Abstract
PURPOSE The purpose of this study was to assess patient and practice outcomes after introducing the Asthma APGAR (Activities, Persistent, triGGers, Asthma medications, Response to therapy) tools into primary care practices.
METHODS We used a pragmatic cluster-randomized controlled design in 18 US family medicine and pediatric practices to compare outcomes in patients with persistent asthma aged 5 to 45 years after introduction of the Asthma APGAR tools vs usual care. Patient outcomes included asthma control, quality of life, and emergency department (ED), urgent care, and inpatient hospital visits. The practice outcome was adherence to asthma guidelines.
RESULTS We enrolled 1,066 patients: 245 children, 174 adolescents, and 647 adults. Sixty-five percent (692 patients) completed both baseline and 12-month questionnaires, allowing analysis for patient-reported outcomes. Electronic health record data were available for 1,063 patients (99.7%) for practice outcomes. The proportion of patients reporting an asthma-related ED, urgent care, or hospital visit in the final 6 months of the study was lower in the APGAR practices vs usual care practices (10.6% vs 20.9%, P = .004). The percentage of patients with “in control” asthma increased more between baseline and 1 year in the APGAR group vs usual care group (13.5% vs 3.4%, P =.0001 vs P =.86) with a trend toward better control scores and asthma-related quality of life in the former at 1 year (P ≤.06 and P = .06, respectively). APGAR practices improved their adherence to 3 or more guideline elements compared with usual care practices (20.7% increase vs 1.9% decrease, P = .001).
CONCLUSIONS Introduction of the Asthma APGAR tools improves rates of asthma control; reduces asthma-related ED, urgent care, and hospital visits; and increases practices’ adherence to asthma management guidelines.
- asthma
- asthma control
- outcomes
- asthma management
- primary care
- pragmatic research
- practice-based research
- protocol
- implementation
- guideline
- asthma tool
- randomized clinical trial
Footnotes
Conflicts of interest: Barbara P. Yawn served on asthma and COPD advisory boards for Boehringer Ingelheim, GlaxoSmithKline, Novartis, and Teva. Young Juhn received support for asthma research from Genentech. All other authors report no conflicts of interest.
Funding support: This work was supported by AHRQ grant R01HS 008745, Barbara P. Yawn, Principal Investigator. Barbara P. Yawn has also received research grants from NIH and PCORI for asthma and COPD research. Young Juhn received support for asthma research from an NIH-funded R01 grant (R01 HL126667), an R21 grant (R21AI116839-01), the T. Denny Sanford Pediatric Collaborative Research Fund, and a Scholarly Clinician Award from the Mayo Foundation. Matthew A. Rank received support for asthma research from the AHRQ (grant R03 HS022126).
Previous presentations: Preliminary results were presented as a late-breaking poster at the American Academy of Allergy, Asthma & Immunology (AAAAI) meeting; March 2017; Atlanta, Georgia.
Trial registration: NCT01446315 at clinicaltrials.gov.
Supplementary materials: Available at http://www.AnnFamMed.org/content/16/2/100/suppl/DC1/.
- Received for publication April 24, 2017.
- Revision received September 19, 2017.
- Accepted for publication September 26, 2017.
- © 2018 Annals of Family Medicine, Inc.