FROM HOSPITAL TO HOME
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1 FROM HOSPITAL TO HOME Changing the Paradigm of Asthma Care Chitra Dinakar, MD Clinical Professor, Stanford University School of Medicine Gies Faculty Scholar, Stanford Child Health Research Institute Allergy & Asthma Clinical Chief, Stanford Health Care for Asthma and Allergy Research
2 ?The Rugged Westerner?The Slum Dog Millionaire? ALL of the above AND MORE
3 I WEAR MORE THAN ONE HAT Clinician Researcher Relentless Champion of my patients locally Passionate Advocate of Health and Wellness globally
4 Coming from the land of oz.. I would like to take you..
5 CRITICAL ISSUE GRADUAL TREND IN INCREASING ACUTE CARE VISITS FOR ASTHMA
6 INNOVATIVE SOLUTIONS 1. Create Risk Stratification Predictive model 2. Use model to design interventions to move the focus of asthma care from the HOSPITAL to the HOME
7 PREDICTIVE RISK STRATIFICATION MODEL Hanson, et. al., Developing a risk stratification model for predicting future health care use in asthmatic children, 2016, Annals of Allergy, Asthma & Immunology, 116(1),
8 DESIGN HRAP INTERVENTIONS BASED ON MODEL Inpatient Added interventions to established asthma care
9 MOVE THE FOCUS OF ASTHMA CARE TO THE HOME NHLBI Guidelines: Reducing Allergens Improves Asthma Control, Asthma Care Requires Multifaceted Approach with partnership between provider and the patient/family
10 Break the Cycle,
11 Mapping Asthma Encounters with Environmental Issues 10 zip codes where most of the community asthma needs reside Data generated through HUD Technical Studies Grant
12 Hospital To Home: Environmental Assessment & Personalized Education On Trigger Avoidance
13 Hospital To Home: In-Home Personalized Education Using Health Literate Tools
14 HOSPITAL TO HOME: ASTHMA FRIENDLY HOME PARTNERSHIP Reduced Health Utilization After Home Assessment And Case Management Home assessment after referral for case management by pediatric allergy specialists in a hospital-based clinic Case management: education, clinic visits, environmental assessment, care coordinator ED Hospitalizations Clinic Visits 1 Year Before Enrollment Year After Enrollment Barnes CS, Amado M, Portnoy J, Allergy Asthma Proc Jul;31(4):317-23
15 FROM HOSPITAL TO HOME: TELEMEDICINE Telemedicine is as effective as in-person visits for patients with Asthma. Portnoy J;; Chitra Dinakar. Ann Allergy Asthma Immunol 117 (2016) 241e245
16 CRITICAL ISSUE Increasing Impact Of Pollution On Asthma Prevalence And Exacerbations Sources of Air Pollution in Fresno : PM 2.5 exposure exceeded federal annual standard by >40% Elevated rates of asthma (up to 21%) and allergies (up to 72%) in Fresno Tager, et al. FACES Report, CA Air Resources Board, 2010 American Lung Association, State of the Air Report, 2014 Nadeau, et al. JACI American Lung Association, California Air Resources Board, California Health Interview Survey
17 Innovative Solution: Study The Impact of Environmental Pollutants on the Immune System Volatile to semivolatile compounds PAHs about ~7x higher in Fresno Air Most frequent PAH in ambient air pollutant in Fresno, CA. Gale, et al. J. Env Science 2012 McDonald-Hyman, Nadeau, Balmes, Hammond, Noth, Mann JACI 2010 Hew KM, Walker AI, Kohli A, et al. CEA 2014 Effects of PAH exposure on immune measurements appear to be sustained Red=asthmatics Black=non asthmatics
18 Hospital To Home: Work With The Community To Ensure Better Air Quality In Homes And Neighborhoods We are asked to be advisors to city planning boards
19 With Appreciation to the Eccles Family Rural West Conference, Patients and Families, Clinical and Laboratory Team and Collaborators
20 CRITICAL ISSUE 1. NO TOOL TO TEST ASTHMA IN CHILDREN < 5 YEARS 2. NO TOOL TO MEASURE AIRWAY INFLAMMATION IN ASTHMA 3. NEED INEXPENSIVE SPACER OPTIONS TO ENHANCE INHALER DELIVERY
21 21 HOME GROWN I NNOVATION: Off-line measurement of exhaled Nitric Oxide using Cleveland Indian Mylar balloons Dinakar C, Ziegler A, Van Osdol TJ, Barnes CS, Dowling PJ. Exhaled nitric oxide levels rise and then fall during the first three months of immunotherapy. Allergy and Asthma Proceedings, 2006; 27(2): Dinakar C, Craff M, Laskowski D. Non-asthmatic Infants and Toddlers with Eczema have Elevated Exhaled Nitric Oxide Levels. J Allerg Clin Immunol 2006 Jan;117(1):212-3
22 LED TO CREATION OF FDA APPROVED DEVICE AND USE : In-clinic (and at home) AAAAI/ACAAI Joint Statement of Support of the ATS Clinical Practice Guideline: Interpretation of Exhaled Nitric Oxide for Clinical Applications (.Dinakar C et al) J Allergy Clin Immunol. 2006;;117(6): Daily home measurements of exhaled nitric oxide in asthmatic children during natural birch pollen exposure.
23 Stanford Global Health BioDesign Innovation: Spacer from Single Sheet of Paper
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