Improving Asthma Care within Vulnerable Populations...¡ Coping with Hospital Stressors ... Hospital...

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

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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.