improving asthma care within vulnerable populations...¡ coping with hospital stressors ... hospital...
TRANSCRIPT
T H E C H I L D R E N ’ S H O S P I T A L O F P H I L A D E L P H I AC H O P C E N T E R F O R O U T C O M E S R E S E A R C H
C H O P P O L I C Y L A B
M E N T O R S : D R . S T E P H A N I E D O U P N I KD R . C H E N K E N Y O N
- - T E A M A I R - -
Improving Asthma Care within Vulnerable Populations
Roadmap
Asthma: Nationally and Locally
Study 1: Mental Health & Hospital Risks
Study 2: Adherence Feedback Intervention
Analysis of Vulnerable Population
What is Asthma?
Asthma Hospital Risk Adherence
Diagnosis and Treatment of Asthma
� Asthma is chronic condition
� Rescue medication and Controller medication
� The Cost of Chronic Illness¡ Asthma in
perspective6
Asthma Hospital Risk Adherence
Asthma: Nationally and Locally
� Socially and Medically Vulnerable Population
Asthma Hospital Risk Adherence
Socioeconomic Status
Living Conditions
Health Literacy
� Nationally¡ Pediatric Asthma Prevalence1
¡ Readmission Rates2
¡ Adherence3
� Locally: Philadelphia, PA¡ Prevalence4
¡ Readmission Rates¡ Adherence5
Aims of our Research
Asthma Hospital Risk Adherence
Improving Asthma
Care
Behavioral “Cue”
Increasing Adherence
to Medication
Improving Mental Health Care
Identifying Risk Factors for Poor Hospital Outcomes in Pediatric
Asthma Patients with Depression or Anxiety
Asthma Hospital Risk Adherence
Study 1
Mental Health & Readmission Risk
� Significance of Co-morbid Conditions
� Mental Health and Hospital Outcomes7-8
� Health Care and Societal Costs
Asthma Hospital Risk Adherence
Children at CHOP w/ Clinically Significant Depression and/or Anxiety
30%
Mental Health & Adherence
� Poor Asthma Control9-11
� Mental Health is a “driver” for asthma adherence
Asthma Hospital Risk Adherence
Study Design & Goals
� Study Design ¡ 2 Surveys—Parent & Child¡ Follow Up¡ Doser
Asthma Hospital Risk Adherence
� Goals:¡ Coping with Hospital Stressors
¡ Improved disease management
� Eligibility criteria¡ Age¡ Comorbidity ¡ Doser
Future Applications
Automated Adherence Feedback for High Risk Children with
Asthma
Asthma Hospital Risk Adherence
Study 2
Asthma Controller Medication Adherence
� Behavioral “Cue”
� Significance
� Objective
Asthma Hospital Risk Adherence
“Cue” Reward
Routine
Study Design & Goals
Asthma Hospital Risk Adherence
Demographic Data of Study Participants
Asthma Hospital Risk Adherence
Education Level Breakdown
Some high school, but did not graduate
High School graduate
Some college or 2-year degree
Four year college graduate
SC HS
Marital Status Breakdown
Married
Widowed
Divorced
Separated
Never Married
Living with a partner
Prefer not to answer
Working with a Vulnerable Population
Successes and Complications
¡ Follow-up Calls
¡ Tech Literacy & Syncing
¡ Multiple Caregivers
Similar trends in Study 1
Asthma Hospital Risk Adherence
Preliminary Data Analysis: Adherence Survey
0.2
.4.6
.81
Pro
babi
lity
of A
dher
ence
0 10 20 30Days
1 18.7% 2 24.8%3 43.7% 4 12.8%
Non (18.7%)Moderate (43.7%)
Early (24.8%)Sustained (12.8%)
Future Steps and Considerations
� Use of ClinCards: Monetary Incentive
� Aiding in Parental Responsibility
� Other Considerations
Asthma Hospital Risk Adherence
*Personalized Asthma Adherence Management*
Patient Preferences
& Needs
Asthma Control
Type of Non-
Adherence
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
Q&A
References
1. "Most Recent Asthma Data." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, Mar. 2016. Web. 15 Aug. 2016.
2. Liu, S. Y., & Pearlman, D. N. (2009, January). Hospital Readmissions For Childhood Asthma. Public Health Reports, 124(1), 65-78. Retrieved August 15, 2016.
3. Drotar D, Bonner MS. Influences on Adherence to Pediatric Asthma Treatment: A Review of Correlates and Predictors: J Dev Behav Pediatr. 2009;30(6):574-582. doi: 10.1097/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), 581-585. doi10.3109/02770903.2012.690476
5. Bartlett SJ, LukkP, Butz A, Lampros-Klein F, Rand CS. Enhancing medication adherence amnoginner-city children with asthma: results from pilot studies. J Asthma Off J Assoc Care Asthma. 2002;39(1):47-54.
6. United States Environmental Protection Agency. Asthma Facts. March 2013. http://www.epa.gov/asthma/pdfs/asthma_fact_sheet_en.pdf
7. 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):42.
8. 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-e1543.
9. Richardson L, Lozano P, Russo J, et al. Asthma Symptom Burden: Relationship to Asthma Severity and Anxiety and Depression Symptoms. Pediatrics. 2006;118(3):1042-1051.
10.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):398-406.
11. 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):1064-1072.