title: Evaluating the impact of an integrated computer-based decision support with person-centered analytics for the management of asthma in primary care: a randomized controlled trial.
abstract: BACKGROUND
  Computer-based decision support has been effective in providing alerts for preventive care. Our objective was to determine whether a personalized asthma management computer-based decision support increases the quality of asthma management and reduces the rate of out-of-control episodes.
  
  
  METHODS
  A cluster-randomized trial was conducted in Quebec, Canada among 81 primary care physicians and 4447 of their asthmatic patients. Patients were followed from the first visit for 3-33 months. The physician control group used the Medical Office of the 21st century (MOXXI) system, an integrated electronic health record. A custom-developed asthma decision support system was integrated within MOXXI and was activated for physicians in the intervention group.
  
  
  RESULTS
  At the first visit, 9.8% (intervention) to 12.9% (control) of patients had out-of-control asthma, which was defined as a patient having had an emergency room visit or hospitalization for respiratory-related problems and/or more than 250 doses of fast-acting β-agonist (FABA) dispensed in the past 3 months. By the end of the trial, there was a significant increase in the ratio of doses of inhaled corticosteroid use to fast-acting β-agonist (0.93 vs. 0.69: difference: 0.27; 95% CI: 0.02-0.51; P = 0.03) in the intervention group. The overall out-of-control asthma rate was 54.7 (control) and 46.2 (intervention) per 100 patients per year (100 PY), a non-significant rate difference of -8.7 (95% CI: -24.7, 7.3; P = 0.29). The intervention's effect was greater for patients with out-of-control asthma at the beginning of the study, a group who accounted for 44.7% of the 5597 out-of-control asthma events during follow-up, as there was a reduction in the event rate of -28.4 per 100 PY (95% CI: -55.6, -1.2; P = 0.04) compared to patients with in-control asthma at the beginning of the study (-0.08 [95% CI: -10.3, 8.6; P = 0.86]).
  
  
  CONCLUSIONS
  This study evaluated the effectiveness of a novel computer-assisted ADS system that facilitates systematic monitoring of asthma control status, follow-up of patients with out of control asthma, and evidence-based, patient-specific treatment recommendations. We found that physicians were more likely to use ADS for out-of-control patients, that in the majority of these patients, they were advised to add an inhaled corticosteroid or a leukotriene inhibitor to the patient s treatment regimen, and the intervention significantly increased the mean ratio of inhaled corticosteroids to FABA during follow-up. It also reduced the rate of out-of-control episodes during follow up among patients whose asthma was out-of-control at the time of study entry. Future research should assess whether coupling patient-specific treatment recommendations, automated follow-up, and home care with comparative feedback on quality and outcomes of care can improve guideline adoption and care outcomes.
  
  
  CONCLUSIONS
  A primary care-personalized asthma management system reduced the rate of out-of-control asthma episodes among patients whose asthma was poorly controlled at the study's onset.
authors: Division of Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada robyn.tamblyn@mcgill.ca.
authors: Robyn
authors: R
authors: Tamblyn
authors: Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada.
authors: Pierre
authors: P
authors: Ernst
authors: Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada.
authors: Nancy
authors: N
authors: Winslade
authors: Division of Geriatric Medicine, University of Ottawa, Ottawa, ON, Canada.
authors: Allen
authors: A
authors: Huang
authors: Herzl Family Practice Centre, Jewish General Hospital, Montreal, QC, Canada.
authors: Roland
authors: R
authors: Grad
authors: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
authors: Robert W
authors: RW
authors: Platt
authors: Division of Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada.
authors: Sara
authors: S
authors: Ahmed
authors: Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada.
authors: Teresa
authors: T
authors: Moraga
authors: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada.
authors: Tewodros
authors: T
authors: Eguale
mesh_terms: D001249:Asthma / Q000628:therapy*; D003658:Decision Making, Computer-Assisted; D005260:Female; D006801:Humans; D008297:Male; D058007:Physicians, Primary Care; D057285:Precision Medicine; D011320:Primary Health Care; D016037:Single-Blind Method; D014584:User-Computer Interface
keywords: MOXXI; RCT; asthma; computer decision support; out-of-control; personalized medicine