CHEST: A Collaboration With Community HEalth Centers to Implement SmarT for Asthma
Washington University School of Medicine
Summary
Purpose: This study aims to improve asthma care by helping clinicians at community health centers prescribe a guideline-recommended treatment called SMART (Single Maintenance and Reliever Therapy). The investigators will provide training and resources to clinicians, give feedback on prescribing patterns, and offer educational tools for patients and providers. The investigators will roll out these resources in stages across clinics. The study will measure how well the program helps clinicians prescribe SMART therapy and whether it reduces asthma exacerbations in patients.
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 an SMART implementation bundle, which contains three components: (1) clinician-level education on SMART with ongoing practice facilitation/supervision, (2) serial clinic- and clinician-level audit and feedback on inhaler prescribing patterns, (3) provision of a paper and online clinician- and patient-centered educatio…
Eligibility
- Age range
- 12+ years
- Sex
- All
- Healthy volunteers
- No
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. Active participation in the St. Louis Integrated Health Center Network for Community Academic Partnerships. 2. Employment of at least 3 clinicians who commonly manage adult asthma (defined as managing asthma for at least one adult asthma patient, on average, on a weekly basis). 3. Data provided to Azara for data queries, and 4. Willing and able to receive all co…
Interventions
- BehavioralImplementation bundle
The intervention is a SMART implementation bundle delivered in Federally Qualified Health Centers. Unlike drug trials, no medication is supplied; providers prescribe according to guidelines. The bundle includes three components: (1) clinician education with practice facilitation, (2) audit and feedback on prescribing, (3) patient education tools such as a SMART-aligned asthma action plan and videos tailored for low health literacy, and (4) operations committee meetings during the implementation period
Locations (7)
- Affinia healthcare, 2220 Lemp AveSt Louis, Missouri
- Affinia healthcare, 1717 Biddle StreetSt Louis, Missouri
- Affinia healthcare, 4414 North Florissant AvenueSt Louis, Missouri
- Family Care Heath Center, 4352 Manchester AveSt Louis, Missouri
- Washington University in St. Louis School of MedicineSt Louis, Missouri
- Family Care Heath Center, 401 Holly Hills AveSt Louis, Missouri