Impact of shared decision making on asthma quality of life and asthma control among children

ABSTRACT

Objective: Few studies have examined the effectiveness of shared decision making (SDM) in clinical practice. This study evaluated the impact of SDM on quality of life and symptom control in children with asthma. Methods: We conducted a prospective 3-year study in six community-based practices serving a low-income patient population. Practices received training on SDM using an evidence-based toolkit. Patients aged 2–17 with a diagnosis of asthma were identified from scheduling and billing data. At approximate 6-month intervals, patients completed a survey consisting of the Mini Pediatric Asthma Quality of Life Questionnaire (range 1–7) and the control domain of the Pediatric Asthma Therapy Assessment Questionnaire (range 0–7). We used propensity scores to match 46 children receiving SDM to 46 children receiving usual care with decision support. Included children had completed a baseline survey and at least one follow-up survey. Random coefficient models incorporated repeated measures to assess the effect of SDM on asthma quality of life and asthma control. Results: The sample was primarily of non-White patients (94.6%) with Medicaid insurance (92.4%). Receipt of SDM using an evidence-based toolkit was associated with higher asthma quality of life [mean difference 0.9; 95% confidence interval (CI) 0.4–1.4] and fewer asthma control problems (mean difference −0.9; 95% CI −1.6–−0.2) compared to usual care with decision support. Conclusions: Implementation of SDM within clinical practices using a standardized toolkit is associated with improved asthma quality of life and asthma control for low-income children with asthma when compared to usual care with decision support.

KEYWORDS:

• Asthma therapy assessment questionnaire (ATAQ)
• Medicaid
• mini asthma quality of life questionnaire (AQLQ)
• practice-based research
• propensity score

Acknowledegment

The authors would like to acknowledge Mark Steuerwald for his assistance with data collection.

Declaration of interest

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

Contributors' statement

Dr. Taylor developed the analysis plan, managed the study data, conducted initial statistical analyses, drafted the manuscript, and approved the final manuscript as submitted.

Dr. Tapp and Ms. Shade assisted with conceptualization of the study, conducted training on shared decision making, assisted with interpretation of results, and approved the final manuscript as submitted.

Dr. Liu conducted statistical analyses, critically reviewed the manuscript, and approved the final manuscript as submitted.

Ms. Mowrer coordinated the data collection, critically reviewed the manuscript, and approved the final manuscript as submitted.

Dr. Dulin conceptualized and designed the study, assisted with interpretation of results and approved the final manuscript as submitted.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Funding

All phases of this study were supported by the Agency for Healthcare Research and Quality Grant Number 1R18HS019946-01.