Condition

• Moderate to Severe Asthma

Eligibility

Eligible Ages

Over 12 Years

Eligible Sex

All

Accepts Healthy Volunteers

No

Criteria

The study population can be viewed from the cluster (clinic), clinician, staff, or
patient level.

At the cluster (clinic) level: To be eligible to participate in this study, a cluster
(clinic) must meet all the following criteria:

(1) Clinics within participating health systems (Affinia Healthcare and Family Care
Health Centers) will be considered eligible if they provided care to ≥100 patients aged
≥12 years with asthma (ICD-10-CM: J45.xx) during the calendar year preceding
implementation (2024).

At the clinician level:

Clinicians will be considered eligible if they:

1. are physicians, nurse practitioners, or physician assistants;

2. are actively employed at a participating clinic during the implementation period;
and

3. provided care to ≥10 patients aged ≥12 years with asthma (ICD-10-CM: J45.xx) during
the 12 months preceding implementation.

At the staff level:

Staff will be considered eligible if they:

1. are actively employed at a participating clinic during the implementation period;
and

2. directly support clinical care delivery for patients aged ≥12 years with asthma.

At the patient level:

Patients will be considered eligible if they:

1. are aged ≥12 years;

2. received care at a participating clinic during the implementation period; and (3)
meet the study-defined definition of moderate-to-severe asthma based on diagnosis
codes, medication use, and/or exacerbation history as defined in the study protocol.

Recruiting Locations

Study Contact

Detailed Description

CHEST is a type 1 hybrid stepped-wedge cluster randomized trial wherein six federally qualified community health center clinics are randomly and iteratively selected to move in a 1-way crossover from the control group to the SMART implementation group. The primary intervention is the SMART implementation bundle includes four components: (1) clinician education on SMART with ongoing practice facilitation, (2) serial clinic- and clinician-level audit and feedback on inhaler prescribing patterns, (3) workflow integration support including prescribing preferences, and (4) provision of an online patient-centered education aid with a SMART congruent asthma action plan designed for patients with lower health literacy. The study is conceptually split into three phases: (1) the pre-implementation (control) phase focused on the development of implementation materials and baseline data gathering of prescription patterns; (2) the active implementation phase; and (3) the sustainment phase, which will focus on an assessment of sustainment and dissemination. 1. Pre-implementation phase: The pre-implementation phase is designed to be a baseline for the study. During this phase, no specific interventions will be introduced to the clinicians at participating IHN clinics. This phase will allow the CHEST study team to collect clinic-level data on current asthma care prescription practices and asthma-related outcomes. 2. Active implementation phase: At the start of the second phase, the implementation phase, the SMART implementation bundle will be introduced to the clinicians and staff at participating IHN clinics. 3. Sustainment phase: The final phase of the study is introduced after the active implementation of the SMART implementation bundle is complete at all participating IHN clinics. In the sustainment phase, formal assessments will be conducted to evaluate the sustainment of the SMART bundle. Additionally, this phase includes efforts to disseminate the findings of the study. This encompasses analyses of the reach and impact of the dissemination efforts, as well as the practical application and adoption of the findings in the broader medical community.