Community health worker home visits for adults with uncontrolled asthma: the HomeBASE Trial randomized clinical trial

Abstract

Importance: Asthma is often poorly controlled. Home visitation by community health workers (CHWs) to improve control among adults has not been adequately evaluated.

Objective: To test the hypothesis that CHW home visits for adults with uncontrolled asthma improve outcomes relative to usual care.

Design, setting, and participants: Randomized parallel group study with 1-year follow-up, conducted 2008 through 2011 at homes of low-income adults aged 18 to 65 years with uncontrolled asthma living in King County, Washington.

Interventions: The CHWs provided a mean of 4.9 home visits during a 1-year period to assess asthma control, self-management, and home environment and to support asthma self-management practices.

Main outcomes and measures: Primary prespecified outcomes were symptom-free days (number of 24-hour periods in prior 2 weeks without asthma symptoms), asthma-related quality of life (Mini Asthma Quality of Life Questionnaire), and asthma-related unscheduled health care use.

Results: Of 463 individuals who completed eligibility screening, 443 were eligible, 366 participated (177 in intervention and 189 in control groups), and 333 completed the study (91%). The intervention group had significantly greater increases in mean symptom-free days per 2 weeks (2.02 [95% CI, 0.94-3.09]; P < .001) and quality of life (0.50 [95% CI, 0.28-0.71] points; P < .001) relative to the control group, adjusted for age, sex, race/ethnicity, and education level. The number needed to treat to increase symptom-free days by 2 days per 2 weeks was 7.4 and to improve quality of life by 0.5 points was 2.6. Mean urgent health care use episodes in the past 12 months decreased significantly and similarly in both groups, from a mean of 3.46 to 1.99 episodes in the intervention group (mean change, -1.47 [95% CI, -2.28 to -0.67]; P < .001) and from a mean of 3.30 to 1.96 episodes in the control group (mean change, -1.34 [95% CI, -2.00 to -0.72]; P < .001) (P = .83 comparing groups).

Conclusions and relevance: The provision of in-home asthma self-management support by CHWs to low-income adults with uncontrolled asthma improves asthma control and quality of life but not unscheduled health care use. Additional studies are needed to confirm these findings and determine the value of wider implementation of this approach.

Trial registration: clinicaltrials.gov Identifier: NCT01783028.