title: Rationale and design of a comparative effectiveness trial of home- and clinic-based self-management support coaching for older adults with asthma.
abstract: Older adults with asthma face numerous barriers to effective self-management and asthma control, and experience worse outcomes than younger asthmatics. Yet, there have been no controlled trials of interventions specifically designed to improve their care and outcomes. Through a multi-stakeholder collaboration (patients, academia, community-based organizations, a state department of health, and an advocacy organization) we developed a multi-component asthma self-management support intervention to address the myriad psychosocial, functional, health status, and cognitive barriers to effective asthma self-management in adults ages 60 and older. We are recruiting 425 New Yorkers in Manhattan and the Bronx for a pragmatic randomized controlled trial with 3 arms: the intervention delivered in primary care settings or in their home, or usual care. In the intervention, care coaches use a novel screening tool to identify the specific barriers to asthma control and self-management they experience. Once identified, the coach and patient choose from a menu of actions to address it. The intervention emphasizes efficiency, flexibility, shared decision making and goal setting, communication strategies appropriate for individuals with limited cognition and literacy skills, and ongoing reinforcement and support. Additionally, we introduced asthma-specific enhancements to the electronic health records of all participating clinical practices, including an asthma severity assessment, clinical decision support, and a patient-tailored asthma action plan. Patients will be followed for 12months and interviewed at baseline, 3, 6, and 12months and data on emergency department visits and hospitalizations will be obtained through the New York State Statewide Planning and Research Cooperative System.
authors.affiliation: Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States. Electronic address: alex.federman@mssm.edu.
authors.forename: Alex D
authors.initials: AD
authors.lastname: Federman
authors.affiliation: Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors.forename: Melissa
authors.initials: M
authors.lastname: Martynenko
authors.affiliation: Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.
authors.forename: Rachel
authors.initials: R
authors.lastname: O'Conor
authors.affiliation: Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kannry
authors.affiliation: Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors.forename: Adam
authors.initials: A
authors.lastname: Karp
authors.affiliation: Institute for Family Health, New York, NY, United States.
authors.forename: Joseph
authors.initials: J
authors.lastname: Lurio
authors.affiliation: City Health Works, New York, NY, United States.
authors.forename: Jamillah
authors.initials: J
authors.lastname: Hoy-Rosas
authors.affiliation: Little Sisters of the Assumption Family Health Service, New York, NY, United States.
authors.forename: Ray
authors.initials: R
authors.lastname: Lopez
authors.affiliation: St. Luke's Hospital, Mount Sinai Healthcare System, New York, NY, United States.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Obiapi
authors.affiliation: Union Settlement, New York, NY, United States.
authors.forename: Edwin
authors.initials: E
authors.lastname: Young
authors.affiliation: Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
authors.affiliation: Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Wisnivesky
keywords: Asthma; Community health workers; Elderly; Pragmatic trial; Randomized controlled trial; Self-management