Asthma dissemination around patient-centered treatments in North Carolina (ADAPT-NC): a cluster randomized control trial evaluating dissemination of an evidence-based shared decision-making intervention for asthma management

Abstract

Objective: To compare three dissemination approaches for implementing an asthma shared decision-making (SDM) intervention into primary care practices. Methods: We randomized thirty practices into three study arms: (1) a facilitator-led approach to implementing SDM; (2) a one-hour lunch-and-learn training on SDM; and (3) a control group with no active intervention. Patient perceptions of SDM were assessed in the active intervention arms using a one-question anonymous survey. Logistic regression models compared the frequency of asthma exacerbations (emergency department (ED) visits, hospitalizations, and oral steroid prescriptions) between the three arms. Results: We collected 705 surveys from facilitator-led sites and 523 from lunch-and-learn sites. Patients were more likely to report that they participated equally with the provider in making the treatment decision in the facilitator-led sites (75% vs. 66%, p = 0.001). Comparisons of outcomes for patients in the facilitator-led (n = 1,658) and lunch-and-learn (n = 2,613) arms respectively vs. control (n = 2,273) showed no significant differences for ED visits (Odds Ratio [OR] [95%CI] = 0.77[0.57–1.04]; 0.83[0.66–1.07]), hospitalizations (OR [95%CI] = 1.30[0.59–2.89]; 1.40 [0.68–3.06]), or oral steroids (OR [95%CI] =0.95[0.79–1.15]; 1.03[0.81–1.06]). Conclusion: Facilitator-led dissemination was associated with a significantly higher proportion of patients sharing equally in decision-making with the provider compared to a traditional lunch-and-learn approach. While there was no significant difference in health outcomes between the three arms, the results were most likely confounded by a concurrent statewide asthma initiative and the pragmatic implementation of the intervention. These results offer support for the use of structured approaches such as facilitator-led dissemination of complex interventions into primary care practices.

Keywords:

• Shared decision making
• asthma
• practice-based research
• primary care

Acknowledgements

We would like to thank the 30 practices who agreed to participate in the study. We also thank the support of Chip Walter and Kristine Schmit. The ADAPT-NC Workgroup: Melissa Calvert, Phrygia Tyson, Diane Derkowski, Kathleen Mottus, Madeline Mitchell, Jennifer Rees, Beth Patterson, Lori Hendrickson, Deborah Nirella.

Conflicts of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Additional information

Funding

Research reported in this publication was funded through a Patient‐Centered Outcomes Research Institute Award (CD-12-11-4276). The opinions in this publication are solely the responsibility of the authors and do not necessarily “represent the views of PCORI, its Board of Governors, or Methodology Committee.” This publication was supported by Grant Number UL1TR001111 from the National Center for Advancing Translational Sciences at the National Institutes of Health.