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

项目摘要：候选人：肯扬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)，他在那里领导CHOP网络的哮喘患者 健康工作组。他以罗伯特·伍德·约翰逊的身份获得了卫生政策研究的科学硕士学位 宾夕法尼亚大学临床学者。他的长期职业目标是成为一名独立的 领导一个专注于改善结果和减少结果差异的研究项目的调查员 对于哮喘儿童，使用纵向健康数据对高危人群进行分层并进行登记 在精心设计和经验严谨的干预下。他提出的项目将有助于实现这一目标。 研究：在这个项目中，肯扬博士建议建立在有希望的初步数据的基础上，这些数据证明 高危儿童哮喘患者在迭代发展的移动健康中的可行性和积极参与 利用行为经济学原理加强吸入性皮质类固醇的技术干预 药物依从性。他的首要目标是确定不同财务激励策略的效果。 5-12岁及以上高危哮喘患者的依从性戒断及医疗利用和费用 通过进行一项三臂随机对照试验。他的具体假设是更长 提供财政奖励的持续时间，以及服药依从性提醒和绩效反馈， 将导致更好的直接和持久的控制者用药依从性，以及更少的卫生系统 利用率和成本。在他的第二个目标中，他将调查这些干预的潜在机制 策略影响依从性轨迹，实施基于群体的轨迹模型来识别和研究 持续坚守的参与者。在他的第三个目标中，他将使用混合方法来探索照顾者和 儿童对干预成分可接受性的感知及其对控制者坚持轨迹的影响。 环境：CHOP每年约有2500名哮喘住院患者，哮喘患病率在 Chop的31 Practice Kid的First Network从20%到25%不等，所有的练习都在一个统一的电子设备上 有哮喘登记处的病历。这一背景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流行病学专家团队 卫生服务研究(Feudtner和Asch博士)、哮喘结果和差异研究(Zorc博士和Asch博士 Bryant-Stephens)，儿童行为改变/维持(Miller博士)，服药依从性(Gross博士)，以及 行为经济学和医疗保健创新(阿施博士)在规划过程中为他提供指导和建议 以及这个项目的执行。Chop和宾夕法尼亚大学致力于杨的成功 研究人员并拥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儿科临床疗效中心和临床流行病学中心 宾夕法尼亚大学生物统计学和健康激励与行为经济学中心。

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.