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

Publication date: Available online 5 December 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Carolyn M. Kercsmar, Christine A. Sorkness, Agustin Calatroni, Peter J. Gergen, Gordon R. Bloomberg, Rebecca S. Gruchalla, Meyer Kattan, Andrew H. Liu, George T. O'Connor, Jacqueline A. Pongracic, Stanley J. Szefler, Stephen J. Teach, Jeremy J. Wildfire, Robert A. Wood, Edward M. Zoratti, William W. Busse, NIAID-sponsored Inner-City Asthma Consortium

Abstract

Background

Multi-center randomized controlled trials (RCTs) for asthma management that incorporate usual care regimens could benefit from standardized application of evidence-based guidelines.

Objective

To evaluate performance of a computerized decision support tool, 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 multi-center 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, adherence estimates) were collected at visits and entered into the ACET Program. Changes in control level and treatment steps were examined during the trials.

Results

At screening, over half the participants were rated as not or poorly controlled. The proportion of participants who gained good control between screening and randomization increased significantly in all three trials. Between 51% and 70% were well-controlled by randomization. The proportion of well-controlled participants remained constant or improved slightly from randomization until the last post-treatment visit. Night symptoms were the most common control level determinant; there were few (<1%) instances of complete overlap of factors. FEV₁ was the driver of control level assignment in 30% of determinations.

Conclusion

The ACET 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.

Graphical abstract

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