Using IT to improve access, communication, and asthma in African American and Hispanic/Latino Adults: Rationale, design, and methods of a randomized controlled trial.
Asthma morbidity is high among inner-city minority adults. Improving access to care and patient-provider communication are believed to be essential for improving outcomes. Access and communication in turn increasingly rely on information technology including features of the Electronic Health Record. Its patient portal offers web-based communication with providers and practices. How patients with limited resources and educational opportunities can benefit from this portal is unclear. In contrast, home visits by community health workers (CHWs) have improved access to care for asthmatic children and promoted caretaker-clinician communication. We describe the planning, design, and methodology of an ongoing randomized controlled trial for 300 adults, predominantly African American and Hispanic/Latino, with uncontrolled asthma recruited from low income urban neighborhoods who are directed to the most convenient internet access and taught to use the portal, with and without home visits from a CHW. The study 1) compares the effects of the 1-year interventions on asthma outcomes (improved asthma control, quality of life; fewer ED visits and hospitalizations for asthma or any cause), 2) evaluates whether communication (portal use) and access (appointments made/kept) mediate the interventions' effects on asthma outcomes, and 3) investigates effect modification by literacy level, primary language, and convenience of internet access. In home visits, CHWs 1) train patients to competency in portal use, 2) enhance care coordination, 3) communicate the complex social circumstances of patients' lives to providers, and 4) compensate for differences in patients' health literacy skills. The practical challenges to design and implementation in the targeted population are presented.
Division of Pulmonary, Allergy, & Critical Care Medicine; Department of Medicine, 3400 Spruce St, Philadelphia, PA 19104, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States. Electronic address: apter@mail.med.upenn.edu.
Andrea J
AJ
Apter
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Children's Hospital of Philadelphia, Philadelphia, PA, United States.
Tyra
T
Bryant-Stephens
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States.
Knashawn H
KH
Morales
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States.
Fei
F
Wan
Children's Hospital of Philadelphia, Philadelphia, PA, United States.
Sharmaine
S
Hardy
Children's Hospital of Philadelphia, Philadelphia, PA, United States.
Shakira
S
Reed-Wells
Children's Hospital of Philadelphia, Philadelphia, PA, United States.
Maria
M
Dominguez
Division of Pulmonary, Allergy, & Critical Care Medicine; Department of Medicine, 3400 Spruce St, Philadelphia, PA 19104, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
Rodalyn
R
Gonzalez
Children's Hospital of Philadelphia, Philadelphia, PA, United States.
NaDea
N
Mak
Temple Physicians, Inc., Temple University Health System, Philadelphia, Pennsylvania, United States.
Alyssa
A
Nardi
School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, United States.
Hami
H
Park
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States.
John T
JT
Howell
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States.
Russell
R
Localio
Asthma; Community health worker; Electronic Health Record; Health literacy; Patient portal