Upload
trinhnguyet
View
216
Download
0
Embed Size (px)
Citation preview
Name of PresentationUNISON HealthPediatric asthma: What we learned and what we are doing
Amelia Mutso, PhDProject Manager
Population Health Sciences [email protected]
On behalf of the Vice Chancellor of Health Affairs
March 22, 2016
Acknowledgements
Bo FernhallAngela Odoms Young
Bruce GrahamLinda Kaste
Jason Leigh
Richard Barrett
Terri WeaverShannon Zenk
Dima Qato
Herand AbcarianRamin AlemzadehAnuja AntonyDimitri AzarJoan BrillerSteve BrownFady CharbelBen GerberVictor GordeukMemoona HasnainTracy IrwinHoonbae JeonRick KittlesDavid KloddSubhash KukrejaJim LashThomas LaydenXavier LlorCraig NeiderbergerRichard NovakBharati PrasadUsha RajMary StephensonNadera SweissTerry Vanden HoekRohit VarmaCindy Velduis
Sheila CastilloCreasie Finney HairstonGina GastonRosemary GeorgeNatalie Meza
Paul Brand-RaufLinda ForstJennifer Hebert-BeirneFred KvizDavid MarderVictoria PerskyRichard Warnecke
Gabriela AvilaAntonio CoxAnne DiffenderfferDouglas HammerTimothy JohnsonGeoffrey ParkerJennifer ParsonsKaren RetzerDavid Schipani
Cynthia Barnes-BoydNancy Tartt
Jerry KrishnanJerry BaumanSonja BooneKevin GibbsHelene GussinBinoy JoeseNicole KazeeJerry KrishnanStephanie LewisAmy SagenAmelia MutsoMaciej Grabarek
2
Goals of UNISON Health
• Understand the health needs of the diverse community served by the UI Health System
• Use this information to improve health care for those who need it the most
3
UNISON HealthWhat? In-person, in home surveys of health-related behaviors, healthcare access and utilization, health conditions and biometric measurements
Where? 24 community areas served by UI
Health
Who? (n = 890 participants)Stratum 1: 454 randomly selected adult community residents
Stratum 2 HTN: 139 UI Health adult patients with uncontrolled hypertension
Stratum 3 DM: 147 UI Health adult patients with uncontrolled diabetes
Stratum 4 asthma: 150 caregivers of UI Health pediatric patients with uncontrolled asthma
When? November 2013 - June 2014
4
Pediatric asthma results1
DemographicsCharacteristics n = 150
Age, mean 7.7 years
Boys 59%
Race/Ethnicity
Non-Hispanic Black 63%
Hispanic 34%
Other 3%
Insured 100%
Public insurance 85%
Private insurance 14%
Unknown 1%
Below or equal to 138% FPL 77%
Health conditions
Born premature2 23%
Sickle cell anemia3 5%
1Children 2 - 17 years old with at least 1 UI Health ED visit Aug 2012 - Jul 2013 2Normal prevalence of sickle cell anemia: 0.2% African-American population, Total U.S. population 1 in 70,000-100,0003Prevalence of premature births in U.S. in 2013 was 11.4% 5
Weekly fast food consumption
65%
Obese50%
Overweight14%
Healthy Weight
28%
Underweight8% Weight
Gaps Identified1: All participants
Medication Adherence
Adherence (n = 149) Past 2 Weeks
Prescribed Inhaled Corticosteroid 99%
Used everyday 39%
Used > 1 day, < 14 days 22%
Never used 39%
Prescribed Montelukast 96%
Used everyday 29%
Used > 1 day, < 14 days 8%
Never used 59%
Home Environmental Modification
Home EnvironmentModifications
n = 149
Sheets washed in hot water 36%
Dehumidifier used 35%
Mattress cover used 30%
Air cleaner or purifier used 23%
Pillow cover used 22%
1Children 2 - 17 years old with at least 1 UI Health ED visit Aug 2012 - Jul 2013 6
Healthcare UtilizationAccess to care and utilization Past 12
months
Seen a doctor 99%
Has primary doctor/nurse 88%
Gone to hospital/ER 82%
Received flu vaccine 75%
Self-management education
How to usean inhaler 97%
How to usea spacer 91%
Given anaction plan 71%
7
Taking asthma medications as prescribed keeps my child from getting sicker…
Extremely sure 31%
Very sure 46%
Moderately sure 14%
Somewhat sure 5%
Not at all sure 2%
Outcome expectancy
21%
Gaps Identified1: All participants
1Children 2 - 17 years old with at least 1 UI Health ED visit Aug 2012 - Jul 2013
8
Demographics1: Uncontrolled asthma
1Children 2 - 17 years old with at least 1 UI Health ED visit Aug 2012 - Jul 2013
Characteristics Uncontrolled(n = 62)
Controlled (n = 88)
Comparison
Race/Ethnicity 0.03
Non-Hispanic Black 76% 54%
Hispanic 21% 43%
Other 2% 3%
Insurance <0.01
Public insurance 91% 81%
Private insurance 5% 20%
Obesity 52% 45%
Uncontrolled42%Controlled
58%
Asthma Control
9
Characteristics1: Uncontrolled asthma
1Children 2 - 17 years old with at least 1 UI Health ED visit Aug 2012 - Jul 2013
Health conditions Uncontrolled(n = 63)
Controlled (n = 87)
Comparison
Allergic conditions
Eczema or skin allergy 56% 29% <0.01
Respiratory allergy 41% 24% 0.04
Food or digestive allergy 23% 12% 0.1
Other health conditions
Speech or language problems 26% 11% 0.02
Epilepsy or seizure disorder 7% 1% <0.01
Age at asthma diagnosis <0.001
< 5 years old 94% 73%
≥ 5 years old 6% 25%
Pre-paid or pay-as-you go phones
55%
PCORI contract # AS 1307-05420 Clinicaltrials.gov identifier: NCT 02319967
Study period: 03/01/2014-02/28/2017
14
Who is the target audience for
discharge instructions in the ER for a child
with asthma?
• ER doctor
• ER nurse
• Child
• Caregiver
• Outpatient physician
– Pulmonologist /allergist
– Primary care
• Family members
• School nurse, teacher
• Daycare
• Others
15
PCORI contract # AS 1307-05420 Clinicaltrials.gov identifier: NCT 02319967
Study period: 03/01/2014-02/28/2017
CHICAGO Action Plan after ED discharge (CAPE)
Example of a discharge instructions given to caregivers in the ED
16
CHICAGO Action Plan after ED discharge (CAPE)A ‘stakeholder-balanced’ communication tool
Erwin K et al. J Compar Eff Res 201617
CHICAGO II:Create an Asthma Care Implementation Program (ACIP) based on a community needs assessment
1. Medical care
e.g., address practitioner’s adherence to asthma guidelines
2. Family and child
e.g., address self-management behaviors; social context of family and cultural perceptions of disease and healthcare seeking; family support; psychosocial factors such as depression and stress
3. Home
e.g., address exposure to allergens, irritants and pollutants
4. CommunityRefers to organization who primary purpose is not healthcare delivery.
e.g., school and child care environment; peer and community levels of health literacy, asthma education, programs/policies to support asthma self-management
22
Amelia Mutso
312-355-3033
PI: Jerry Krishnan, MD, PhD
Associate Vice President for Population Health
Office of the Vice Chancellor of Health Affairs
Interested in becoming involved in this city-wide initiative?
24