The Coordinated Healthcare Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO Trial)

Valerie Press, MD, MPHAssistant Professor, Section of

Hospital Medicine

S. Margaret Paik, MDAssociate Professor of Pediatrics

February 12, 2015

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Conduct a 3-arm multicenter pragmatic trial comparing the effectiveness of an enhanced ED-discharge intervention (CAPE-ED) v. enhanced ED-discharge combined with a patient-level CHW-led intervention that includes a focus on reducing environmental triggers at home (CAPE-ED plus Patient-Home) v. Usual Care.

Aim

Asthma Care Action PlanCAPE

Inclusion Criteria (1 of 2)

1. Children age 5-11 years

2. Presenting to the ED

3. Clinical diagnosis of AE by ED Attending

4. Receiving care in the ED for AE– at least 1 dose of inhaled short acting

bronchodilator – at least 1 dose of systemic corticosteroids

Inclusion Criteria (2 of 2)

5. ≥ 1 hour since receiving the first dose of

medications

6. ED Attending >75% likely to be dc’d home from ED

7. English or Spanish speaking caregiver/child

8. The patient lives in Chicago

Exclusion Criteria (1 or 2)

1. Discharged from ED to location other than home – Hospital– other acute care or chronic care facility– died prior to ED discharge

2. Caregiver declines to provide informed consent 3. If child ≥7 years old, child declines to provide assent

4. Current or previous participant – Child/other member of household is in the CHICAGO Trial

Exclusion Criteria (2 of 2)

5. Child is currently enrolled in another research study involving an intervention for any condition – observational studies are not an exclusion criterion

6. CHW is expected to conduct ≥1 home visits over 6 mths

to home as part of any other CHW program

7. Child expected to move within next 6 months

8. Caregiver unable/unwilling to provide a valid phone no.

• 2 Co-primary outcomes: Patient/Family- centered– PROMIS: Asthma Impact Scale (child) – PROMIS: Satisfaction with social roles (caregiver)

• Secondary outcomes: Adherence to self-management skills:– Child: cACT (childhood Asthma Control Test)– Caregiver: PACQLQ (pediatric asthma caregiver QOL quest)– Acute care visits (all-cause UC visits, ED visits, hospitalizations)– Adherence to meds prescribed in ED (RX filled within 7 days)– Inhaler technique for meds prescribed in ED– Trigger reduction behavior (eg., smoking, roach, mice)

Outcomes

Next Steps

Recruitment starts March 1, 2015!

Our Team

• [CHICAGO Trial PI: Jerry Krishnan, MD, PhD (UIC)]• Site PI: Valerie Press, MD, MPH• ED co-I: Maggie Paik, MD• Community Health Worker: Brendia Bell• Main ED Coordinator: Nicole Woodrick• ED Coordinator: Ashley Hull• ED Coordinator: John Kim

The CHICAGO Trial Collaborators

Ann & Robert Lurie Children’s Hospital of Chicago. Rush University Medical Center. Sinai Health System. Cook County Health & Hospital System (Stroger). University of Illinois Hospital & Health Sciences System (UI-Health). University of Illinois – Chicago (UIC). Chicago Asthma Consortium (CAC). Respiratory Health Association (RHA). NorthShore University HealthSystem (NSUHS). Northwestern University (NWU). Illinois Emergency Department Asthma Surveillance Project (IEDASP). Chicago Department of Public Health (CDPH). Illinois Institute of Technology (IIT).

8 PCORI awards: Treatment options for African American and Latinos / Hispanics with uncontrolled asthma

John Elder, San Diego State Univ

Stephen Teach, Children’s Research Institute

Kaharu Sumino, WashU

Alex Federman, Icahn SOM at Mt. Sinai

Andrea Apter, UPenn

Winifred Hamilton, BCM

James Krieger, Seattle-King County Pub Health Dept

December 17, 2013 - PCORI Announces Research Awards: Congratulations!