A Hybrid Effectiveness–Implementation Study of SMART in Community Health Centers - CANDIDATE: I am an Assistant Professor of Medicine in the Division of Pulmonary and Critical Care Medicine at Washington University in St. Louis School of Medicine (WUSM). My long-term goal is to become an independent, federally funded physician-scientist who applies rigorous implementation science and pragmatic, stakeholder-engaged approaches to improve outcomes for patients with asthma. To date, I have received support from the NIH Loan Repayment Program, institutional T32 and KL2 awards, and the American Lung Association. While this training has been foundational, additional mentored training in implementation science methods and real-world intervention design is essential to achieve independence. In this proposal, I am mentored by established leaders in implementation science and health services research, and together we have developed an integrated research and career development plan designed to position me for R01-level or equivalent funding by the end of the award period. PROPOSED ENVIRONMENT: This project is supported by three complementary environments. First, WUSM provides a strong clinical and research infrastructure, including access to EHR-based data systems, pragmatic trial support, and career development resources. Second, the Brown School at Washington University offers nationally recognized expertise in implementation science, where I will complete advanced coursework in implementation science methods during the K23 award period. Third, the study will be conducted within community health centers in the St. Louis Integrated Health Network, a real-world primary care setting serving patients with a high burden of asthma. RESEARCH ABSTRACT: National asthma guidelines recommend single maintenance and reliever therapy (SMART) for patients with moderate-to-severe asthma, based on evidence demonstrating a ~30% reduction in exacerbations. However, uptake of SMART in U.S. practice remains low, including <10% prescribing within our partnered network of community health centers in St. Louis. To address this evidence-to-practice gap, we have developed a multilevel implementation strategy to increase SMART adoption. This strategy includes: clinician education with practice facilitation, audit and feedback, and patient-centered electronic tools including SMART-specific asthma action plans. In this type 1 hybrid stepped-wedge cluster randomized trial, we will: (1) evaluate the effectiveness of the implementation strategy on SMART prescribing (Aim 1, 1° effectiveness outcome), and (2) assess implementation outcomes using the RE-AIM framework, with a focus on adoption (primary implementation outcome) through integrated quantitative and qualitative methods (Aim 2, 1° implementation outcome).
