Overview

This trial is active, not recruiting.

Conditions asthma, communication
Treatments portal training and home visits, portal training
Sponsor University of Pennsylvania
Collaborator Patient-Centered Outcomes Research Institute
Start date March 2014
End date June 2017
Trial size 300 participants
Trial identifier NCT02086565, R-1307-05218

Summary

Background: Asthma morbidity is high in inner-city minority adults, despite the existence of efficacious therapy. Tailored, patient-centered interventions are needed to improve access to care and patient-provider communication. Access and communication increasingly rely on information technology (IT) as new incentives arise to use the Electronic Health Record (EHR). The EHR patient portal (PP) gives patients web-based communication with providers and practices. How the poor and those with limited educational opportunities can take advantage of these is unclear. In contrast, the investigators have found that home visits (HVs) by community health workers (CHWs) can improve access to care for children and promote caretaker-clinician communication. The investigators also found many inner-city adults have internet access and are willing to learn to use the PP.

Objective: to examine the benefits for adults of using the PP with and without HVs by CHWs who will encourage/facilitate PP use, understand patients' social context, and enhance communication with the medical team. The investigator hypothesize all patients will benefit from PPs, and that the addition of HVs will be particularly helpful for those with low literacy or language barriers. Specific Aims test if the 1-year interventions result in 1) better within-group asthma outcomes, 2) better outcomes in one group over the other, 3) more communication (use of PP) and access (appointments made and kept) which mediate the interventions' effects on asthma outcomes, and 4) effect modification by literacy level, primary language, and convenience of internet access.

Methods: In a randomized controlled trial, 300 adults, predominantly African American and Hispanic/Latino, with uncontrolled asthma recruited from low income urban neighborhoods will be assured internet access and taught to use the PP, with and without HVs from a CHW. CHWs will 1) train patients to competency in PP use, 2) enhance care coordination, 3) transmit a view of the complex social circumstances of patients' lives to providers, and 4) make up for differences in patients' health literacy skills.

Patient Outcomes are asthma control, asthma-related quality of life, emergency department (ED) visits, and hospitalizations for asthma or any cause. Together asthma and other health conditions affect patients' ability to perform their daily tasks and care for their families. Potential benefits of the intervention are enhanced patient-clinician communication, access to care, improved health, and ability to use IT.

United States No locations recruiting
Other Countries No locations recruiting

Study Design

Allocation randomized
Endpoint classification efficacy study
Intervention model parallel assignment
Masking single blind (subject)
Primary purpose health services research
Arm
(Experimental)
Portal training and home visits from a community health worker to promote care coordination and use of the patient portal
portal training and home visits
patient portal training and home visits by CHW to coordinate care
(Active Comparator)
Participants are assured internet access and taught to use the patient portal
portal training
training in use of patient portal

Primary Outcomes

Measure
asthma control
time frame: one year

Secondary Outcomes

Measure
asthma-related quality of life
time frame: one year

Eligibility Criteria

Male or female participants at least 18 years old.

Inclusion Criteria: - adults predominantly African American and Hispanic/Latino with uncontrolled asthma recruited from low income urban neighborhoods Exclusion Criteria: - severe psychiatric or cognitive problems that would make it impossible to understand and complete the protocol.

Additional Information

Official title Using IT to Improve Access, Communication and Asthma in African American and Hispanic/Latino Adults
Principal investigator Andrea J Apter, MD, MSc, MA
Trial information was received from ClinicalTrials.gov and was last updated in June 2016.
Information provided to ClinicalTrials.gov by University of Pennsylvania.