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Abstract：
Multicenter randomized controlled trials (RCTs) for asthma management that incorporate usual-care regimens could benefit from standardized application of evidence-based guidelines.
We sought to evaluate performance of a computerized decision support tool, the Asthma Control Evaluation and Treatment (ACET) Program, to standardize usual-care regimens for asthma management in RCTs.
Children and adolescents with persistent uncontrolled asthma living in urban census tracts were recruited into 3 multicenter RCTs (each with a usual-care arm) between 2004 and 2014. A computerized decision support tool scored asthma control and assigned an appropriate treatment step based on published guidelines. Control-level determinants (symptoms, rescue medication use, pulmonary function measure, and adherence estimates) were collected at visits and entered into the ACET Program. Changes in control levels and treatment steps were examined during the trials.
At screening, more than half of the participants were rated as having symptoms that were not controlled or poorly controlled. The proportion of participants who gained good control between screening and randomization increased significantly in all 3 trials. Between 51% and 70% had symptoms that were well controlled by randomization. The proportion of well-controlled participants remained constant or improved slightly from randomization until the last posttreatment visit. Nighttime symptoms were the most common control-level determinant; there were few (<1%) instances of complete overlap of factors. FEV1 was the driver of control-level assignment in 30% of determinations.
The ACET Program decision support tool facilitated standardized asthma assessment and treatment in multicenter RCTs and was associated with attaining and maintaining good asthma control in most participants.
We sought to evaluate performance of a computerized decision support tool, the Asthma Control Evaluation and Treatment (ACET) Program, to standardize usual-care regimens for asthma management in RCTs.
Children and adolescents with persistent uncontrolled asthma living in urban census tracts were recruited into 3 multicenter RCTs (each with a usual-care arm) between 2004 and 2014. A computerized decision support tool scored asthma control and assigned an appropriate treatment step based on published guidelines. Control-level determinants (symptoms, rescue medication use, pulmonary function measure, and adherence estimates) were collected at visits and entered into the ACET Program. Changes in control levels and treatment steps were examined during the trials.
At screening, more than half of the participants were rated as having symptoms that were not controlled or poorly controlled. The proportion of participants who gained good control between screening and randomization increased significantly in all 3 trials. Between 51% and 70% had symptoms that were well controlled by randomization. The proportion of well-controlled participants remained constant or improved slightly from randomization until the last posttreatment visit. Nighttime symptoms were the most common control-level determinant; there were few (<1%) instances of complete overlap of factors. FEV1 was the driver of control-level assignment in 30% of determinations.
The ACET Program decision support tool facilitated standardized asthma assessment and treatment in multicenter RCTs and was associated with attaining and maintaining good asthma control in most participants.
摘要：
纳入常规治疗方案的哮喘管理多中心随机对照试验(RCT)可受益于循证指南的标准化应用。
我们试图评估计算机化决策支持工具的性能，哮喘控制评估和治疗（ACET）计划，规范RCT中哮喘管理的常规治疗方案。
在2004年至2014年期间，在城市人口普查区生活的患有持续不受控制的哮喘的儿童和青少年被纳入3个多中心随机对照试验（每个都有一个常规护理组）。计算机化决策支持工具对哮喘控制进行评分，并根据已发布的指南分配适当的治疗步骤。控制水平决定因素(症状，抢救药物的使用，肺功能测量，和依从性估计)在访问时收集并进入ACET计划。在试验期间检查了对照水平和治疗步骤的变化。
筛选时,超过一半的参与者被评为症状未得到控制或控制不佳.在所有3项试验中，在筛选和随机化之间获得良好控制的参与者比例显着增加。51％至70％的症状通过随机化得到了很好的控制。从随机分组到最后一次治疗后就诊，控制良好的参与者的比例保持不变或略有改善。夜间症状是最常见的控制水平决定因素；因素完全重叠的情况很少（<1％）。在30%的测定中，FEV1是控制水平分配的驱动因素。
ACET计划决策支持工具促进了多中心随机对照试验中的标准化哮喘评估和治疗，并与大多数参与者获得和维持良好的哮喘控制有关。
我们试图评估计算机化决策支持工具的性能，哮喘控制评估和治疗（ACET）计划，规范RCT中哮喘管理的常规治疗方案。
在2004年至2014年期间，在城市人口普查区生活的患有持续不受控制的哮喘的儿童和青少年被纳入3个多中心随机对照试验（每个都有一个常规护理组）。计算机化决策支持工具对哮喘控制进行评分，并根据已发布的指南分配适当的治疗步骤。控制水平决定因素(症状，抢救药物的使用，肺功能测量，和依从性估计)在访问时收集并进入ACET计划。在试验期间检查了对照水平和治疗步骤的变化。
筛选时,超过一半的参与者被评为症状未得到控制或控制不佳.在所有3项试验中，在筛选和随机化之间获得良好控制的参与者比例显着增加。51％至70％的症状通过随机化得到了很好的控制。从随机分组到最后一次治疗后就诊，控制良好的参与者的比例保持不变或略有改善。夜间症状是最常见的控制水平决定因素；因素完全重叠的情况很少（<1％）。在30%的测定中，FEV1是控制水平分配的驱动因素。
ACET计划决策支持工具促进了多中心随机对照试验中的标准化哮喘评估和治疗，并与大多数参与者获得和维持良好的哮喘控制有关。
