improving asthma care within vulnerable populations...¡ coping with hospital stressors ... hospital...
TRANSCRIPT
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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
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Roadmap
Asthma: Nationally and Locally
Study 1: Mental Health & Hospital Risks
Study 2: Adherence Feedback Intervention
Analysis of Vulnerable Population
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What is Asthma?
Asthma Hospital Risk Adherence
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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
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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
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Aims of our Research
Asthma Hospital Risk Adherence
Improving Asthma
Care
Behavioral “Cue”
Increasing Adherence
to Medication
Improving Mental Health Care
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Identifying Risk Factors for Poor Hospital Outcomes in Pediatric
Asthma Patients with Depression or Anxiety
Asthma Hospital Risk Adherence
Study 1
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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%
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Mental Health & Adherence
� Poor Asthma Control9-11
� Mental Health is a “driver” for asthma adherence
Asthma Hospital Risk Adherence
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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
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Automated Adherence Feedback for High Risk Children with
Asthma
Asthma Hospital Risk Adherence
Study 2
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Asthma Controller Medication Adherence
� Behavioral “Cue”
� Significance
� Objective
Asthma Hospital Risk Adherence
“Cue” Reward
Routine
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Study Design & Goals
Asthma Hospital Risk Adherence
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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
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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
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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%)
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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
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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
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Q&A
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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.