SBIR-STTR Award

Asthma is a significant public health concern affecting the quality of life of over 8% of the US population and causing more than a million emergency department visits every year. The standard of care for asthma changed dramatically with the publication of the 2020 NHLBI Asthma Management Guidelines: Focused Updates. The guidelines contained paradigm-shifting recommendations for treatment and monitoring. Of 19 recommendations, 16 were considered "˜conditional', meaning that shared decision making (SDM) between the provider and patient was advised prior to choosing an option. Unfortunately, many of the recommendations have yet to be incorporated into the care of asthma patients: less than 50% of the recommendations had been incorporated into clinical practice and over a third of surveyed of physicians had no awareness of the new asthma recommendations. Such delays in guideline implementation have been associated with adverse health outcomes, increased costs, and worsening health disparities. We previously developed an intervention that can collect patient-entered data pertinent to SDM in asthma which is then utilized by providers during office visits. This intervention was well received by both patients and physicians, improving patient satisfaction and quality of SDM during the clinical encounter. There is now an urgent need to develop a clinical decision-support (CDS) application that incorporates the key recommendations from the Asthma Guidelines Update, patient-specific clinical information, SDM-relevant patient values and preferences, and the social determinants of the health (SDOH) of the patient. To make the application widely usable, the CDS application must be based on EHR interoperability standards that will make it easier to implement CDS at multiple sites. The long-term objectives of this project are to design, develop, rigorously evaluate, and disseminate TIBSA (tailored interoperable guideline-based clinical decision-support system for asthma). TIBSA will be designed to address common deficiencies in CDS such as usability and poor applicability to the patient. In this Phase I project we will focus on the treatment of asthma in adults with these objectives: 1. Identify the requirements and create the design of TIBSA collaboratively with patients, clinicians and informaticians. The design will be validated and refined in two focus group panels representing clinical users and patients with asthma. 2. Create a minimally viable product version of TIBSA. We will create the application with Sapphire, our rapid application development platform that has capabilities for clinician SMART on FHIR apps, workflow automation, decision-support logic evaluation, and flexible engagement with patients. The application will be evaluated with clinicians and patients in a usability studyl. We will obtain data from these subjects on feasibility, acceptability, and appropriateness of TIBSA. In Phase II of this project, we will further refine TIBSA, and test its integration with EHRs. We will deploy the application within at least two clinical sites and perform an evaluation of its acceptance and impact on clinician adherence to guidelines and patient satisfaction with treatment decisions.

Public Health Relevance Statement:
Narrative This project will design and develop a shared decision-making software application for the treatment of asthma in adults. The application will request, prior to their visit with their doctor, information from patients about their preferences for treatment, the medications they are using for asthma, and how well-controlled is their asthma. During the visit, the application will combine this information with data from the patient's medical records and show treatment options for this patient ffrom the national guidelines for treatment of asthma. The patient and the doctor can then make adjustments to the patient's treatment plan that is based on guideline recommendations and the patient's preferences. We will design this application together with patients and doctors. When our application prototype is ready, we will test its acceptance and usability by patients and doctors. Terms: <21+ years old; AHCPR; AHRQ; Address; Adoption; Adult; Adult Human; Adult asthma; Affect; Agency for Health Care Policy and Research; Agency for Healthcare Research and Quality; Asthma; Automation; Awareness; Baptist Church; Baptists; Bronchial Asthma; Caring; Client satisfaction; Clinical; Clinical Data; Clinical Decision Support Systems; Computer software; Data; Development; Dissemination and Implementation; Drugs; ED visit; EHR system; ER visit; Electronic Health Record; Emergency care visit; Emergency department visit; Emergency hospital visit; Emergency room visit; Evaluation; Expedite Dissemination; FHIR; Fast Healthcare Interoperability Resources; Focus Groups; Guidelines; Health; Informatics; Intervention; Intervention Strategies; Logic; Medication; Michigan; Monitor; NHLBI; National Heart, Lung, and Blood Institute; Office Visits; Outcome; Patient Preferences; Patient Satisfaction; Patients; Pharmaceutical Preparations; Phase; Physicians; Population; Position; Positioning Attribute; Provider; Public Health; Publications; QOL; Quality of life; Recommendation; Sapphire; Scientific Publication; Site; Software; Specialist; Specific qualifier value; Specified; Survey Instrument; Surveys; Testing; United States Agency for Health Care Policy and Research; United States Agency for Healthcare Research and Quality; Universities; Update; Visit; adherence by clinicians; adherence by providers; adulthood; asthma patient; asthmatic patient; clinical decision support; clinical encounter; clinical practice; clinical research site; clinical site; clinician adherence; clinician compliance; cost; design; designing; determine efficacy; developmental; disparity in health; drug/agent; efficacy analysis; efficacy assessment; efficacy determination; efficacy evaluation; efficacy examination; electronic health care record; electronic health data; electronic health medical record; electronic health plan record; electronic health record system; electronic health registry; electronic medical health record; evaluate efficacy; examine efficacy; experience; flexibility; flexible; health disparity; implementation science; improved; interoperability; interventional strategy; participant engagement; patient engagement; patient health information; patient health record; patient medical record; physician adherence; physician compliance; physician office visit; preference; primary care clinician; prototype; provider adherence; provider compliance; shared decision making; social determinants; social health determinants; sociodeterminant; standard of care; support tools; treatment guidelines; treatment planning; usability; web site; website