JMIR Publications

ABSTRACT

Background:

Asthma affects 1 in every 12 persons in the U.S., resulting in 1.9 million emergency department (ED) visits annually. However, the lack of patient-reported outcomes measures (PROMs) validated for use in the ED limits the evaluation of interventions to improve ED asthma care.

Objective:

To address this knowledge gap, this study protocol will (1) develop and test the validity and reliability of the Patient Reported Outcomes for Acute Asthma Care and Treatment instrument; 2) test whether receiving more guideline-concordant emergency Department (ED) care is associated with improved PROAACT responses; and 3) evaluate the association between PROAACT score and subsequent ED revisits and hospitalizations.

Methods:

This is a prospective cohort study of adult patients visiting the ED for acute asthma exacerbation across 3 EDs at an urban, tertiary care health system. Eligible patients are age 18 or older, have a prior diagnosis of asthma (self-reported or documented in the electronic health record), English-speaking, and experiencing an ED visit for asthma exacerbation as determined by treating clinician. Enrolled participants complete an initial PROM survey during their ED visit assessing their symptoms in the preceding seven days, then complete a follow-up survey 7 days after ED discharge assessing changes in the symptoms in the subsequent seven days. To test whether guideline-concordant care is associated with improved PROAACT scores, we will conduct retrospective chart review of medications ordered during the ED visit, then compare guideline adherence to changes in PROAACT scores. To test whether improved PROAACT scores are associated with fewer return ED visits and hospitalizations, we will extract all-cause ED visits and hospitalizations within 30 days from a regional health information exchange, then compared utilization to changes in PROAACT scores. We will use item response theory to develop scale responses based on summed item responses, which will allow us to test associations with clinical outcomes, including adherence to guideline-recommended care and return ED visits and hospitalizations.

Results:

Recruitment is ongoing and has experienced numerous challenges related to the COVID pandemic. To date, we have enrolled over 250 participants and have completed over 200 follow-ups. Recruitment is expected to conclude in spring 2025.

Conclusions:

Our study is intended to validate the use of PROMs during ED visits for acute asthma exacerbation among adult patients. Completion of the proposed aims will result in one of the first PROMs intended for use among adult ED patients and support the feasibility of collecting PROMs in the ED setting. Clinical Trial: Clinical Trials.gov, NC04349020