Engaging stakeholders to design a comparative effectiveness trial in children with uncontrolled asthma

Erwin, Kim; Martin, Molly A.; Flippin, Tara; Norell, Sarah; Shadlyn, Ariana; Yang, Jie; Falco, Paula De; Rivera, J F; Ignoffo, Stacy; Kumar, Rajesh; Margellos-Anast, Helen; McDermott, Michael; McMahon, Kate; Mosnaim, Giselle; Nyenhuis, Sharmilee M.; Press, Valerie G.; Ramsay, Jessica; Soyemi, Kenneth; Thompson, Trevonne M.; Krishnan, Jerry A.

doi:10.2217/cer.15.52

Cited by 24 publications

(16 citation statements)

References 20 publications

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“…(17,18) The CAPE is intended to support guideline recommended asthma care on ED discharge (a course of systemic corticosteroids; daily inhaled corticosteroids or other controller; as needed quick-relief inhaled medication; assess and teach appropriate inhaler technique; arrange a post-discharge follow-up appointment; and avoid known asthma triggers) and to support appropriate asthma self-management in the home. The CAPE tool uses simplified language, visual learning, and options for individualization to also facilitate communication about discharge instructions between clinicians and the child and caregiver.…”

Section: Design and Methodsmentioning

confidence: 99%

Design of a pragmatic trial in minority children presenting to the emergency department with uncontrolled asthma: The CHICAGO Plan

Krishnan

Martin

Lohff

et al. 2017

Contemporary Clinical Trials

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Among children with asthma, black children are two to four times as likely to have an emergency department (ED) visit and die from asthma, respectively, compared to white children in the United States. Despite the availability of evidence-based asthma management guidelines, minority children are less likely than white children to receive or use effective options for asthma care. The CHICAGO Plan is a three-arm multi-center randomized pragmatic trial of children 5 to 11 years old presenting to the ED with uncontrolled asthma that compares: (1) an ED-focused intervention to improve the quality of care on discharge to home, (2) the same ED-focused intervention together with a home-based community health worker (CHW)-led intervention, and (3) enhanced usual care. All children receive spacers for the metered dose inhaler and teaching about its use. The Patient-Reported Outcomes Measurement Information System (PROMIS) Asthma Impact Scale and Satisfaction with Participation in Social Roles at 6 months are the primary outcomes in children and in caregivers, respectively. Other patient-reported outcomes and indicators of healthcare utilization are assessed as secondary outcomes. Innovative features of the CHICAGO Plan include early and continuous engagement of children, caregivers, the Chicago Department of Public Health, and other stakeholders to inform the design and implementation of the study and a shared research infrastructure to coordinate study activities. The objective of this report is to describe the development of the CHICAGO Plan, including the methods and rationale for engaging stakeholders, the shared research infrastructure, and other features of the pragmatic clinical trial design.

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Section: Design and Methodsmentioning

confidence: 99%

Design of a pragmatic trial in minority children presenting to the emergency department with uncontrolled asthma: The CHICAGO Plan

Krishnan

Martin

Lohff

et al. 2017

Contemporary Clinical Trials

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“…The CAPE was designed using a process of contextual inquiry that engaged ED providers and administrators, ambulatory care providers, caregivers of children with asthma, and CHWs. 40 This formative work also concluded that the completion of the CAPE by existing ED staff and providers would not be feasible. The CAPE is therefore generated by ED coordinators hired specifically by the trial to serve as discharge coordinators, in consultation with both the ED providers and the patients’ caregivers.…”

Section: A Patient-centered Approach To Ed Pediatric Asthma Interventmentioning

confidence: 99%

Care transition interventions for children with asthma in the emergency department

Martin

Press

Nyenhuis

et al. 2016

Journal of Allergy and Clinical Immunology

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The Emergency Department (ED) is a critical point of identification and treatment for some of the most high risk children with asthma. This review summarizes the evidence regarding care transition interventions originating in the ED for children with uncontrolled asthma, with a focus on care coordination and self-management education. While many interventions on care transition for pediatric asthma have been tested, only a few were actually conducted in the ED setting. Most of these targeted both care coordination and self-management education but ultimately did not improve attendance at follow up appointments with primary care providers, improve asthma control, or reduce healthcare utilization. Conducting any ED-based intervention in the current environment is challenging due to the many demands on ED providers and staff, poor communication within and outside of the medical sector, and caregiver/patient burden. The evidence to date suggests ED care transition interventions should consider expanding beyond the ED to bridge the multiple sectors children with asthma navigate, including health care settings, homes, schools, and community spaces. Patient-centered approaches may also be important to ensure adequate intervention design, enrollment, retention, and evaluation of outcomes important to children and their families.

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“…Other stakeholders engaged in the study include asthma advocacy groups, insurance agencies, and government officials (34). The CHICAGO trial (35), another PCORI-funded study that builds on multiple decades of collaboration among diverse stakeholders, is investigating the impact of multiple levels of provider and patient education on asthma outcomes in children of color presenting to emergency departments.…”

Section: Addressing Pulmonary Health Disparitiesmentioning

confidence: 99%

Community-based Participatory Research Is Needed to Address Pulmonary Health Disparities

Harris

Pensa²,

Redlich

et al. 2016

Annals ATS

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Socioeconomic and racial disparities in the outcomes of medical management remain common across pulmonary diseases in the United States and worldwide. Acknowledging this, the American Thoracic Society recently put forth recommendations to advance respiratory health equity. Through engagement of vulnerable communities in search of collaborative solutions to improve health disparities, community-based participatory research embodies concepts essential to the American Thoracic Society mission for respiratory health equity. The purpose of this commentary is to provide an overview of the principles of community-based participatory research and the application of this approach to addressing inequity in the outcomes of treatment for lung disease. Community-based participatory research aims to decrease health disparities by recognizing the social and ecological paradigms of health care and by partnering community members with academic researchers in all aspects of the research process. Community partners are uniquely poised to offer insight into local culture, circumstances that guide health behaviors, and other challenges to improve their own community's health. Sustainable interventions, either through strengthening existing community assets or through community empowerment and local capacity building throughout the research process, are essential to the success of community-based participatory research. The National Institutes of Health and other funding agencies offer funding opportunities to support specific interventions aimed at engaging community members in the research process. In pulmonary medicine, community-based initiatives have focused primarily on improving pediatric asthma outcomes. Using a community-based approach in adult asthma and other pulmonary diseases could be an ideal manner in which to decrease pulmonary health disparities.

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Engaging stakeholders to design a comparative effectiveness trial in children with uncontrolled asthma

Cited by 24 publications

References 20 publications

Design of a pragmatic trial in minority children presenting to the emergency department with uncontrolled asthma: The CHICAGO Plan

Design of a pragmatic trial in minority children presenting to the emergency department with uncontrolled asthma: The CHICAGO Plan

Care transition interventions for children with asthma in the emergency department

Community-based Participatory Research Is Needed to Address Pulmonary Health Disparities

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