# Clinic navigation and home visits to improve guideline-based care and outcomes in low income minority adults with asthma

> **NIH NIH R01** · UNIVERSITY OF PENNSYLVANIA · 2021 · $786,116

## Abstract

PROJECT SUMMARY/ ABSTRACT
Asthma-related deaths, hospitalizations, and ED visits are more numerous among low-income and minority
patients, including African Americans and among older adults who tend to suffer from other chronic diseases.
Guidelines for asthma management have not met the unique needs of this older group with their
socioeconomic burdens and frequent comorbidities. We recently demonstrated the feasibility, acceptability,
and evidence of effectiveness of two separate interventions to improve access to care, patient-provider
communication, and asthma outcomes: 1) CI: clinic intervention using a patient advocate to prepare for,
attend, and confirm understanding of an office visit, and 2) HV: home visits for care coordination and
informing clinicians of home barriers to managing asthma. This project explores whether these interventions
can be combined for greater effectiveness and better delivery of guideline-based asthma care and outcomes in
low-income minority patients. In addition, we explore whether giving clinicians real-time feedback on the
patient’s health and home status structured in the framework of adherence to asthma guidelines is associated
with subsequent improvement in asthma outcomes.
In a randomized controlled factorial trial, 400 adults with uncontrolled asthma living in low-income urban
neighborhoods will be offered 18-months participation: 12 months of clinical intervention and 6 months of
evaluation to monitor sustainability of interventions and outcomes. Patients will be randomized to (1) patient
advocate alone, (2) patient advocate with home visits, (3) patient advocate with real-time feedback to asthma
provider (clinician) at each clinic visit of guidelines-relevant elements of a patient’s current care, and (4) both
(2) and (3). The interventions will be delivered by a lay Community Health Navigator (CHN). The study will
estimate:
Specific Aim 1: improvement over time of within-group (before-after in four groups) asthma outcomes (asthma
control, quality of life, ED visits, hospitalizations, prednisone bursts)
Specific Aim 2: across group differences in improvement over time in asthma outcomes;
Specific Aim 3: the costs associated with each of the interventions, and we will conduct a cost-offset analysis
to determine which intervention costs are offset by savings attributable to reductions in ED, hospitalization or
other visits for asthma control and other outcomes.
Exploratory Aim: changes in behavior from the interventions using interviews of clinicians and patients.
Hypothesis and Impact: We hypothesize improved outcomes in asthma patients through enhanced
communication of patient and clinician, clinician attention to home environmental exposure, and clinician
consideration of the guidelines, at a program cost offset by lower patient health care utilization.

## Key facts

- **NIH application ID:** 10170404
- **Project number:** 5R01HL143364-03
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** ANDREA J. APTER
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $786,116
- **Award type:** 5
- **Project period:** 2019-06-01 → 2024-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10170404

## Citation

> US National Institutes of Health, RePORTER application 10170404, Clinic navigation and home visits to improve guideline-based care and outcomes in low income minority adults with asthma (5R01HL143364-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10170404. Licensed CC0.

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