合，为患者提供个性化反馈。这些反馈旨在帮助患者知道在医生访问期间应该问什么，以便更好地控制他们的哮喘。

DESCRIPTION (provided by applicant): Asthma is one of the most important underlying causes of morbidity and lost productivity in the US. Though more US adults with asthma have controller medicines, fewer than half of adults have their asthma controlled. To improve the quality of asthma care in the US it is essential for providers to continue to intensify treatments (e.g., adding additional controller medications), in keeping with the NAEPP Guidelines, until asthma symptoms are controlled, as well as to consistently apply other recommendations from evidence-based guidelines. Prompting patients to ask doctors for tests and treatments improves preventive care, but its effect on asthma management has not been studied. We have developed an interactive website to be used by patients with asthma between and before doctor visits. The program asks patients questions about their asthma symptoms and medications. Based on responses to these questions and decision rules, patients are given personalized feedback. The feedback includes questions that the patient should consider asking during their next doctor visit, along with a lay explanation of why they should ask each question and links to reputable websites (e.g., NHLBI) for further reading on each topic. As patients tend to get tests and treatments that they ask their physicians for, the website is designed to activate patients to ask questions that lead to better asthma care. The main aim of the study is to test the efficacy of providing access to the asthma module of the interactive website. We will randomize 408 adults with asthma, who are members of Highmark, to use the asthma (IC) or preventive services module of the website for 12 months. We hypothesize that, after 12 months of using the website, 70% of patients in the IC will have controlled asthma, compared to 55% of patients in the CC. Uncontrolled asthma is one of the greatest threats to the public's health and the productivity of the US workforce. As three in four Americans now have access to the Internet, interventions being tested such as this interactive website hold great promise for improving asthma care and for improving the public's health by improving the quality of care for other common, chronic illnesses. PUBLIC HEALTH RELEVANCE: This study will test the efficacy of a website to be used by patients with asthma between and before visits with their asthma care provider. Patients enter information about their symptoms and medications, which is combined with decision rules from evidence-based guidelines to provide patients with personalized feedback. The feedback is designed to help patients know what to ask during doctor visits, in order to better control their asthma.