Project Summary / Abstract (30 lines)
Changing behavior of health providers can be challenging, and significant gaps exist in our knowledge of how
to best implement new medical evidence into everyday practice. Numerous individual- and system-level factors
contribute to poor asthma outcomes which persist due to the lack of a comprehensive approach for asthma
care that is scalable, sustainable, and widely disseminated. Improved asthma outcomes are associated with
effective communication strategies between the patient and provider. Shared decision making (SDM) is a
patient-centered process in which patients and providers work together to make decisions and select tests,
treatments, and care plans based on evidence that balances risks with patient preferences and values.
Previous studies, including our PCORI-funded dissemination study, have shown that SDM is associated with
improved outcomes for asthma patients in primary care. Here we will evaluate the implementation of Coach
McLungsSM, a virtual evidence-based asthma SDM intervention with built-in asthma education and clinical
decision support, into primary care practices across a large healthcare system. Atrium Health, the 2nd largest
virtually integrated healthcare system in the nation, with over 14 million patient visits per year and the region's
largest primary care network, provides an ideal venue to evaluate implementation into primary care. Coach
McLungsSM will be fully integrated into the electronic medical record at all primary care practices. All asthma
patients aged 5-17 who attend these practices will be assessed for uncontrolled asthma. The goal of this study
will be to evaluate the implementation of the Coach McLungsSM SDM intervention into primary care.
Implementation will be guided using the Expert Recommendations for Implementing Change (ERIC), a
compilation of implementation strategies, and evaluated using the RE-AIM (Reach Effectiveness, Adoption,
Implementation, Maintenance) framework. Research questions are: How best can we implement the Coach
McLungsSM SDM asthma intervention into primary care? Will use of Coach McLungsSM in primary care improve
outcomes for patients with uncontrolled asthma? After convening a Stakeholder Advisory Committee (SAC)
composed of providers, researchers, patients, stakeholders with expertise in implementation science, asthma
research and advocacy, we will implement the Coach McLungsSM SDM intervention into primary care practices
using a stepped wedge randomized control study design. Providers and staff will be trained in SDM
communication and use of the Coach McLungsSM tool. We will measure changes in emergency department
visits, hospitalizations, and oral steroid use, which serve as surrogate measures for patient-centered asthma
outcomes. The SAC will use an iterative process improvement method and give best practice
recommendations back to the practices for implementation improvement. We will disseminate findings through
local stakeholders, practice-based research networks, asthma advocacy national organizations, and academic
research meetings for healthcare, primary care, and asthma.
