Background
Methods
Design of website/pretesting/ theoretical basis
Functions Supported by the BostonBreathes Websites
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Enter measured peak flow and review web site response of corresponding zone (red, yellow, or green)
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Report symptoms (“problems”) (cough, wheeze, shortness of breath)
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Report limitations in activities, missed school, emergency room visits
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View and listen to asthma educational Flash animations
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Report medication use
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View graphs of data entered: symptoms, peak flow, medication use
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Complete asthma educational activities (puzzles, word searches, quizzes)
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Review asthma library of information
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View personal web pages of participants
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Edit personal webpage
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Participate in discussion board with peers
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Participate in discussion board with primary care provider
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Review points earned
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Review patient-level data on symptoms, medication usage, ER visits
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View patient graphical data of peak flow and symptoms
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Review peakflow data and peakflow zones
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Participate in private discussion board with patient and/or asthma nurse
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Submit queries to asthma nurse and/or asthma specialist physician
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Administrative Website
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Subject and physician registration and enrollment
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Monitoring of participation
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Alerts for dangerous values (red zone peak flow range)
Study design
Population and eligibility
Educational content
Symptom assessment
Technical specifications
Statistical methods
Results
Characteristic | Intervention, (N = 37) | Control, (N = 21) | P |
---|---|---|---|
Demographics
| |||
Age (years) | |||
Mean | 11.9 ± 2.0 | 12.9 ± 3.0 | 0.13 |
Median and Range | 12 (8–16) | 14 (7–17) | |
Male gender | 22 (59.5%) | 12 (57.1%) | 1.0 |
Race | |||
Hispanic | 4 (10.8%) | 2 (9.5%) | 0.70 |
Black | 20 (54.1%) | 14 (66.7%) | |
White | 8 (21.6%) | 2 (9.5%) | |
Other | 5 (13.5%) | 3 (14.3%) | |
Parental Education: at least High School completion | 29 (78.4%) | 20 (100%) | 0.041 |
Employed caregiver in household | 29 (78.4%) | 13 (61.9%) | 0.23 |
Total family Income under $15,000 | 9 (28.1%) | 6 (42.9%) | 0.50 |
Child covered by health insurance | 32 (91.4%) | 17 (81%) | 0.41 |
Home Environment
| |||
Cockroaches at home | 8 (22.9%) | 7 (33.3%) | 0.53 |
Dog at home | 6 (17.1%) | 3 (14.3%) | 1.0 |
Cat at home | 6 (17.1%) | 9 (42.9%) | 0.06 |
Pet rodent at home | 3 (8.6%) | 2 (9.5%) | 1.0 |
Smokers at home | 8 (22.9%) | 9 (42.9%) | 0.14 |
Computer Use
| |||
Computer Competence Score, self reported (1–5), Mean (SD) | 4.3 ± 0.6 | 4.6 ± 0.5 | 0.07 |
Hours/day on computer, Mean (SD) | 2.0 + 1.8 | 1.6 + 1.6 | 0.51 |
Type of Internet Connection | |||
Dial-Up | 10 (32.3%) | 2 (13.3%) | 0.29 |
Broadband | 21 (67.7%) | 13 (86.7%) | |
Able to log onto Boston Breathes website | |||
With assistance | 2 (7.1%) | 2 (11.1%) | 0.64 |
Without assistance | 26 (92.9%) | 16 (88.9%) |
Clinical outcomes
Intervention, N = 28 | Control, N = 14 | ||||||
---|---|---|---|---|---|---|---|
Symptoms over previous 2 weeks | Mean at baseline | Mean change at 6 months | P-value | Mean at baseline | Mean change at 6 month | P-value | P-value for differences in changes |
Days of wheeze | 2.9 | −1.4 | 0.03 | 5.1 | −4.2 | 0.004 | 0.10 |
Days had to slow down | 2.5 | −1.4 | 0.07 | 1.1 | −0.4 | 0.48 | 0.79 |
Nights woke-up | 1.2 | −0.8 | 0.04 | 1.9 | −1.0 | 0.06 | 0.66 |
Days limited activity from asthma | 0.6 | −0.2 | 0.99 | 2.0 | −1.8 | 0.13 | 0.14 |
Days parent lose sleep | 0.9 | −0.6 | 0.01 | 0.9 | −0.6 | 0.13 | 0.71 |
Days missed school for asthma | 0.2 | −0.2 | 0.38 | 0.4 | −0.4 | 0.25 | 0.31 |
Baseline N(%) | 6-Month N (%) | p-value | Baseline N(%) | 6-Month N (%) | P-value | P-value for differences in changes | |
Acute asthma-related PCP or ER visit in prior 2 months | 5 (19.2) | 1 (3.9) | 0.18 | 1 (7.1) | 1 (7.1) | 0.99 | 0.64 |
Primary controller compliance (%)
| Mean at baseline | Mean Change at 6 months | P-value | Mean at baseline | Mean Change at 6 month | P-value | P-value for differences in changes |
All subjects (I = 21, C = 9) | 38.0 | +11.2 | 0.30 | 45.9 | −4.4 | 0.81 | 0.46 |
High risk subjects* (I = 15, C = 8) | 16.3 | +29.8 | 0.01 | 39.2 | −5.0 | 0.81 | 0.10 |
Asthma Knowledge
| Baseline N(%) | 6-Month N (%) | P-value | Baseline N(%) | 6-Month N (%) | P-value | P-value for differences in changes |
Correctly Described Purpose of Personal Controller Medicine (I = 12, C = 8) | 4 (33.3) | 9 (75.0) | 0.03 | 4 (50.0) | 3 (37.5) | 0.25 | 0.03 |
Communication, teamwork, and messaging outcomes
Originator of message | Total # of messages sent, N (%) |
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Asthma nurse | 235 (38.7) |
Asthma specialist | 4 (7.0) |
PCP | 100 (16.5) |
Patient | 216 (35.6) |
BB team | 36 (5.9) |
Parent | 12 (2.0) |
Blank/None | 4 (7.0) |
Primary Message Content | Total # of postings, N (%) |
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Medication adherence encouraged or inquired by MD or RN | 82 (13.5) |
Encouraged patient to use BostonBreathes | 78 (12.9) |
Asthma education for patient | 74 (12.2) |
Asthma symptom or Peak Flow- addressed or asked by MD/RN | 68 (11.2) |
Socializing | 61 (10.1) |
Subject telling progress- asthma mentioned | 42 (6.9) |
Doctor/nurse providing general encouragement- positive feedback | 38 (6.3) |
Team review summary | 29 (4.8) |
Medication adherence issue addressed by patient | 28 (4.6) |
Coordination of care | 21 (3.5) |
Asthma symptoms or peak flow reported by patient | 20 (3.3) |
Non asthma illness posting | 11 (1.8) |
Socializing (doctor posting) | 11 (1.8) |
Appointment reminder for patient or patient asked to make appointment | 10 (1.7) |
Acknowledgement of a team posting by PCP or patient | 7 (1.2) |
Discussion of incentive points | 7 (1.2) |
Issue with Peak Flow meter | 4 (0.7) |
Blank message | 4 (0.7) |
Medicine dose change or medicine change discussed | 2 (0.3) |
All other | 10 (1.7) |
Attitude statement | Mean*, N = 14 |
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BostonBreathes provided me with useful information about my patient(s) that I would not have had otherwise. | 6.5 |
The BostonBreathes website was easy to use. | 6.9 |
I had enough time in my schedule to use BostonBreathes. | 4.6 |
I changed the asthma management of my patient(s) based on data from the site. | 4.6 |
It was easy to remember to login to BostonBreathes. | 5.0 |
I would recommend that other MDs use BostonBreathes for their asthma patients | 5.6 |
BostonBreathes is best for severe asthmatics only. | 5.0 |
I trusted the information being entered by my patient(s). | 5.7 |
I believe my patient(s) benefited from using the BostonBreathes website. | 6.6 |
I would recommend BostonBreathes for my asthmatic patients. | 6.2 |
The discussion board was an effective way to communicate with my patient(s). | 5.6 |
The feedback from Asthma Specialist posted to the discussion board was useful in helping me to manage my asthma patient(s). | 6.3 |