A computerized decision support tool to implement asthma guidelines for children and adolescents

National Institute of Allergy and Infectious Diseases–sponsored Inner-City Asthma Consortium

Research output: Contribution to journalArticle

2 Citations (Scopus)

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. FEV 1 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.

Original languageEnglish (US)
Pages (from-to)1760-1768
Number of pages9
JournalJournal of Allergy and Clinical Immunology
Volume143
Issue number5
DOIs
StatePublished - May 1 2019

Fingerprint

Asthma
Guidelines
Program Evaluation
Randomized Controlled Trials
Random Allocation
Therapeutics
Censuses
Lung

Keywords

  • Asthma guidelines
  • asthma control
  • decision support
  • inner-city asthma

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

National Institute of Allergy and Infectious Diseases–sponsored Inner-City Asthma Consortium (2019). A computerized decision support tool to implement asthma guidelines for children and adolescents. Journal of Allergy and Clinical Immunology, 143(5), 1760-1768. https://doi.org/10.1016/j.jaci.2018.10.060
National Institute of Allergy and Infectious Diseases–sponsored Inner-City Asthma Consortium. / A computerized decision support tool to implement asthma guidelines for children and adolescents. In: Journal of Allergy and Clinical Immunology. 2019 ; Vol. 143, No. 5. pp. 1760-1768.
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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. FEV 1 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.",
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National Institute of Allergy and Infectious Diseases–sponsored Inner-City Asthma Consortium 2019, 'A computerized decision support tool to implement asthma guidelines for children and adolescents', Journal of Allergy and Clinical Immunology, vol. 143, no. 5, pp. 1760-1768. https://doi.org/10.1016/j.jaci.2018.10.060

A computerized decision support tool to implement asthma guidelines for children and adolescents. / National Institute of Allergy and Infectious Diseases–sponsored Inner-City Asthma Consortium.

In: Journal of Allergy and Clinical Immunology, Vol. 143, No. 5, 01.05.2019, p. 1760-1768.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A computerized decision support tool to implement asthma guidelines for children and adolescents

AU - National Institute of Allergy and Infectious Diseases–sponsored Inner-City Asthma Consortium

AU - Kercsmar, Carolyn M.

AU - Sorkness, Christine A.

AU - Calatroni, Agustin

AU - Gergen, Peter J.

AU - Bloomberg, Gordon R.

AU - Gruchalla, Rebecca S.

AU - Kattan, Meyer

AU - Liu, Andrew H.

AU - O'Connor, George T.

AU - Pongracic, Jacqueline A

AU - Szefler, Stanley J.

AU - Teach, Stephen J.

AU - Wildfire, Jeremy J.

AU - Wood, Robert A.

AU - Zoratti, Edward M.

AU - Busse, William W.

PY - 2019/5/1

Y1 - 2019/5/1

N2 - 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. FEV 1 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.

AB - 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. FEV 1 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.

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National Institute of Allergy and Infectious Diseases–sponsored Inner-City Asthma Consortium. A computerized decision support tool to implement asthma guidelines for children and adolescents. Journal of Allergy and Clinical Immunology. 2019 May 1;143(5):1760-1768. https://doi.org/10.1016/j.jaci.2018.10.060