Implementation of SMART therapy for asthma patients in low-resource community health centers

PROJECT ABSTRACT CANDIDATE: I am currently an Assistant Professor of Medicine in the Division of Pulmonary and Critical Care at Washington University in St. Louis School of Medicine (WUSM). My career goal is to become an independent, federally funded physician-scientist who utilizes rigorous implementation science and community- based participatory research methods to improve the lives of patients with asthma, especially those from disadvantaged backgrounds. To date I have received funding from the NIH Loan Repayment Program, institutional T32 and KL2 awards, and the American Lung Association. While this past support has been foundational, to reach my long-term goals, advanced training in implementation science and community-based participatory research is required. In this proposal, I am mentored by world-renowned leaders in these areas. Together, we have designed a research project and career development plan that, we believe, is impactful and will provide me the training necessary to be competitive for R01-level, or equivalent, support before its conclusion. PROPOSED ENVIRONMENT: This proposal occurs within three complementary settings. First, this research occurs at WUSM. To date, I have benefited immensely from WUSM’s career development resources and will continue to leverage them to reach my career goals. The second setting for this proposal is the Brown School at Washington University, which is one of the leading institutions for implementation science and community- based participatory research. During a K23 award I will take two classes in advanced implementation science methodology offered by its expert faculty. Finally, this study will be deployed within community health centers in the St. Louis Integrated Health Network and complemented by didactic education and participation in activities within the Center for Community Health Partnership and Research at WUSM. RESEARCH ABSTRACT: The NHLBI’s asthma guideline body recommends single maintenance and reliever therapy (SMART) for all patients with moderate/severe asthma. This recommendation is based on findings that SMART decreases the risk of asthma exacerbations by one-third. However, within a network of federally qualified health centers in St. Louis with whom we have partnered, <10% of asthma patients are prescribed SMART. My team and I are developing and contextualizing a multi-level SMART implementation bundle, which includes: clinician-level education with practice facilitation/supervision; an audit and feedback program; and provision of patient-centered, electronic SMART education aides with updated asthma action plans. In this proposed type 1 hybrid stepped-wedge cluster randomized trial, we aim to: 1) assess the effectiveness of the SMART implementation bundle at increasing prescription of SMART (Aim 1, 1° effectiveness outcome), and (2) utilize the RE-AIM framework to guide a quantitative and qualitative assessment of implementation outcomes, including adoption (Aim 2, 1° implementation outcome).