Asthma diagnosis and treatment
Reliability and predictive validity of the Asthma Control Test administered by telephone calls using speech recognition technology

https://doi.org/10.1016/j.jaci.2006.08.042Get rights and content

Background

The Asthma Control Test (ACT) has been validated in a paper and pencil version but has not been validated for use by telephone.

Objective

The purpose of this study was to provide validation data for the ACT administered by interactive telephone calls using speech recognition technology.

Methods

The ACT was administered to patients who confirmed a diagnosis of physician-diagnosed asthma, and information regarding race/ethnicity, smoking, and asthma course was also obtained during the call. Asthma emergency department visits, hospitalizations, and oral corticosteroid and β-agonist canister dispensings were assessed for the 12 months after the date of each patient's call. Internal consistency reliability and predictive validity were assessed.

Results

Asthma Control Test scores (higher indicates better control) were completed by 2244 patients and were inversely related to black or Hispanic race/ethnicity and smoking. Reliability was 0.83. ACT scores were significantly related to emergency hospital care and oral corticosteroid and β-agonist dispensings over the period of the subsequent 6 and 12 months. After adjusting for demographic characteristics, a score ≤ 15 was associated significantly with an increased 12-month risk of emergency hospital care (odds ratio [OR], 2.5), oral corticosteroid dispensings (OR, 2.6) and dispensing of more than 6 β-agonist canisters (OR, 6.8) compared with a score ≥ 20.

Conclusion

These data support the reliability and predictive validity of the ACT administered by interactive telephone calls using speech recognition technology.

Clinical implications

The ACT can be used for outreach or follow-up by means of interactive telephone calls using speech recognition technology.

Section snippets

Patients

Patients were members of the San Diego asthma database as of August 2004. The criteria for membership in this database were 1 year of continuous membership and 1 or more of the following in the previous 12 months:

  • Any discharge diagnosis (principal or other diagnosis) of asthma in the hospitalization database (International Classification of Diseases, Ninth Revision [ICD-9] code: 493.xx)

  • Two or more asthma-related medication dispensings (excluding oral steroids) in the prescription database,

Results

A total of 12,004 patients were identified who met the study criteria from the San Diego Kaiser Permanente asthma database. Of those, 1011 (8.4%) opted out of the study, and 10,045 (83.7%) were called (Fig 1). Of those called, 5494 target patients (54.7%) were reached, and 3515 (64.0%) of those stayed on the call and confirmed a diagnosis of physician-diagnosed asthma. An ACT score was completed in 2244, which represented 18.7% of total patients and 63.8% of the reached patients with a

Discussion

Asthma assessment and management by telephone has been reported to increase the proportion of patients whose asthma status was reviewed and reduce the cost per clinical encounter without compromising asthma control, quality of life, or patient satisfaction.11, 12, 13 The goal of asthma therapy is asthma control, and accurate assessment of asthma control is critical to improving it.5 Good asthma control implies symptoms or rescue therapy use less than 3 times per week, interference with sleep

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    Supported by an unrestricted grant from GlaxoSmithKline.

    Disclosure of potential conflict of interest: M. Schatz has received grant support from GlaxoSmithKline and Sanofi-Aventis and has received honoraria for talks from AstraZeneca, Merck, GlaxoSmithKline, and Genentech. R. S. Zeiger has consulting arrangements with Aerocrine, AstraZeneca, Genentech, GlaxoSmithKline, Merck, Novartis, and Sanofi-Aventis and has received grant support from AstraZeneca, GlaxoSmithKline, Merck, Sanofi-Aventis, and TEVA Pharmaceuticals. A. Drane, A. Cibildak, and J. E. Oosterman all own stock in and are employed by Eliza Corp ISO. The other authors have declared that they have no conflict of interest.

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