Improving Asthma Care within Vulnerable Populations
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- Buddy Dorsey
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1 Improving Asthma Care within Vulnerable Populations THE CHILDREN S HOSPITAL OF PHILADELPHIA CHOP CENTER FOR OUTCOMES RESEARCH CHOP POLICY LAB MENTORS: DR. STEPHANIE DOUPNIK DR. CHEN KENYON --TEAM AIR--
2 Roadmap Asthma: Nationally and Locally Study 1: Mental Health & Hospital Risks Study 2: Adherence Feedback Intervention Analysis of Vulnerable Population
3 What is Asthma?
4 Diagnosis and Treatment of Asthma Asthma is chronic condition Rescue medication and Controller medication The Cost of Chronic Illness Asthma in perspective 6
5 Asthma: Nationally and Locally Nationally Pediatric Asthma Prevalence 1 Readmission Rates 2 Adherence 3 Socially and Medically Vulnerable Population Locally: Philadelphia, PA Prevalence 4 Readmission Rates Adherence 5 Socioeconomic Status Living Conditions Health Literacy
6 Aims of our Research Improving Mental Health Care Behavioral Cue Increasing Adherence to Medication Improving Asthma Care
7 Study 1 Identifying Risk Factors for Poor Hospital Outcomes in Pediatric Asthma Patients with Depression or Anxiety
8 Mental Health & Readmission Risk Significance of Co-morbid Conditions Mental Health and Hospital Outcomes 7-8 Children at CHOP w/ Clinically Significant Depression and/or Anxiety 30% Health Care and Societal Costs
9 Mental Health & Adherence Poor Asthma Control9-11 Mental Health is a driver for asthma adherence Asthma Hospital Risk Adherence
10 Study Design & Goals Study Design 2 Surveys Parent & Child Follow Up Doser Eligibility criteria Age Comorbidity Doser Goals: Coping with Hospital Stressors Improved disease management Future Applications
11 Study 2 Automated Adherence Feedback for High Risk Children with Asthma
12 Asthma Controller Medication Adherence Behavioral Cue Significance Cue Reward Objective Routine
13 Study Design & Goals
14 Demographic Data of Study Participants Marital Status Breakdown Education Level Breakdown Married Widowed Divorced Separated Never Married Living with a partner Prefer not to answer SC HS Some high school, but did not graduate High School graduate Some college or 2-year degree Four year college graduate
15 Successes and Complications Follow-up Calls Tech Literacy & Syncing Multiple Caregivers Similar trends in Study 1 Working with a Vulnerable Population
16 Preliminary Data Analysis: Adherence Survey Days % Early 2 (24.8%) % % Non (18.7%) Moderate (43.7%) Sustained (12.8%)
17 Future Steps and Considerations Use of ClinCards: Monetary Incentive Asthma Control Type of Non- Adherence Aiding in Parental Responsibility Patient Preferences & Needs Other Considerations *Personalized Asthma Adherence Management*
18 Summary: Care for Chronic Conditions What I learned Primary Data Collection Study & Survey Design Use of Statistical Tools Working with Patients What our research informs Asthma Adherence Broader Scope of Chronic Conditions Asthma Adherence Hospital Risk
19 Q&A
20 References 1. "Most Recent Asthma Data." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, Mar Web. 15 Aug Liu, S. Y., & Pearlman, D. N. (2009, January). Hospital Readmissions For Childhood Asthma. Public Health Reports, 124(1), Retrieved August 15, Drotar D, Bonner MS. Influences on Adherence to Pediatric Asthma Treatment: A Review of Correlates and Predictors: J Dev Behav Pediatr. 2009;30(6): doi: /DBP.0b013e3181c3c3bb. 4. Bryant-Stephens, T., West, C., Dirl, C., Banks, T., Briggs, V., & Rosenthal, M. (2012). Asthma Prevalence in Philadelphia: Description of Two Community-Based Methodologies to Assess Asthma Prevalence in an Inner-City Population. Journal of Asthma, 49(6), doi / Bartlett SJ, LukkP, Butz A, Lampros-Klein F, Rand CS. Enhancing medication adherence amnog inner-city children with asthma: results from pilot studies. J Asthma Off J Assoc Care Asthma. 2002;39(1): United States Environmental Protection Agency. Asthma Facts. March Knight A, Weiss P, Morales K, et al. Depression and anxiety and their association with healthcare utilization in pediatric lupus. Pediatr Rheumatol. 2014;12(1): Baca CB, Vickrey BG, Caplan R, et al. Psychiatric and Medical Comorbidity and Quality of Life Outcomes in Childhood-Onset Epilepsy. Pediatrics. 2011;128(6):e1532-e Richardson L, Lozano P, Russo J, et al. Asthma Symptom Burden: Relationship to Asthma Severity and Anxiety and Depression Symptoms. Pediatrics. 2006;118(3): Richardson L, et al. The effect of comorbid anxiety and depressive disorders on health care utilization & costs among adolescents with asthma. Gen Hosp Psych. 2008;30(5): Katon WJ, Richardson L, Russo J, et al. Quality of mental health care for youth with asthma and comorbid anxiety and depression. Med Care. 2006;44(12):
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