The Breathewell Program to Improve Asthma Outcomes

改善哮喘结果的呼吸计划

基本信息

批准号：
9754856
负责人：
Bruce George Bender
金额：
$ 4.63万
依托单位：
NATIONAL JEWISH HEALTH
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-09-15 至 2022-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9754856
关键词：
Address Adherence Agonist American Asthma Behavioral Caring Chronic Clinic Clinical Clinical Trials Design Clinical effectiveness Collaborations Colorado Communication Cost Analysis Cost Savings Data Decision Making Development Effectiveness Electronic Health Record Emergency department visit Enrollment Evaluation Exhibits Fatigue Guidelines Health system Healthcare Systems Healthy People 2020 Home environment Hospitalization Informatics Inhalators Intervention Knowledge Lead Measures Mediating Mediator of activation protein Medical center Modeling Monitor Morbidity - disease rate Nurses Oral Outcome Patients Pharmaceutical Preparations Physicians Pragmatic clinical trial Primary Health Care Provider Quality of life Randomized Reporting Research Research Priority Risk Smoke Smoking Speed Steroids Symptoms System Technology Therapeutic Time Translations United States National Institutes of Health Visit asthma exacerbation asthma inhaler asthmatic patient base behavior change care providers clinical care cost cost effectiveness evidence base experience group intervention health care service organization high risk implementation science impression improved improved outcome innovation intervention effect medication compliance patient engagement patient oriented patient-clinician communication pragmatic trial prevent primary endpoint programs public health relevance safety net smoking cessation support tools treatment as usual urgent care

项目摘要

DESCRIPTION (provided by applicant): Despite established, evidence-based therapies, major gaps exist in asthma treatment, increasing the risk of asthma-related emergency department visits, hospitalizations, and oral steroid bursts. Provider (therapeutic inertia, insufficient time, patient (poor adherence, smoking), and system barriers (challenges with data, monitoring, communication, and medication refill) contribute to these gaps. The application of Electronic Health Records (EHRs) has the potential to lower these barriers leading to better asthma control and fewer exacerbations. The objective of this study is to conduct a large pragmatic trial to assess the effectiveness, cost-effectiveness, and implementation of the Breathewell intervention, which combines an evidence-based EHR intervention and team-based care to improve asthma outcomes. Breathewell employs EpicCare, the most widely used commercial EHR in the U.S, to identify poor medication adherence or unaddressed smoking and automatically enroll patients in a medication refill or smoking cessation program. For patients with asthma exacerbations or B-agonist inhaler overuse, the EHR sends the patients a decision support tool and notifies a nurse who uses an EHR-generated report to engage the patient in a shared-decision discussion, leading to development of an asthma care plan. EHR templated notes and order sets facilitate care plan execution. The study will be conducted in 26 primary care clinics of Kaiser Permanente Colorado using a cluster- randomized pragmatic clinical trial design. More than 10,400 asthma patients will be assigned to Breathewell or Usual Care based on their clinic. The evaluation assesses clinical effectiveness (asthma exacerbations, quality of life, and cost) and implementation (mediators and moderators of intervention effect, intervention barriers and facilitators, patient and provider impressions and RE-AIM framework translational measures). This study is significant because it could substantially reduce morbidity by addressing gaps in evidence-based asthma care. This research is innovative because it 1) uses the EHR to simultaneously addresses provider, patient, and system barriers to evidence-based care; 2) facilitates patient-centered decision making; 3) integrates evidence-based EHR and interactive behavioral change technologies; 4) is conducted as part of routine clinical care; and 5) is delivered in English and Spanish. Our results are likely to impact the field by speeding the translation of asthma care knowledge into practice. Successful deployment of Breathewell could serve as an implementation model for using EHRs to improve care for many chronic conditions, an NIH research priority and an objective of Healthy People 2020.

描述（由申请人提供）：尽管已有基于证据的治疗方法，但哮喘治疗仍存在重大差距，增加了哮喘相关急诊就诊、住院和口服类固醇爆发的风险（治疗惰性、时间不足、患者（依从性差、吸烟）和系统障碍（数据、监测、沟通和药物补充方面的挑战）导致了这些差距，电子健康记录 (EHR) 的应用有可能降低这些障碍，从而实现更好的哮喘控制。本研究的目的是进行一项大型务实试验，以评估 Breathewell 干预的有效性、成本效益和实施情况，该干预结合了基于证据的 EHR 干预和基于团队的护理，以改善哮喘结果。 Breathewell 采用 EpicCare（美国使用最广泛的商业 EHR）来识别药物依从性差或未解决的吸烟情况，并自动将患者纳入药物补充或戒烟计划。 B 激动剂吸入器过度使用时，EHR 会向患者发送决策支持工具，并通知护士，护士使用 EHR 生成的报告让患者参与共同决策讨论，从而制定 EHR 模板化笔记和计划。该研究将在科罗拉多州 Kaiser Permanente 的 26 个初级保健诊所进行，采用整群随机实用临床试验设计，将分配超过 10,400 名哮喘患者。呼吸良好或基于诊所的常规护理评估临床效果（哮喘加重、生活质量和成本）和实施情况（干预效果的中介因素和调节因素、干预障碍和促进因素、患者和提供者的印象以及 RE-AIM 框架转化）。这项研究意义重大，因为它可以通过解决循证哮喘护理方面的差距来大幅降低发病率。这项研究具有创新性，因为它 1) 使用 EHR 同时解决提供者、患者和系统障碍。基于证据的护理；2) 促进以患者为中心的行为决策；3) 整合基于证据的电子病历和交互式变革技术；4) 作为常规临床护理的一部分进行；5) 以英语和西班牙语提供结果。可能会通过加速哮喘护理知识转化为实践来影响该领域，成功部署 Breathewell 可以作为使用 EHR 改善许多慢性病护理的实施模型，这是 NIH 研究的重点和健康人群的目标。 2020.

项目成果

期刊论文数量（6）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Adapting adaptive design methods to accelerate adoption of a digital asthma management intervention.

采用适应性设计方法来加速数字哮喘管理干预措施的采用。

DOI：
发表时间：
2023-04-03
期刊：
影响因子：
3.6
作者：
Bender, Bruce G;Cvietusa, Peter J;Goodrich, Glenn K;King, Diane K;Shoup, Jo Ann
通讯作者：
Shoup, Jo Ann

Non-response to Communication Technology Outreach for Beta-agonist Overuse in a Pragmatic Randomized Trial of Patients with Asthma.

在哮喘患者的务实随机试验中，对过度使用β受体激动剂的通信技术外展没有反应。

DOI：
发表时间：
2018
期刊：
影响因子：
5.7
作者：
Raebel, Marsha A;Shetterly, Susan M;Goodrich, Glenn K;Anderson, Courtney B;Shoup, Jo Ann;Wagner, Nicole;Bender, Bruce G
通讯作者：
Bender, Bruce G

Planning for Implementation Success Using RE-AIM and CFIR Frameworks: A Qualitative Study.

使用 RE-AIM 和 CFIR 框架规划成功实施：定性研究。

DOI：
发表时间：
2020
期刊：
影响因子：
0
作者：
King, Diane K;Shoup, Jo Ann;Raebel, Marsha A;Anderson, Courtney B;Wagner, Nicole M;Ritzwoller, Debra P;Bender, Bruce G
通讯作者：
Bender, Bruce G

Effect of an Asthma Exacerbation on Medication Adherence.

哮喘加重对药物依从性的影响。

DOI：
发表时间：
2023-01
期刊：
影响因子：
0
作者：
Cvietusa, Peter J;Goodrich, Glenn K;Shoup, Jo Ann;King, Diane K;Bender, Bruce G
通讯作者：
Bender, Bruce G

Refill Reminder Preference and Inhaled Corticosteroid Adherence Among Patients with Asthma.

哮喘患者的补充提醒偏好和吸入皮质类固醇依从性。

DOI：
发表时间：
2020
期刊：
影响因子：
0
作者：
Raebel, Marsha A;Shetterly, Susan M;Goodrich, Glenn K;Anderson, Courtney B;Bender, Bruce G;Wagner, Nicole M
通讯作者：
Wagner, Nicole M