Pulmonary Specialist-Health Coach Consult Model Study
Pulmonary Specialist-Health Coach Consult Model Study
The Pulmonary Specialist-Health Coach Consultation (PuSHCon) study examines the
 implementation of health coach-assisted consultations to improve access to specialist care
 and implementation of specialist recommendations for patients with COPD, asthma, and asthma
 COPD overlap syndrome (ACOS) for low-income and vulnerable patients seen at public health
 clinics. Three hundred sixty (360) patients from ten clinics will be enrolled in the study
 and randomized at the individual level to receive health coaching or usual care; 180 patients
 will receive usual care and 180 patients will receive the PuSHCon model.
While evidence-based care for chronic obstructive pulmonary disease (COPD) and asthma can
 substantially reduce disease burden and prevent emergency visits and hospitalizations, it is
 estimated that 55% of patients with COPD do not receive all recommended care and that less
 than 50% of patients with asthma are well controlled.

 The proposed study will evaluate the effectiveness of a novel model for pulmonary
 specialist-health coach consultations (PuSHCon) in its ability to increase access to
 specialty recommendations and the provision of evidence-based care for patients with chronic
 obstructive pulmonary disease (COPD) and/or asthma receiving care at federally qualified
 health centers (FQHCs). The specific aims of the study are to compare the use of
 evidence-based care and of patient reported outcomes 4 months after the consultation. In
 addition, the study will evaluate the cost per patient in each model to determine the model's
 effectiveness in increasing access and lowering cost.

 The first aim of comparing the use of evidence-based care will be measured as the proportion
 of guideline-based recommendations that are ultimately received by the patients. The
 secondary endpoint for this aim will be measured through the proportion of patients receiving
 guideline-concordant medications at 4 months after consultation compared to baseline.

 The second aim of the study regarding patient-reported outcomes will be measured primarily
 through the change in COPD and/or asthma related quality of life measures from baseline to 4
 months post consultation. The secondary measure for this aim will look at changes in COPD
 and/or asthma specific symptom scores.

 The third aim of the study is to assess the impact of this model on access to care and cost
 of care. Access will be measured by tracking the number of patients who successfully complete
 a consultation per month. Costs will be determined by calculating time spent per patients, as
 well as by health care utilization.
Inclusion Criteria:

 -  English or Spanish speaking

 -  At least 18 years of age

 -  Diagnosed with asthma or COPD

 -  Experiencing uncontrolled symptoms or exacerbations

 Exclusion Criteria:

 -  Do not plan to attend primary care clinic for at least 3 months

 -  Already engaged in pulmonary specialty care (defined as at least one visit in last 12
 months)

 -  Cognitive dysfunction that would prevent interaction with a health coach

 -  Not having a phone at which the participant can be reached