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ACCI valid measurement tool for assessing asthma disease status in both black, white subjects, study finds

Monday, December 01 2008 | Comments

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What's This? In a recent study that evaluated the psychometric properties of the Asthma Control and Communication Instrument (ACCI)--a measure designed to capture patient-reported disease status during regular visits--researchers found it to be a "promising clinical tool" for assessing asthma disease status, with validity in both black and white subjects.

"Differences in assessment of asthma and in the quality of asthma care received have been implicated as contributing factors to racial/ethnic disparities in the quality of asthma treatment independent of access to care, health insurance status, and socioeconomic status," researchers indicated.

To explore the utility of the ACCI in a racially diverse population for assessing asthma disease status, distinguishing differences in disease status, and categorizing patients with uncontrolled asthma, the investigators conducted a cross-sectional study that included 270 adults with asthma, 55% of whom were black. The participants were recruited from outpatient clinics of both specialists and generalists practicing in an urban setting.

Prior to seeing the physician, patients completed the 12-item ACCI and were then interviewed to collect information on demographics, asthma treatment, and asthma health care use. They also completed several well-accepted questionnaires (eg, the Asthma Control Questionnaire, the Asthma Therapy and Assessment Questionnaire, and the Mini-Asthma Quality of Life Questionnaire) to compare against the ACCI for evidence of construct validity. Finally, all patients underwent spirometric testing.

The analysis involved testing the associations between ACCI Bother, Control, and Direction domains with asthma control, quality of life (QOL), and lung function, and also the associations between ACCI Acute Care items and patient self-reports of ever having had a hospitalization, an emergency department visit, or the use of oral steroids.

The ACCI categories classified 71% of the patients as having moderate or severe-persistent asthma. The analysis demonstrated that ACCI Bother, Control, and Direction domains all showed significant (P<.001) concurrent validity with asthma control and QOL, and the ACCI Acute Care and Direction domains showed significant (P<.001) validity with individual validation items.

Clinically important levels of disease status as reflected in measures of asthma control and QOL were significantly discriminated by the ACCI Control domain (P<.001 for both). Percent predicted peak expiratory flow rate also was significantly discriminated by the ACCI Control domain (P<.005). In addition, the ACCI Control domain was significantly associated with specialist rating of disease status (P<.001).

In terms of racial differences, the accuracy of the ACCI Control domain was "very good" in classifying both black and white patients with uncontrolled asthma.

"Use of the ACCI in clinical care has the potential to increase the quality of asthma care, especially for black subjects, by offering a systematic approach to periodic disease status assessment during the clinical encounter and thereby reduce asthma disparities," the authors of the study concluded. (Patino CM, et al. J Allergy Clin Immunol 2008;122:936-943.)

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