ADAPT-NC stands for Asthma Dissemination Around Patient-centered Treatments in North Carolina. It is a state-wide dissemination project funded by the Patient-Centered Outcomes Research Institute (PCORI). In the ADAPT-NC project, the research team has leveraged partnerships between the statewide Medicaid network and the statewide consortium of research networks to identify best practices for dissemination of an evidence-based shared decision making (SDM) toolkit for asthma management. The asthma toolkit development was funding by the Agency for Healthcare Research and Quality (AHRQ) and tested across a regional network of pediatric, family medicine, and internal medicine ambulatory practices in Mecklenburg County, North Carolina. The initial results have showed marked improvement in patient outcomes (improved medication adherence and decreased asthma exacerbations) with increased patient involvement in the creation of the care plan. For more information and results from the asthma shared decision making toolkit development (through the Asthma Comparative Effectiveness study):
Tapp H, McWilliams A, Ludden T, Kuhn L, Taylor Y, Alkhazraji T, Halladay J, Derkowski D, Mohanan S, and Dulin M. Comparing traditional and participatory dissemination of a shared decision making intervention (ADAPT-NC). Implementation Science 2014; 9(1): 158. Mowrer L, Tapp H, Ludden T, Kuhn, L E Reeves, K, Courtlandt, Cheryl, Hege, Tami Taylor, Y McWilliams, A, Dulin, M. Patients’ and Providers’ Perceptions of Asthma and Asthma Care: 2015 A Qualitative Study. J of Asthma. 2015 May 15:1-8. During ADAPT-NC, key principles of community based participatory research were used in engaging providers and patients to develop a facilitator-led participatory approach to dissemination. This This study will test a novel method for dissemination on a larger scale by randomizing 30 practices to 1 of 3 arms:
1. Facilitator-Led Participatory Approach to Dissemination (FLOW)
2. Traditional Dissemination (one didactic session with educational material)
3. Control with no dissemination
The objective of this trial was to examine whether a facilitator-led (FLOW) approach to dissemination would result in a higher level of SDM than a traditional lunch-and-learn approach. Outcomes measured include 1) reduction in asthma exacerbations, 2) Beta agonist over use, 3) controller medication use, 4) reported practice level use of the SDM toolkit, and 5) patients’ perceptions of involvement in their asthma care decisions. The FLOW approach to dissemination may be a more effective way to incorporate SDM into practices by helping providers overcome traditional implementation barriers and has the potential for greater sustainability by considering unique practice characteristics.
