Clinic Navigation and Home Visits to Improve Guideline-based Care and Outcomes in Low Income Minority Adults With Asthma
NCT ID: NCT04023422
Last Updated: 2025-05-18
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.
ACTIVE_NOT_RECRUITING
NA
367 participants
INTERVENTIONAL
2019-08-21
2026-04-30
Brief Summary
Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.
In a randomized controlled factorial trial, 400 adults with uncontrolled asthma living in low-income urban neighborhoods are offered 18-months' participation: 12 months of clinical intervention and 6 months of evaluation to monitor sustainability of interventions and outcomes. Patients will be randomized to 1) a patient advocate and (2) an advocate and home visits, (3) an advocate and real-time feedback to the asthma provider (clinician) at each clinic visit of guidelines-relevant relevant information, and 4) (2), and (3). Interventions will be delivered by a community health worker. The study estimates Specific Aim 1: improvement over time of within-group (before-after in four groups) asthma outcomes (asthma control, quality of life, ED visits, hospitalizations, prednisone bursts) Specific Aim 2: across group differences in improvement over time in asthma outcomes; Specific Aim 3: the costs associated with each of the interventions. A cost-offset analysis will determine which intervention costs are offset by savings attributable to reductions in ED, hospitalization or other visits for asthma control and other outcomes.
Exploratory Aim: changes in behavior from the interventions using interviews of clinicians and patients.
Investigators hypothesize that improved outcomes in asthma patients will result from enhanced patient-clinician communication, clinician attention to home environmental exposures, and clinician consideration of the guidelines, at a program cost offset by lower patient health care utilization.
Related Clinical Trials
Explore similar clinical trials based on study characteristics and research focus.
A Patient Advocate to Improve Real-world Asthma Management for Inner City Adults
NCT01972308
A Patient Advocate and Literacy-Based Treatment of Asthma
NCT01128348
Asthma Symptom Perception Study
NCT06612294
Promoting Asthma Management Guidelines With Technology-Based Intervention and Care Coordination in Clinics and Schools
NCT07224061
Case Management and Environmental Control in Asthma
NCT00514436
Detailed Description
Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.
The Expert Panel Report 3 (EPR3) Guidelines for Asthma Diagnosis and Management, currently undergoing revision, is primarily directed at children and young adults. It overlooks older patients, many with comorbidities and many who live in poverty. Action plans are infrequently used and their benefits, strongly recommended by guidelines, have not been evaluated in older or low-income minority adults. Regular use of inhaled steroids, endorsed by the Guidelines for all but the mildest asthma is limited by social and economic barriers, e.g. cost and accessibility of medication. Failure of guidelines to address the barriers of poverty, limited education, poor housing and communication infrastructure, and suboptimal public transportation may promote non-adherence by clinicians.
For these vulnerable adults, the investigators recently demonstrated the feasibility, acceptability, and evidence of effectiveness of two separate interventions to improve access to care, patient-provider communication, and asthma outcomes: 1) a patient advocate (PA) (HAP2 Study (R18 HL116285)) to prepare for, attend, and confirm understanding of an office visit, and 2) community health workers (CHWs) (ARC Study (PCORI AS 1307-05218)) to assess home barriers to asthma management and coordinate care between home and clinic. Both protocols, well-accepted by patients and clinicians, allow prompting, delivery, and testing of guideline recommendations in a tailored real-world setting. Although these studies were designed and initiated separately, patient advocates in the clinic-based study felt that understanding the home circumstances would be beneficial to clinicians making guideline-based recommendations, while the CHWs visiting homes in the second study wanted more communication with treating clinicians. The proposed project combines these interventions by offering all "PA activities", called the Clinic Intervention (CI) and randomizing half to Home Visits (HV). Additionally, in a factorial design half of patients will be randomized to have their clinician receive feedback on guideline-relevant domains recommended for discussion with patients at appointments. The proposed interventions facilitate communication between clinicians and patients, enriched by understanding of the home environment, the unique view of the patient-clinician interaction at appointments, and barriers to asthma management that patients encounter. While the communication focuses on asthma management, it extends to general care coordination of common co-morbidities such as diabetes, hypertension, obesity and patients will be recruited from both primary care and specialty practices. Community Health Navigators (CHNs), who are lay health workers, will deliver the CI in all patients and the HVs in those so randomized. CHNs with close ties to patients' neighborhoods and also embedded in the clinics, will ensure patients' voices are heard in the delivery of guideline-based care and support patients at risk for health disparities, e. g., older adults, those with comorbidities, low income or limited literacy.
In a randomized controlled factorial trial, adults with uncontrolled asthma living in low-income urban neighborhoods will be offered 18-months participation in four groups of 100 each (1) CI only, (2) CI plus Home Visits (HV), (3) CI and clinician feedback, and (4) CI + HV + clinician feedback. Patients will be evaluated quarterly for 12 months and then observed for 6 months to assess sustainability of the intervention. The investigators will estimate:
Specific Aim 1: improvement over time of within-group (before-after in four groups) asthma outcomes (asthma control, quality of life, ED visits, hospitalizations, prednisone bursts) Specific Aim 2: across group differences in improvement over time in asthma outcomes; Specific Aim 3: the costs associated with each of the intervention, and the investigators will conduct a cost-offset analysis to determine which intervention costs are offset by savings attributable to reductions in ED, hospitalizations or other visits for asthma control and other outcomes.
Exploratory Aim: changes in behavior from the interventions using interviews of clinicians and patients.
Hypothesis and Impact: The investigators hypothesize improved outcomes in asthma patients through enhanced communication of patient and clinician, clinician attention to home environmental exposure, and clinician consideration of the guidelines, at a program cost offset by lower patient health care utilization.
Conditions
See the medical conditions and disease areas that this research is targeting or investigating.
Study Design
Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.
RANDOMIZED
FACTORIAL
HEALTH_SERVICES_RESEARCH
SINGLE
Study Groups
Review each arm or cohort in the study, along with the interventions and objectives associated with them.
Clinical intervention
Clinical health navigator, a community health worker, facilitates preparation for, attends, and confirms patients's understanding of an office visit.
Clinical intervention
The community health navigator will ask patient to produce medications, to indicate if there are current smokers in the home, to look for structural problems within the home, presence of pests, allergens, pollutants. Pt will be asked to produce their current medications. At the end a report will be written for the clinician.
Feedback
The community health navigator will give the clinician real-time feedback on guideline-related health.
Clinical intervention AND Home Visit
Patient receives Clinical intervention and Home visits. Care coordination activities occur taking into account the home environment, its social and physical characteristics.
Clinical intervention
The community health navigator will ask patient to produce medications, to indicate if there are current smokers in the home, to look for structural problems within the home, presence of pests, allergens, pollutants. Pt will be asked to produce their current medications. At the end a report will be written for the clinician.
Feedback
The community health navigator will give the clinician real-time feedback on guideline-related health.
Clinical intervention AND Feedback
Clinical intervention
The community health navigator will ask patient to produce medications, to indicate if there are current smokers in the home, to look for structural problems within the home, presence of pests, allergens, pollutants. Pt will be asked to produce their current medications. At the end a report will be written for the clinician.
Feedback
The community health navigator will give the clinician real-time feedback on guideline-related health.
Clinical intervention AND Home Visit AND Feedback
Clinical intervention
The community health navigator will ask patient to produce medications, to indicate if there are current smokers in the home, to look for structural problems within the home, presence of pests, allergens, pollutants. Pt will be asked to produce their current medications. At the end a report will be written for the clinician.
Feedback
The community health navigator will give the clinician real-time feedback on guideline-related health.
Interventions
Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.
Clinical intervention
The community health navigator will ask patient to produce medications, to indicate if there are current smokers in the home, to look for structural problems within the home, presence of pests, allergens, pollutants. Pt will be asked to produce their current medications. At the end a report will be written for the clinician.
Feedback
The community health navigator will give the clinician real-time feedback on guideline-related health.
Other Intervention Names
Discover alternative or legacy names that may be used to describe the listed interventions across different sources.
Eligibility Criteria
Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.
Inclusion Criteria
* A patient in a participating clinic
* Doctor's diagnosis of asthma
* Prescribed an inhaled corticosteroid for asthma
* Required prednisone or an Emergency Department (ED) visit or hospitalization for asthma within 12 months before enrollment.
* Some patients with a diagnosis of asthma and prescribed inhaled corticosteroid may also have mention of Chronic Obstructive Pulmonary Disease (COPD) in their record, particularly if they smoke. Asthma and COPD are both heterogeneous diseases, and may be impossible to distinguish by clinical characteristics.Both COPD and asthma can have evidence of reversible obstruction and also of irreversible obstruction. It is important not to exclude these patients, sometimes called overlap patients as they may benefit from these interventions.
Exclusion Criteria
* Excluded are those with other chronic lung diseases: lung cancer, cystic fibrosis, heart failure, chronic bronchitis, pulmonary hypertension, a candidate or recipient for lung transplant, a history of bronchial thermoplasty.
Excluded are those with more than 20 pack year tobacco use.
18 Years
ALL
Yes
Sponsors
Meet the organizations funding or collaborating on the study and learn about their roles.
National Heart, Lung, and Blood Institute (NHLBI)
NIH
University of Pennsylvania
OTHER
Responsible Party
Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.
Andrea Apter
Prinicipal Investigator, Professor of Medicine
Locations
Explore where the study is taking place and check the recruitment status at each participating site.
University of Pennsylvania Health Center
Philadelphia, Pennsylvania, United States
University of Pennsylvania Health System
Philadelphia, Pennsylvania, United States
Countries
Review the countries where the study has at least one active or historical site.
Other Identifiers
Review additional registry numbers or institutional identifiers associated with this trial.
More Related Trials
Additional clinical trials that may be relevant based on similarity analysis.