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

Figures & data

Figure 1. Consort diagram. n=number of practices; *Data received from CCNC already excluded those practices with less than 75 patients.

Figure 2. Description of roll-out of Facilitator-led intervention.

Figure 3. Practice recruited in North Carolina by Practice Based Research Networks (PBRNS) for the ADAPT-NC Study.

Table 1. Baseline data for the 30 practices recruited for the study.

ID	Pre #Patients	Post #Patients	Female	African American	Caucasian	Hispanic	Under 21
Facilitator-led practices
P1	153	186	35.4%	78.2%	14.4%	7.0%	98.3%
P2	131	160	41.8%	9.8%	86.4%	3.3%	92.9%
P3	272	292	41.2%	26.4%	71.4%	15.1%	97.3%
P4	25	30	60.0%	17.8%	80.0%	2.2%	57.8%
P5	89	98	55.3%	52.7%	42.7%	5.3%	66.7%
P6	221	208	46.6%	53.0%	36.2%	11.4%	95.0%
P7	101	91	64.0%	74.0%	16.8%	6.4%	59.2%
P8	175	186	36.6%	63.4%	34.8%	6.3%	97.3%
P9	220	274	38.8%	35.7%	59.1%	5.5%	96.5%
P10	116	133	58.0%	53.7%	41.4%	3.1%	67.3%
Average	150	166	47.8%	46.5%	48.3%	6.6%	82.8%
Total	1503	1658
Lunch-And-Learn
P11	716	707	41.8%	40.0%	58.5%	2.6%	97.0%
P12	329	371	43.6%	67.3%	22.0%	16.0%	95.9%
P13	75	81	55.2%	23.8%	75.2%	2.9%	53.3%
P14	61	60	55.2%	44.8%	51.7%	11.5%	59.8%
P15	78	93	67.2%	56.6%	37.7%	11.5%	34.4%
P16	298	326	52.4%	67.8%	26.8%	3.6%	71.1%
P17	106	63	37.4%	64.5%	15.9%	17.8%	93.5%
P18	52	61	72.0%	82.9%	14.6%	1.2%	45.1%
P19	47	55	40.3%	52.2%	40.3%	1.5%	100.0%
P20	761	796	39.3%	62.6%	24.1%	18.2%	95.6%
Average	252	261	50.4%	56.2%	36.7%	8.7%	74.6%
Total	2523	2613
Control
P21	163	169	44.1%	61.6%	29.9%	11.8%	94.8%
P22	361	369	42.8%	63.8%	26.1%	17.4%	93.6%
P23	98	101	36.1%	50.8%	40.2%	4.1%	95.1%
P24	144	138	39.9%	34.4%	60.1%	12.6%	98.4%
P25	831	810	39.2%	68.4%	20.7%	14.9%	95.3%
P26	80	104	69.0%	71.0%	26.9%	0.7%	0.0%
P27	373	348	41.7%	72.4%	12.2%	14.1%	100.0%
P28	54	59	51.9%	84.4%	15.6%	0.0%	48.1%
P29	57	68	48.3%	55.1%	36.0%	5.6%	93.3%
P30	87	107	43.8%	32.1%	54.7%	29.2%	99.3%
Average	225	227	45.7%	59.4%	32.2%	11.0%	81.8%
Total	2248	2273

Table 2. Final Survey results for the facilitator-led and “lunch and learn” dissemination arms. The survey asked “Who made the decision in your meeting with the care team (health coach and provider) about what your asthma treatment would be?”

	Facilitator-led N = 705	Lunch-and-Learn N = 523	p-value
Question Answer: 1–5	Percent of Surveys (95% CI)
The provider alone made the decision	4.8 (3.2–6.4)	7.6 (5.6–9.6)	0.08
The provider mostly made the decision, and I played a small role in the decision-making	12.2 (9.8–14.6)	15.1 (12.5–17.7)	0.15
The provider and I participated equally in making the decision	74.9 (71.7–78.1)	66.3 (62.8–69.8)	0.001
I mostly made the decision, and the provider played a small role in the decision- making	4.3 (2.8–5.8)	5.0 (3.4–6.6)	0.56
I alone made the decision	3.8 (2.4–5.2)	5.9 (4.2–7.6)	0.10

Table 3. Within arm comparison of exacerbation outcomes for patients with asthma.

	Baseline – 12 months	Post-Randomization – 12 months^a
Study Arm (N = Patients)	%(Patients)	%(Patients)	Absolute	Relative	p-value
Patients with ED visits
Facilitator-led (N = 1658)	9.6%	8.3%	–1.3%	–13.76%	0.21
Lunch-and-Learn (N = 2613)	14.1%	12.4%	–1.6%	–11.60%	0.09
Control (N = 2273)	12.8%	13.9%	1.1%	8.86%	0.28
Patients with Hospitalizations
Facilitator-led (N = 1658)	1.5%	1.6%	0.1%	6.42%	0.93
Lunch-and-Learn (N = 2613)	1.1%	1.0%	–0.2%	–13.43%	0.68
Control (N = 2273)	1.7%	1.1%	–0.6%	–34.93%	0.12
Patients with Oral Steroid Prescriptions
Facilitator-led (N = 1658)	36.6%	30.8%	–5.8%	–15.94%**	<0.001
Lunch-and-Learn (N = 2613)	38.7%	33.6%	–5.1%	–13.23%**	<0.001
Control (N = 2273)	34.0%	30.4%	–3.6%	–10.55%**	<0.001
Patients with one or more exacerbations
Facilitator-led (N = 1658)	39.9%	32.6%	–7.3%	–18.20%**	<0.001
Lunch-and-Learn (N = 2613)	40.9%	37.0%	–3.9%	–9.53%*	<0.01
Control (N = 2273)	36.0%	32.2%	–3.8%	–10.50%*	<0.01

* p < 0.01,

** p < 0.001.

^a This 12-month data collection period begins 6 months after the randomization date which coincides with the end of data collection time period 18 months post randomization.

^b Patients have either one or multiple Hospitalizations, ED Visit, or Oral Steroid Prescription with in the time period.

Table 4. Odds of exacerbation between study arms post randomization for all three arms of the study.

Study Arm (N = Patients)	Practices		Patients (%)	Adjusted Odds Ratio^a (95% CI)	p-value
Patients with ED visits
Facilitator-Led (N = 1658)	10		137(8.3)	0.77(0.60 to 1.01)	0.09
Lunch-and-Learn (N = 2613)	10		325(12.4)	0.83(0.66 to 1.07)	0.15
Control (N = 2273)	10		317(13.9)	1.0
Patients with Hospitalizations
Facilitator-Led (N = 1658)	10		27(1.6)	1.3(0.59 to 2.89)	0.74
Lunch-and-Learn (N = 2613)	10		26(1.0)	1.4(0.68 to 3.06)	0.33
Control (N = 2273)	10		25(1.1)	1.0
Patients with Oral Steroid Prescriptions
Facilitator-Led (N = 1658)	10		510(30.8)	0.95(0.79 to 1.15)	0.60
Lunch-and-Learn (N = 2613)	10		996(33.6)	1.03(0.81 to 1.06)	0.75
Control (N = 2273)	10		629(30.4)	1.0
Patients with One or More exacerbations
Facilitator-Led (N = 1658)	10		540(32.9)	0.91(0.75 to 1.10)	0.34
Lunch-and-Learn (N = 2613)	10		966(39.1)	0.98(0.92 to 1.17)	0.85
Control (N = 2273)	10		733(32.0)	1.0

* p < 0.01, **p < 0.001.

^a Models adjusted for proportion of patients for a 12-month data collection period beginning 6 months after the randomization date which coincides with the end of data collection time period 18 months post randomization.