Barbara P Yawn1, Peter C Wollan2, Matthew A Rank3, Susan L Bertram2, Young Juhn4, Wilson Pace5. 1. Department of Research, Olmsted Medical Center, Rochester, Minnesota byawn47@gmail.com. 2. Department of Research, Olmsted Medical Center, Rochester, Minnesota. 3. Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic, Scottsdale, Arizona. 4. Department of Pediatrics and Adolescent Medicine, Asthma Epidemiology Research Unit, Mayo Clinic, Rochester, Minnesota. 5. National Research Network, American Academy of Family Physicians, Leawood, Kansas.
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.
RCT Entities:
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.
Authors: Robert L Williams; Kurt Stange; William R Phillips; Louise S Acheson; Bijal Balasubramanian; Elizabeth A Bayliss; Robert L Ferrer; James M Gill Journal: Ann Fam Med Date: 2013 May-Jun Impact factor: 5.166
Authors: William M Vollmer; Leona E Markson; Elizabeth O'Connor; E Ann Frazier; Marc Berger; A Sonia Buist Journal: Am J Respir Crit Care Med Date: 2002-01-15 Impact factor: 21.405
Authors: Gregory B Diette; Cecilia M Patino; Barry Merriman; Laura Paulin; Kristin Riekert; Sande Okelo; Kathy Thompson; Jerry A Krishnan; Ruth Quartey; Deanna Perez-Williams; Cynthia Rand Journal: Arch Intern Med Date: 2007-07-09
Authors: Barbara P Yawn; Peter C Wollan; Susan L Bertram; David Lowe; Joseph H Butterfield; Denise Bonde; James T C Li Journal: Mayo Clin Proc Date: 2007-04 Impact factor: 7.616
Authors: Andrew J Cave; Heather Sharpe; Mark Anselmo; A Dean Befus; Gillian Currie; Christina Davey; Neil Drummond; Jim Graham; Lee A Green; Jeremy Grimshaw; Karen Kam; Donna P Manca; Alberto Nettel-Aguirre; Melissa L Potestio; Brian H Rowe; Shannon D Scott; Tyler Williamson; David W Johnson Journal: JMIR Res Protoc Date: 2016-03-08
Authors: Amelia Licari; Ilaria Brambilla; Alessia Marseglia; Maria De Filippo; Valeria Paganelli; Gian L Marseglia Journal: Front Pediatr Date: 2018-06-19 Impact factor: 3.418