CHEST Study: Improving Asthma Care with SMART Therapy
This study, called CHEST, aims to improve how doctors at community health centers treat moderate to severe asthma. It focuses on a treatment approach called SMART (Single Maintenance and Reliever Therapy), which is a guideline-recommended way to manage asthma. Instead of testing a new medication, this study provides training and resources to healthcare providers on how to best use SMART therapy. This includes educating clinicians, giving them feedback on prescribing patterns, and offering educational tools for both patients and providers. The goal is to see if this program helps doctors prescribe SMART therapy more effectively and if it reduces asthma attacks in patients. The study plans to enroll 2000 participants aged 12 and older, and its current status is unclear.
- Study design
- This is an interventional study that will involve six community health center clinics, with clinics moving from a control group to an intervention group over time. It plans to enroll 2000 participants.
- What's involved
- The study will measure patient-level effectiveness and clinician-level adoption of the SMART implementation bundle for up to 24 months. Specific patient commitments are not detailed.
- Compensation
- Not stated in the trial record.
- Follow-up
- Participants will be followed through study completion, up to 24 months.
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CHEST: A Collaboration With Community HEalth Centers to Implement SmarT for Asthma
At a glance
Conditions
Where it's being run
7 sites across 1 statesWho to contact
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What this trial measures
- Patient-level Effectiveness (of the SMART implementation bundle)Through study completion, up to 24 months
A clinic-level assessment of the SMART implementation bundle with the endpoint of between-group difference in the proportion of SMART-recommended asthma encounters, wherein SMART was the prescribed inhaler regimen. Patient encounters wherein any diagnosis of asthma was coded in patients ≥12 years old will be queried. Asthma encounters will then be in a binary fashion, as either "SMART- non-recommended" or "SMART- recommended" based on asthma exacerbation history and currently prescribed maintenance inhaler medications. A SMART prescription will be defined as clinician prescription of budesonide- formoterol 160/4.5µg or mometasone-formoterol 100/6µg ordered for maintenance and reliever usage. The proportion of SMART prescriptions will be compared between control and intervention groups. The control period will include pre-intervention data, while the intervention period will include all time post-implementation, but exclude the first 2 months as a "transition phase."
- Clinician-level adoption (of the SMART implementation bundle)Through study completion, up to 24 months
Proportion of eligible clinicians who adopt all three core components of the SMART implementation bundle. Clinician-level adoption will be defined as completion and initial use of all three core SMART implementation bundle components: (1) Participation in at least one SMART-focused education and practice facilitation session; (2) Participation in at least one audit-and-feedback session reviewing SMART prescribing performance; and (3) Initial use of SMART patient-centered education tools, defined as documentation and/or clinician self-report of the use of the SMART asthma action plan and/or patient education materials during clinical care. Clinicians will be considered eligible if they: (1) are state-licensed physicians, assistant physicians, nurse practitioners, or physician assistants; (2) provide outpatient clinical care to patients aged ≥12 years with asthma at participating clinics; and (3) are actively employed at the clinic during the implementation period.
- Clinic-level effectiveness of the SMART implementation bundle, measured as the proportion of SMART-eligible asthma encounters in which SMART is prescribedThrough study completion, up to 24 months
Between-group difference in the proportion of SMART-eligible asthma encounters in which SMART is prescribed, comparing implementation vs control periods. Encounters will be SMART-eligible if patients meet study-defined criteria consistent with GINA Step 3-5 treatment, based on exacerbation history and prescribed controller medications, as defined in the study algorithm. SMART prescribing will be defined as prescription of an inhaled corticosteroid-formoterol inhaler (budesonide-formoterol 160/4.5 µg or mometasone-formoterol 100/6 µg or equivalent) with instructions consistent with use as both maintenance and reliever therapy: The primary effectiveness analysis will compare SMART prescribing rates between implementation and control periods across clinics. The control period will include pre-implementation encounters, and the implementation period will include encounters occurring after implementation initiation, excluding a predefined 2-month transition period after randomization.