Salt Lake City,
The investigators have developed a tool to facilitate asthma self-management in children,
the electronic-AsthmaTracker (e-AT). The e-AT changes ambulatory asthma care delivery to a
new model that is continuous and proactive, focusing on prevention and control, rather than
reactive and focusing on management of asthma attacks. The e-AT 1) engages parents in weekly
monitoring of their child's chronic asthma symptoms, 2) guides parents to recognize warning
signs of asthma attacks in order to prompt appropriate interventions and timely visits to
Primary Care Providers, and 3) provides Primary Care Providers with real-time, objective
patient data to assess the effectiveness of asthma therapy and prompt adjustments. In a
preliminary study of the paper-based version of the AT, frequent users had significantly
fewer emergency department (ED) and hospital visits. Parent comments during the e-AT pilot
testing revealed that the tool was useful in helping them manage their child's asthma and
were interested in assessing the tool's effectiveness and in identifying and addressing
barriers to their sustained use of the e-AT.
Improving asthma control in children will be facilitated by broad e-AT dissemination, and by
identifying and addressing critical factors that contribute to parent sustained
participation in self-management. The investigators propose to assess the effectiveness of
the new ambulatory care model supported by the e-AT and conduct an e-AT process evaluation,
assessing barriers and facilitators of sustained parent use. The investigators will engage
parents throughout this study to identify and address themes that matter to them. The target
population is children with persistent asthma, ages 2-17 years. The investigators have
engaged 10 parents since conception of this project, from the planning to design and
validation of the paper-AT, and the design and pilot testing of the e-AT. Input from parents
was received through 3 iterative focus groups (one for the paper-AT and 2 for the e-AT) and
facilitated discussions to inform the development of this proposal including research
objectives and outcome measures. In addition, the investigators have recruited other key
stakeholders for whom the results of the research will be relevant.
Through the following specific aims, the investigators will:
Aim 1: Assess the effectiveness of the new ambulatory care model, by comparing outcomes at
the 1.a. child (child's quality of life (QOL), asthma control, missed school days),
1.b.parent (satisfaction, parent missed work days) and 1.c. clinic (ED/hospital visits)
levels, between clinics randomly assigned to either the standard e-AT intervention vs.
intensive e-AT intervention. 1.d. Use non randomized comparisons to determine the
effectiveness of the e-AT relative to a control group (usual care) in which the e-AT was not
Aim 2: Assess the association of QOL, asthma control, and ED/hospital admissions with the
prior frequency of e-AT use and assess if the association differs between parent subgroups
(high vs. low literacy, Medicaid vs. private insurance, and frequent vs. less frequent e-AT
Aim 3: Determine the association of demographic, socio-economic, behavioral, and technology
factors with sustained parent participation in asthma self-management.
The outcome measures are:
1. Child quality of life (QOL)
2. Child asthma control
3. Child interrupted/missed school days
4. Child use of oral steroids (surrogate measure of an asthma exacerbation)
5. Parent satisfaction with care
6. Parent interruption/missed work days
7. Clinics: ED/Hospital admissions
Clinics are eligible for participation if they meet the following criteria:
1. Primary care clinics with the clinical leadership to adopt use of e-AT for asthma
2. Have patients between 2 and 17 years of age with persistent asthma.
3. Ability of the facility to accommodate patient enrollment and training about use of
Patient Inclusion Criteria
1. Children ages 2 through 17 years and their parents (main parents or caregiver)
2. English speakers
3. Children who received or are receiving asthma treatment (at participating clinics).
4. Parents have Internet access
5. Children with persistent asthma.
Patient Exclusion Criteria:
As this is a pragmatic trial assessing evidence of the e-AT in a real clinical
environment, no patients will be excluded as long as they meet inclusion criteria.
However, during the time of analysis, we will conduct a sub-analysis, comparing the
effectiveness of the new care model among patients with or without co-morbid conditions
that may affect measured asthma outcomes. These include patients with a history or
increased risk of pulmonary disease (cystic fibrosis, bronco-pulmonary dysplasia,
aspiration pneumonia, severe CP with aspiration risk, technology dependency (gastrostomy
tube, tracheostomy), history of congenital heart disease requiring surgical correction or
with complicating congestive heart failure requiring medical management, immunodeficiency
(including patients on immunosuppressants), and malignancies.
Flory Nkoy, MD, MS, MPH
University of Utah