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

描述（由申请人提供）：哮喘再入院率仍然很高，与多种因素有关，包括1）出院时医院提供者不遵守循证（EB）哮喘预防措施; 2）向初级保健提供者（PCP）的出院后护理过渡管理不善; 3）PCP未能在门诊环境中监测和管理慢性哮喘疾病的严重程度;（4）患者对哮喘家庭治疗不依从。我们将开发和实施两个信息技术（IT）应用程序，这将改变哮喘护理的方式，从以急性护理和间歇性医生就诊为中心的方法，到其中IT用于实现患者和护理提供者之间的持续沟通，以便做出决策。我们假设，这些IT应用程序的有效使用将需要实施策略，解决多个和独特的因素，在每个类别的用户（医院提供者，PCP和患者/护理人员）。我们还假设，交叉主题将被确定的用户类别，可以推广到其他医疗保健设置。我们将测试我们的假设，通过以下具体目标：目标1：开发两个IT应用程序，以改善医院后的护理过渡和门诊护理。我们将开发：1A。一个针对哮喘的提醒和决策支持（RADS）系统，将帮助医院提供者在出院时：1）遵守EB哮喘预防措施，2）确定患者的慢性哮喘严重程度，3）确定与严重程度相适应的哮喘预防药物。1b.一个基于网络的哮喘家庭监测系统（AHMS），将：1）使在家里持续评估患者的哮喘控制水平，2）支持PCP监测和管理慢性哮喘症状。目标2：评估的态度，可接受性和使用：2a。医院提供者的RADS; 2b. PCP的电子排放总结和AHMS;以及2c.患者/护理人员的AHMS。目标3：确定与有效使用3a相关的因素。医院提供者的RADS; 3b.由PCP提供的自动化排放信息和AHMS;以及3c.患者/护理人员的AHMS。目标4：确定实施新IT工具的效果。我们将评估的效果：4a。通过测量医院提供者对EB预防性哮喘措施的依从性和出院时严重程度适当的预防性药物处方来评估RADS; 4 b.通过测量实践中对PCP感知变化的影响（EB预防性哮喘措施的意识提高，哮喘行动计划的审查，哮喘预防药物的变化，如逐步增加或逐步减少护理），自动化出院信息和AHMS; 4c. AHMS通过测量患者出院后对预防性哮喘家庭药物的依从性;以及，4d。信息技术在艾德/再入院方面的应用。该项目将确保哮喘儿童出院后有效的护理过渡和连续性，以减少再入院。它还将确定有助于在过渡和门诊护理中有效使用IT应用程序的可推广因素。 公共卫生相关性：因哮喘住院的儿童随后入院/艾德的风险增加。拟议的示范项目将确保儿童的有效护理过渡和连续性，以降低再入院的风险。我们的研究将为转化科学方法做出重大贡献，以确保所有儿童的高质量哮喘护理。

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. PUBLIC HEALTH RELEVANCE: Children hospitalized for asthma are at increased risk for subsequent hospital/ED admissions. The proposed demonstration project will ensure effective care transitions and continuity for children to decrease risk for readmission. Our research will make significant contributions to translational science methods for assuring high quality of asthma care for all children.