Using IT to Improve Access, Communication and Asthma in African American and Hispanic/Latino Adults

NCT02086565 | Completed Results DMC

• 1 other identifier: R-1307-05218
• Study Type: interventional
• Target: 301
• Locations: 1 country
• Sites: 1

Brief Summary

Background: Asthma morbidity is high in inner-city minority adults, despite the existence of efficacious therapy. Tailored, patient-centered interventions are needed to improve access to care and patient-provider communication. Access and communication increasingly rely on information technology (IT) as new incentives arise to use the Electronic Health Record (EHR). The EHR patient portal (PP) gives patients web-based communication with providers and practices. How the poor and those with limited educational opportunities can take advantage of these is unclear. In contrast, the investigators have found that home visits (HVs) by community health workers (CHWs) can improve access to care for children and promote caretaker-clinician communication. The investigators also found many inner-city adults have internet access and are willing to learn to use the PP. Objective: to examine the benefits for adults of using the PP with and without HVs by CHWs who will encourage/facilitate PP use, understand patients' social context, and enhance communication with the medical team. The investigator hypothesize all patients will benefit from PPs, and that the addition of HVs will be particularly helpful for those with low literacy or language barriers. Specific Aims test if the 1-year interventions result in 1) better within-group asthma outcomes, 2) better outcomes in one group over the other, 3) more communication (use of PP) and access (appointments made and kept) which mediate the interventions' effects on asthma outcomes, and 4) effect modification by literacy level, primary language, and convenience of internet access. Methods: In a randomized controlled trial, 301 adults, predominantly African American and Hispanic/Latino, with uncontrolled asthma recruited from low income urban neighborhoods will be assured internet access and taught to use the PP, with and without HVs from a CHW. CHWs will 1) train patients to competency in PP use, 2) enhance care coordination, 3) transmit a view of the complex social circumstances of patients' lives to providers, and 4) make up for differences in patients' health literacy skills. Patient Outcomes are asthma control, asthma-related quality of life, emergency department (ED) visits, and hospitalizations for asthma or any cause. Together asthma and other health conditions affect patients' ability to perform their daily tasks and care for their families. Potential benefits of the intervention are enhanced patient-clinician communication, access to care, improved health, and ability to use IT.

Conditions

Asthma; Communication

Keywords

asthma,; asthma control,; asthma-related quality of life; electronic health record,; portal,; health literacy

Outcome Measures

Primary Outcomes (1)

• Score of Asthma Control Questionnaire

  This is a validated test with 6 items each with Likert score 0 to 6, reflecting symptoms over the past week. Lower score is a better outcome. We measured change in Asthma Control Questionnaire score from baseline to at least 12 months.

  baseline and over a year

Secondary Outcomes (4)

• Asthma-related Quality of Life

  baseline and over a year

• Emergency Department Visits

  one year before baseline to one year after baseline

• Hospitalizations

  Hospitalizations for asthma in the year before baseline to one year after baseline

• Prednisone Bursts

  bursts at baseline and at one year

Study Arms (2)

Portal training and home visits

EXPERIMENTAL

Portal training and home visits from a community health worker to promote care coordination and use of the patient portal

Behavioral: Portal training and home visits

portal training

ACTIVE COMPARATOR

Participants are assured internet access and taught to use the patient portal

Behavioral: Portal training

Interventions

Portal training and home visits BEHAVIORAL

patient portal training and home visits by CHW to coordinate care

Portal training and home visits

Portal training BEHAVIORAL

training in use of patient portal

portal training

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• adults predominantly African American and Hispanic/Latino with uncontrolled asthma recruited from low income urban neighborhoods

You may not qualify if:

• severe psychiatric or cognitive problems that would make it impossible to understand and complete the protocol.

Sponsors & Collaborators

• University of Pennsylvania: lead
• Patient-Centered Outcomes Research Institute: collaborator

Study Sites (1)

University of Pennsylvania Health System

Philadelphia, Pennsylvania, 19104, United States

Location

Related Publications (2)

• Localio AM, Klusaritz H, Morales KH, Ruggieri DG, Han X, Apter AJ. Primary language and the electronic health record patient portal: Barriers to use among Spanish-speaking adults with asthma. J Asthma. 2022 Oct;59(10):2081-2090. doi: 10.1080/02770903.2021.1989462. Epub 2021 Oct 20.

  PMID: 34634975 DERIVED

• Apter AJ, Localio AR, Morales KH, Han X, Perez L, Mullen AN, Rogers M, Klusaritz H, Howell JT, Canales MN, Bryant-Stephens T. Home visits for uncontrolled asthma among low-income adults with patient portal access. J Allergy Clin Immunol. 2019 Sep;144(3):846-853.e11. doi: 10.1016/j.jaci.2019.05.030. Epub 2019 Jun 7.

  PMID: 31181221 DERIVED

Related Links

• Patient Centered Outcomes Research Institute

MeSH Terms

Conditions

Asthma; Communication

Interventions

House Calls

Condition Hierarchy (Ancestors)

Bronchial Diseases; Respiratory Tract Diseases; Lung Diseases, Obstructive; Lung Diseases; Respiratory Hypersensitivity; Hypersensitivity, Immediate; Hypersensitivity; Immune System Diseases; Behavior

Intervention Hierarchy (Ancestors)

Professional Practice; Organization and Administration; Health Services Administration

Results Point of Contact

• Title: Andrea J Apter, MD
• Organization: University of Pennsylvania

andrea.apter@uphs.upenn.edu

215 349-5120

Study Officials

• Andrea J Apter, MD, MSc, MA

  University of Pennsylvania

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: March 11, 2014
• First Posted: March 13, 2014
• Study Start: July 17, 2014
• Primary Completion: June 30, 2017
• Study Completion: June 30, 2017
• Last Updated: June 19, 2019
• Results First Posted: June 5, 2019

Record last verified: 2019-06

Locations

US (1)