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Volume 122, Issue 5 , Pages 936-943.e6, November 2008

The Asthma Control and Communication Instrument: A clinical tool developed for ethnically diverse populations

Cecilia M. Patino, MD
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Md
Sande O. Okelo, MD
- School of Medicine, University of Massachusetts, Worcester, Mass
Cynthia S. Rand, PhD
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Md
Kristin A. Riekert, PhD
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Md
Jerry A. Krishnan, MD, PhD
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Ill
Kathy Thompson, RN
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Md
Ruth I. Quartey, PhD
- Department of Microbiology, Howard University, Washington, DC
Deanna Perez-Williams, PhD
- Department of Microbiology, Howard University, Washington, DC
Andrew Bilderback, PhD
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Md
Barry Merriman, MA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md
Laura Paulin, MHS
- Department of Pediatrics, Johns Hopkins University, Baltimore, Md
Nadia Hansel, MD, MHS
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Md
Gregory B. Diette, MD, MHS
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Md
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md
- Reprint requests: Gregory B. Diette, MD, MHS, Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, 1830 East Monument St, 5th Floor, Baltimore, MD 21205.

Received 30 November 2007; received in revised form 22 August 2008; accepted 25 August 2008. published online 13 October 2008.

Background

Lower levels of quality asthma care among racially diverse populations might be due to inaccurate disease status assessments. The Asthma Control and Communication Instrument (ACCI) is a new tool that captures patient report of disease status during routine care.

Objective

We sought to test the ACCI's psychometric properties in a racially diverse population.

Methods

We performed a cross-sectional study. Subjects were recruited from specialist and generalist urban outpatient clinics. The ACCI and measures of asthma control, quality of life, lung function, and specialist rating of asthma status were collected. Four ACCI domains were separately validated: Acute Care, Bother, Control, and Direction. Principal component analysis, internal consistency, concurrent, discriminative, known-groups validity, and accuracy were evaluated.

Results

Two hundred seventy asthmatic patients (77% female subjects, 55% black) participated. ACCI Control domain internal consistency was 0.80. ACCI Bother, Control, and Direction domains showed strong concurrent validity with asthma control and quality-of-life measures (all P < .001). ACCI Acute Care and Direction domains showed strong concurrent validity with individual validation items (all P < .001). The ACCI Control domain discriminated clinically important levels of disease status measured by asthma control, quality of life (both P < .001), and percent predicted peak expiratory flow rate (P = .005) and was associated with specialist rating of disease status (P < .001), confirming known-groups validity. The accuracy of the ACCI Control domain in classifying patients with uncontrolled asthma was very good (area under the curve, 0.851; 95% CI, 0.742-0.95870). Results were similar for both black and white subjects.

Conclusion

The ACCI is a promising clinical tool that measures asthma disease status during routine health care and is valid for use in both black and white populations.

Key words: Asthma control, asthma treatment assignment, validation, racial disparities, quality of asthma care

Abbreviations used: ACCI, Asthma Control and Communication Instrument, ACQ, Asthma Control Questionnaire, ACT, Asthma Control Test, ATAQ, Asthma Therapy and Assessment Questionnaire, AUC, Area under the curve, m-AQLQ, Mini-Asthma Quality of Life Questionnaire, MCID, Minimal clinically important difference, PCA, Principal component analysis, PEFR, Peak expiratory flow rate, QOL, Quality of life, ROC, Receiver operating characteristic, SF-36, 36-Item Short-form Health Survey, SGRQ, St Georges Respiratory Questionnaire

Supported by the National Heart, Lung, and Blood Institute (5UO1HL072455).

Disclosure of potential conflict of interest: C. S. Rand is on the advisory boards for Schering-Plough, Merck, and Novartis. K. A. Riekert receives grant support from the National Institutes of Health (NIH). J. A. Krishnan received grant support from the Bowman Lingle Trust. B. Merriman received grant support from the NIH. N. Hansel receives grant support from Pfizer. G. B. Diette receives grant support from the NIH. The rest of the authors have declared that they have no conflict of interest.

PII: S0091-6749(08)01549-2

doi:10.1016/j.jaci.2008.08.027

« Previous Next »The Journal of Allergy and Clinical Immunology
Volume 122, Issue 5 , Pages 936-943.e6, November 2008