A computerized decision support tool to implement asthma guidelines for children and adolescents - 04/05/19
, Christine A. Sorkness, PharmD b, ∗, Agustin Calatroni, MA, MS c, Peter J. Gergen, MD d, Gordon R. Bloomberg, MD e, Rebecca S. Gruchalla, MD f, Meyer Kattan, MD g, Andrew H. Liu, MD h, George T. O'Connor, MD i, Jacqueline A. Pongracic, MD j, Stanley J. Szefler, MD k, Stephen J. Teach, MD l, Jeremy J. Wildfire, MS c, Robert A. Wood, MD m, Edward M. Zoratti, MD n, William W. Busse, MD bfor the
National Institute of Allergy and Infectious Diseases–sponsored Inner-City Asthma Consortium
Abstract |
Background |
Multicenter randomized controlled trials (RCTs) for asthma management that incorporate usual-care regimens could benefit from standardized application of evidence-based guidelines.
Objective |
We sought to evaluate performance of a computerized decision support tool, the Asthma Control Evaluation and Treatment (ACET) Program, to standardize usual-care regimens for asthma management in RCTs.
Methods |
Children and adolescents with persistent uncontrolled asthma living in urban census tracts were recruited into 3 multicenter RCTs (each with a usual-care arm) between 2004 and 2014. A computerized decision support tool scored asthma control and assigned an appropriate treatment step based on published guidelines. Control-level determinants (symptoms, rescue medication use, pulmonary function measure, and adherence estimates) were collected at visits and entered into the ACET Program. Changes in control levels and treatment steps were examined during the trials.
Results |
At screening, more than half of the participants were rated as having symptoms that were not controlled or poorly controlled. The proportion of participants who gained good control between screening and randomization increased significantly in all 3 trials. Between 51% and 70% had symptoms that were well controlled by randomization. The proportion of well-controlled participants remained constant or improved slightly from randomization until the last posttreatment visit. Nighttime symptoms were the most common control-level determinant; there were few (<1%) instances of complete overlap of factors. FEV1 was the driver of control-level assignment in 30% of determinations.
Conclusion |
The ACET Program decision support tool facilitated standardized asthma assessment and treatment in multicenter RCTs and was associated with attaining and maintaining good asthma control in most participants.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Key Words : Asthma guidelines, asthma control, decision support, inner-city asthma
Abbreviations used : ACE, ACET, EHR, EPR, ICAC, ICATA, ICS, NAEPP, PROSE, RCT, SABA
Plan
| This project was funded in whole or in part with federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services, under contract numbers NO1-AI-25496, NO1-AI-25482, HHSN272200900052C, HHSN272201000052I, 1UM1AI114271-01, UM1AI109565, and UM2AI117870. Additional support was provided by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health under grants NCRR/NIH RR00052, M01RR00533, UL1RR025741, UL1TR000451, UL1RR024982, M01RR00071, 1UL1RR024156, 5M01RR020359-04, UL1RR031988, 1ULRR025771, 1UL1RR025780, 1UL1RR031988, UL1TR000150, UL1TR000077-04, UL1TR001105, 1UL1RR025780, UL1TR000154, NCATS/NIH UL1TR001082, UL1TR000040, UL1TR000075, and National Institutes of Health/National Institute of Allergy and Infectious Diseases 5R01AI098077. The authors gratefully acknowledge receiving donated product for these studies from Lincoln Diagnostics (skin testing materials), GlaxoSmithKline (study drug), Novartis Pharmaceuticals (study drug and EpiPens), SC Johnson (household pest control), Mylan (EpiPens), and BF Ascher & Co (Ayr nasal rinse). |
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| Disclosure of potential conflict of interest: C. M. Kercsmar reports personal fees from GlaxoSmithKline outside the submitted work. C. A. Sorkness reports institutional grants from Novartis during the conduct of study and institutional grants from the National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (NHLBI) outside the submitted work. R. S. Gruchalla reports personal fees from Consulting Massachusetts Medical Society, as well as employment at the Center for Biologics Evaluation and Research without monetary compensation, outside the submitted work. M. Kattan reports personal fees from Novartis Pharma outside the submitted work. A. H. Liu reports personal fees from Merck Sharp & Dohme and uncompensated involvement with GlaxoSmithKline as a Data Monitoring Committee member for an asthma study outside the submitted work. G. T. O'Connor reports personal fees from AstraZeneca and institutional grants from Janssen Pharmaceuticals and the NIH outside the submitted work. J. A. Pongracic reports provision of study drug from GlaxoSmithKline, Teva, Merck, Boehringer Ingelheim, and Genentech/Novartis for research studies outside the submitted work. S. J. Szefler reports personal fees from Merck and GlaxoSmithKline; money paid to his institution from Boehringer Ingelheim, Genentech, Aerocrine, Novartis, AstraZeneca, Daiichi Sankyo, Roche, and Teva; and a grant from GlaxoSmithKline outside the submitted work. S. J. Teach reports personal fees from Novartis for consulting and royalties from UpToDate, as well as grants from the NIH/NHLBI, the Patient-Centers Outcome Research Institute, the Fight for Children Foundation, and EJF Philanthropies outside the submitted work. R. A. Wood reports employment at Johns Hopkins University, royalties from UpToDate, and grants from the NIH, DBV, Aimmune, Astellas, and HAL Allergy outside the submitted work. E. M. Zorrati reports personal fees from Wayne State University and an institutional grant from the NIH outside the submitted work. W. W. Busse reports personal fees from Boston Scientific, ICON, Novartis, GlaxoSmithKline, Genentech, Roche, Boehringer Ingelheim, Sanofi Genzyme, AstraZeneca, Teva, 3M, PrEP Biopharm, Circassia, Regeneron, Peptinnovate, and Elsevier outside the submitted work. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 143 - N° 5
P. 1760-1768 - mai 2019 Retour au numéro
Article précédent
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