Adapting, Scaling, and Spreading an Algorithmic Asthma Mobile Intervention to Promote Patient-Reported Outcomes Within Primary Care Settings (New York)

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Project Details - Ongoing


Asthma morbidity and mortality rates in the Bronx borough of New York City are the highest in the state of New York. Almost every Bronx community has asthma hospitalization and emergency department visit rates triple the state average, regardless of age group. Increased patient education and the use of patient-reported outcome (PRO) measures can help primary care providers (PCPs) and patients better control asthma, but there are barriers to use, including time constraints and prioritizing comorbid conditions. Additionally, the lack of evidence-based, personalized, and easy-to-use mobile health applications to collect and implement PRO measures is an important gap in the realm of patient-centered health information technology.

To address these barriers to achieving better asthma control, researchers will evaluate a smartphone- and tablet-based application called ASTHMAXcel for adult asthma patients at Montefiore Medical Center (MMC). ASTHMAXcel consists of 10 guideline-based asthma education chapters delivered through animated videos, games, personalized algorithms, and push notifications. ASTHMAXcel incorporates and collects PRO measures, which enable the application to individualize patient education, encourage continued use, and promote asthma self-management.

The specific aims of the project are as follows:

  • To adapt, test, and iteratively refine the ASTHMAXcel application for the primary care setting. 
  • To conduct a randomized controlled trial (RCT) to compare the adapted and refined ASTHMAXcel program to usual care. 
  • To evaluate the process of ASTHMAXcel implementation within the primary care setting. 

Researchers will conduct participatory design sessions with PCPs and adult patients with asthma in year 1 of the study to identify how to best adapt the existing application. Once refined, ASTHMAXcel will be integrated with MMC’s electronic health record, allowing providers to view PRO measures and encouraging more informed decision making as part of their workflow. They will test the adapted electronic health record (EHR)-enabled ASTHMAXcel mobile intervention to evaluate functionality and usability, and use provider and patient feedback to refine the application. Researchers will conduct an RCT in years 2 and 3 of the study at six primary care sites to compare the adapted ASTHMAXcel application to usual care with regards to process outcomes, asthma knowledge, PROs, and clinical outcomes. Investigators will share lessons learned with other teams that seek to design patient-centered EHR-enabled mobile applications for chronic disease management with an emphasis on PRO collection and use.