AUTOMATED SYSTEM FOR TELEPHONE HOME MANAGEMENT OF ASTHMA

Asthma is a highly prevalent disease with a significant morbidity leading to emergency room visits, hospitalizations and absenteeism from work and school. Two major factors contributing to asthma morbidity (and mortality) are failure to detect asthma decompensation and use of inappropriate treatment strategies. Asthma severity can be assessed by clinical symptoms and peak flow measurements. There are internationally accepted guidelines for asthma management. However, rapid translation of asthma symptoms into a change in therapy is frequently impeded by the patient's inability to understand self management, reluctance to contact the health care provider, or delays in feedback from the provider to the patient. The objective of this proposal is to develop a prototype Automated System for Telephonic Home Management of Asthma (ASTHMA) in analogy to an existing and successful on-line management system for diabetes. Specifically, we will transform the algorithms for asthma management into a format suitable for computer implementation, develop a computer platform for the testing of these algorithms, and conduct off-line clinical tests to establish the technical merit and feasibility of a prototype system. This will be accomplished in 200-250 ambulatory children and adults with asthma who are served in three clinics at the University of Miami School of Medicine. A comparison between the "mock recommendations" of the prototype system with the physicians' actual interventions will test the feasibility of the computerized system. The goals of the ASTHMA system described in this proposal are to save time (efficiency), decrease morbidity (efficacy), and increase patient and health care provider satisfaction (attractiveness).