Supporting asthma guideline-based management by integrating patient navigators.

BACKGROUND: Asthma-related deaths, hospitalizations, and ED visits are more numerous among low-income communities, yet management guidelines overlook this group. Navigators, typically community members trained as health educators and advocates, may improve access to care and asthma outcomes. OBJECTIVE: In a randomized controlled trial, we study whether Navigators who identify barriers to health-related social needs (at home or with clinical management) lead to improved health in adults with asthma living in low-income areas. METHODS: Over 18 months patients were followed for patient-reported outcomes/symptoms and service use (hospitalizations, ED visits, prednisone requirement); the first 3 months were observational. Half of patients were randomized for a Navigator Home Visit (HV) to identify social needs important for the clinician to know the context of patients' lives (e.g., pests, water leaks, smokers). Half were randomized to Clinician Feedback (CF): clinicians receive brief information on guideline-based symptoms and recommendations, prepared by patient/Navigator. All random patients received a Clinical Intervention: Navigator-guided preparation for, attendance at, and review of recommendations for asthma appointments. RESULTS: 350 of 369 enrolled were randomized: mean age 45, 88% female, 83% self-reported Black. As compared to participants with only clinic intervention over 12 months: participants receiving both HV and clinic intervention improved asthma control (-0.47 [95% CI: -0.84 to -0.10]); and participants who had both CF and clinic intervention had larger decrease in hospitalizations or ER visits unrelated to asthma (-1.05 [95%CI: -1.90 to -0.19] CONCLUSION: By bridging the gaps between healthcare and social needs, navigators improve asthma control.