Improving Post-Hospital Transitions and Ambulatory Care for Children with Asthma

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DESCRIPTION (provided by applicant): Asthma readmission rates remain high and are related to multiple factors including 1) hospital providers' non- compliance with evidence-based (EB) asthma preventive measures at discharge; 2) poorly managed post- hospital care transitions to primary care providers (PCPs); 3) failure of PCPs to monitor and manage chronic asthma disease severity in ambulatory setting; and 4) patient non-compliance with asthma home therapy. We will develop and implement two information technology (IT) applications that will change the way asthma care is delivered-from an approach centered on acute care and intermittent physician visits, to one in which IT is used to enable continuous communication between patients and care providers for decision making. We hypothesize that effective use of these IT applications will require implementation strategies that address multiple and unique factors within each category of users (hospital providers, PCPs, and patients/caregivers). We also hypothesize that cross-cutting themes will be identified among user categories that can be generalized to other health care settings. We will test our hypotheses through the following Specific Aims: Aim 1: Develop two IT applications to improve post-hospital care transitions and ambulatory care. We will develop: 1a. An asthma-specific Reminder and Decision Support (RADS) system that will help hospital providers at discharge to: 1) comply with EB asthma preventative measures, 2) determine the patient's chronic asthma severity level, and 3) identify severity-appropriate asthma preventative medications. 1b. A Web-based Asthma Home Monitoring System (AHMS) that will: 1) enable at-home ongoing assessment of the patient's level of asthma control, and 2) support PCPs in monitoring and managing chronic asthma symptoms. Aim 2: Evaluate the attitudes, acceptability, and use of: 2a. RADS by hospital providers; 2b. Electronic discharge summary and AHMS by PCPs; and 2c. AHMS by patients/caregivers. Aim 3: Determine factors associated with the effective use of 3a. RADS by hospital providers; 3b. Automated discharge information and AHMS by PCPs; and 3c. AHMS by patients/caregivers. Aim 4: Determine the effect of implementing the new IT tools. We will evaluate the effect of: 4a. RADS by measuring hospital provider compliance with EB preventive asthma measures and prescription of severity-appropriate preventive medications at discharge; 4b. Automated discharge information and AHMS by measuring the impact on PCPs perceived change in practice (increased awareness of EB preventive asthma measures, review of asthma action plan, change in asthma preventive medications such as step-up or step-down care); 4c. AHMS by measuring patient compliance with preventive asthma home medications after hospital discharge; and, 4d. IT applications on ED/hospital readmissions. This project will ensure effective care transitions and continuity for children with asthma after hospital discharge-to reduce readmissions. It also will identify generalizable factors contributing to effective use of IT applications in transitions and ambulatory care.