Mosen D, Vollmer W, O'Connor E, Peters D, Kirshner M, Buist S; AcademyHealth. Meeting (2005 : Boston, Mass.).
Abstr AcademyHealth Meet. 2005; 22: abstract no. 4292.
Kaiser Permanente, Care Management Institute, 500 NE Multnomah, Suite 240, Portland, OR 97236 Tel. 503-813-3827 Fax 503-813-2428
RESEARCH OBJECTIVE: Interactive Voice Recognition (IVR) technologies offer a cost-effective method to deliver automated, low intensity outreach for persistent asthmatics. This technology can be used to not only provide useful asthma health education, but can alert health providers when a patients asthma is poorly controlled. Despite these apparent benefits, little research has evaluated the impact of such interventions on outcomes of care. The primary objective of this study is to evaluate the impact of an IVR Disease Management Intervention on medication use, asthma-related hospital and emergency department (ED) utilization, asthma control, quality of life assessment (QOL), and satisfaction with care. STUDY DESIGN: Using an intent-to-treat study design, we randomized 6948 adults with persistent asthma to receive usual care (UC, n = 3367) or an asthma outreach program (AOP, n = 3581). The AOP consisted of 3 calls spaced evenly over 11 months. Computerized calls were made using IVR technology. Each call lasted 5-10 minutes and asked about recent acute care, patterns of medication use, and current asthma control, followed by tailored feedback. Calls were documented in the medical record, and high risk patients were flagged for further follow-up. Random sample of the identified population completed surveys at baseline and follow-up to assess asthma control, QOL, and satisfaction with care. Electronic medical data were obtained for all and used to assess asthma related medication use and Hospital/ED utilization. Appropriate bivariate statistical tests (e.g. chi-square, t-tests) were used to assess differences in outcomes of care between the UC and AOP groups. POPULATION STUDIED: Adults with asthma enrolled in large staff model HMO located in the Pacific Northwest. PRINCIPAL FINDINGS: A total of 47% of AOP participants completed >=1 call. Those responding were significantly likely to: be older and female, report worse QOL, and have used more inhaled corticosteroids during the baseline year. Overall, we found no significant (p < .05) differences at follow-up between UC and AOP for key study outcomes. However at follow-up, the subset of AOP patients who completed calls, compared to UC, use significantly more controller medications, and reported significantly better QOL on symptom and emotional scales and significantly greater satisfaction with their asthma care, and tended (p=.11) to report fewer asthma control problems. CONCLUSIONS: Although we did not find a difference in outcomes using the original intent-to-treat design, post hoc analysis of actual AOP users suggests a possible benefit in asthma-related health outcomes for the AOP intervention, among those respondents that completed 1 or more calls. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Further research is needed to evaluate the effectiveness of IVR technologies as a medium to provide health education and modify behavior change among persistent asthmatics. Such research will provide needed information to health providers on how to best modify these strategies to improve their effectiveness.
Publication Types:
Keywords:
- Adult
- Asthma
- Data Collection
- Disease Management
- Female
- Humans
- Outcome Assessment (Health Care)
- Outcome and Process Assessment (Health Care)
- Patient Education as Topic
- Research
- methods
- therapy
- utilization
- hsrmtgs
UI: 103623755
From Meeting Abstracts