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

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. (J Allergy Clin Immunol 2008;122:936-43.)