# Promoting Asthma Guidelines and Management through Technology-Based Intervention and Care Coordination (PRAGMATIC)

> **NIH NIH R01** · ALBERT EINSTEIN COLLEGE OF MEDICINE · 2020 · $831,387

## Abstract

PROJECT SUMMARY/ABSTRACT
Asthma disproportionately affects low-income, minority children residing in inner cities such as the Bronx, NY.
The use of national guidelines reduces asthma morbidity by 70%; yet, these guidelines are not consistently
implemented by health care providers. Although several interventions to improve provider adherence to
asthma guidelines have been described, few studies have addressed translation of guidelines into routine care.
This study builds on our experience evaluating a multifaceted prompting intervention (MPI) in 12 urban clinics
(R01HL091835, PI Halterman). Although effective in the short-term, this intervention must be modified to
translate into routine practice. We will enhance MPI in several ways: (1) use clinic rather than research staff to
facilitate assessment for prompts at every visit; (2) ensure prompting for guideline-based care for all children
ages 2-12 with persistent or uncontrolled asthma, rather than just a research sample; (3) routinely deliver
prompts to the provider via Electronic Health Record (EHR); (4) offer telephone-based care coordination,
education and support to children with the highest morbidity via a dedicated Outreach Worker (OW); and (5)
provide practice-level supports (e.g. clinic champions, on-going performance feedback and participatory
problem solving) to promote full adoption of guidelines. The enhanced MPI program (eMPI) consists of
innovative multi-level and team-based strategies to enable providers to effectively and efficiently adopt asthma
care guidelines. In response to PAR-15-279, this study will address the guideline-to-practice gap by evaluating
eMPI in real-world primary care settings. We will conduct a cluster randomized trial comparing eMPI to
enhanced usual care (eUC) in 22 Bronx practices serving over 5,000 children ages 2-12 years with persistent
or uncontrolled asthma. Practices will join the study in 4 waves over 4 years. Lessons learned about facilitators
and barriers to eMPI implementation in earlier study waves will be used to improve the implementation in later
clinics. Eleven eUC practices will receive guideline information and assess children's asthma severity and
control, but active intervention components will not be provided. This study will (1) test the impact of eMPI on
provider adoption of asthma management guidelines (primary outcome measure is the proportion of visits with
>1 guideline-based corrective actions taken by the provider); (2) determine whether consistent use of eMPI
leads to both short- and long-term improvements in clinical outcomes (measured by the symptom-free days);
and (3) evaluate the process of program implementation using RE-AIM framework. We will also evaluate group
differences in the extent of healthcare utilization and resources used (i.e., adherence to follow-up visits,
specialty referrals, emergency and in-patient care, referrals to OW). The proposed research will provide critical
new knowledge about how to implement guide...

## Key facts

- **NIH application ID:** 9952413
- **Project number:** 5R01HL133789-06
- **Recipient organization:** ALBERT EINSTEIN COLLEGE OF MEDICINE
- **Principal Investigator:** Marina Reznik
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $831,387
- **Award type:** 5
- **Project period:** 2016-07-01 → 2024-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9952413

## Citation

> US National Institutes of Health, RePORTER application 9952413, Promoting Asthma Guidelines and Management through Technology-Based Intervention and Care Coordination (PRAGMATIC) (5R01HL133789-06). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9952413. Licensed CC0.

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