Incentive-based Mobile Health Adherence Intervention for High Risk Children with Asthma

针对哮喘高危儿童的基于激励的移动健康依从性干预

• 批准号: 10117038
• 负责人: Chen Collin Kenyon
• 金额: $ 18.69万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-02-01 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10117038
• 关键词: Adherence; Admission activity; Adrenal Cortex Hormones; Adult; Age; Area; Asthma; Behavior; Behavior Therapy; Behavioral Sciences; Biometry; Caregivers; Cessation of life; Child; Child Behavior; Childhood; Childhood Asthma; Clinical; Clinical effectiveness; Computerized Medical Record; Country; Data; Data Analyses; Drops; Effectiveness; Enhancement Technology; Enrollment; Environment; Epidemiology; Family; Feedback; Foundational Skills; Future; Goals; Habits; Health; Health Policy; Health Services; Health Services Research; Health Technology; Health behavior change; Health system; Healthcare; Healthcare Systems; Hospitalization; Incentives; Infrastructure; Inhalation; Inpatients; Intervention; Interview; Knowledge; Lead; Learning; Literature; Maintenance; Master of Science; Mediating; Mentors; Methods; Minority; Modeling; Multicenter Trials; Outcome; Participant; Patients; Pediatric Hospitals; Pennsylvania; Perception; Performance; Pharmaceutical Preparations; Phase; Philadelphia; Pilot Projects; Policy Research; Population; Prevalence; Randomized Controlled Trials; Registries; Reminder Systems; Research; Research Personnel; Resources; Sampling; Self Efficacy; Structure; Technology; Testing; Training Support; Universities; Visit; Withdrawal; Wood material; arm; asthmatic; base; behavior change; behavioral economics; behavioral health; career; clinical center; clinical epidemiology; cohort; cost; design; experience; experimental study; financial incentive; health care service utilization; health data; high risk; high risk population; improved; improved outcome; incentive strategies; innovation; mHealth; medication compliance; minority children; multidisciplinary; pediatrician; peer; population health; programs; randomized trial; smoking cessation; social; success; therapy design; three-arm trial; time interval; trial design; urban minority

Project Abstract: Candidate: Dr. Kenyon is a general pediatrician and asthma health services researcher at Children's Hospital of Philadelphia (CHOP), where he leads the CHOP Network's Asthma Population Health Workgroup. He completed a Masters of Science in Health Policy Research as a Robert Wood Johnson Clinical Scholar at the University of Pennsylvania. His long-term career goal is to become an independent investigator who leads a research program focused on improving outcomes and reducing outcome disparities for children with asthma using longitudinal health data to stratify and target high-risk populations for enrollment in well-designed and empirically rigorous interventions. His proposed project would facilitate this goal. Research: In this project, Dr. Kenyon proposes to build on promising preliminary data that demonstrates feasibility and robust engagement of high-risk childhood asthmatics in an iteratively developed mobile health technology intervention that leverages principles of behavioral economics to enhance inhaled corticosteroid medication adherence. His first aim is to determine the effects of different strategies of financial incentive withdrawal on adherence and health care utilization and cost in high-risk asthmatics ages 5-12 and their caregivers by conducting a three-arm randomized controlled trial. His specific hypotheses are that longer duration of financial incentive delivery, as well as medication adherence reminders and performance feedback, will lead to better immediate and enduring controller medication adherence, as well as less health system utilization and cost. In his second aim, he will investigate the potential mechanisms by which these intervention strategies influenced adherence trajectories, implementing group-based trajectory models to identify and study participants with sustained adherence. In his third aim, he will use mixed methods to explore caregiver and child perceptions of intervention component acceptability and their influence on controller adherence trajectory. Environment: CHOP has about 2,500 inpatient asthma admissions per year, the prevalence of asthma in CHOP's 31 practice Kid's First Network ranges from 20-25%, and all practices are on a unified electronic medical record with an asthma registry. This context provides a robust patient cohort and infrastructure for the proposed study. Dr. Kenyon has assembled a strong multidisciplinary team of experts in epidemiology and health services research (Drs. Feudtner and Asch), asthma outcomes and disparities research (Drs. Zorc and Bryant-Stephens), child behavior change/maintenance (Dr. Miller), medication adherence (Dr. Gross), and behavioral economics and health care innovation (Dr. Asch) to mentor and advise him through the planning and execution of this project. CHOP and the University of Pennsylvania are committed to the success of young investigators and have many unique resources to support the training plan and research of Dr. Kenyon, including the Center for Pediatric Clinical Effectiveness at CHOP and the Center for Clinical Epidemiology and Biostatistics and Center for Health Incentives and Behavioral Economics at Penn.

项目摘要：候选人：凯尼恩博士是一名普通儿科医生和哮喘健康服务研究员， 费城儿童医院（CHOP），在那里他领导CHOP网络的哮喘人群 健康工作组。他以罗伯特·伍德约翰逊的身份完成了卫生政策研究硕士学位 宾夕法尼亚大学的临床学者。他的长期职业目标是成为一名独立的 领导一个研究项目的调查员，该项目的重点是改善结果和减少结果差异 使用纵向健康数据对哮喘儿童进行分层，并针对高危人群进行招募 精心设计和严格的经验干预。他提出的项目将有助于实现这一目标。 研究：在这个项目中，凯尼恩博士建议建立在有希望的初步数据基础上， 在反复开发的移动的健康中，高危儿童哮喘患者的可行性和稳健参与 利用行为经济学原理的技术干预， 药物依从性。他的第一个目标是确定不同的财务激励策略的效果 5-12岁高危哮喘患者的依从性、卫生保健利用和费用的退出情况及其 护理人员进行了一项三臂随机对照试验。他的具体假设是， 财务激励交付的持续时间，以及药物依从性提醒和绩效反馈， 将导致更好的即时和持久的控制药物依从性，以及更少的卫生系统 利用率和成本。在他的第二个目标中，他将研究这些干预的潜在机制。 策略影响的坚持轨迹，实施基于组的轨迹模型，以确定和研究 参与者持续坚持。在他的第三个目标中，他将使用混合方法来探索照顾者和 儿童对干预组件可接受性的感知及其对控制器依从轨迹的影响。 环境：CHOP每年约有2，500名哮喘住院患者， CHOP的31实践孩子的第一个网络范围从20- 25%，所有的做法都在一个统一的电子 哮喘登记处的医疗记录这种背景为研究提供了强大的患者队列和基础设施。 建议的研究。凯尼恩博士组建了一支强大的多学科专家团队， 健康服务研究（Feudtner和Asch博士）、哮喘结果和差异研究（Zorc和 Bryant-Stephens）、儿童行为改变/维持（米勒博士）、药物依从性（格罗斯博士）和 行为经济学和卫生保健创新（阿希博士）指导和建议他通过规划 和执行这个项目。CHOP和宾夕法尼亚大学致力于年轻人的成功 研究人员，并有许多独特的资源来支持凯尼恩博士的培训计划和研究， 包括CHOP儿科临床有效性中心和临床流行病学中心， 宾夕法尼亚大学的生物统计学和健康激励与行为经济学中心。