Name of PresentationUNISON HealthPediatric asthma: What we learned and what we are doing

Amelia Mutso, PhDProject Manager

Population Health Sciences Programamutso@uic.edu

On behalf of the Vice Chancellor of Health Affairs

March 22, 2016

Acknowledgements

Bo FernhallAngela Odoms Young

Bruce GrahamLinda Kaste

Jason Leigh

Richard Barrett

Terri WeaverShannon Zenk

Dima Qato

Herand AbcarianRamin AlemzadehAnuja AntonyDimitri AzarJoan BrillerSteve BrownFady CharbelBen GerberVictor GordeukMemoona HasnainTracy IrwinHoonbae JeonRick KittlesDavid KloddSubhash KukrejaJim LashThomas LaydenXavier LlorCraig NeiderbergerRichard NovakBharati PrasadUsha RajMary StephensonNadera SweissTerry Vanden HoekRohit VarmaCindy Velduis

Sheila CastilloCreasie Finney HairstonGina GastonRosemary GeorgeNatalie Meza

Paul Brand-RaufLinda ForstJennifer Hebert-BeirneFred KvizDavid MarderVictoria PerskyRichard Warnecke

Gabriela AvilaAntonio CoxAnne DiffenderfferDouglas HammerTimothy JohnsonGeoffrey ParkerJennifer ParsonsKaren RetzerDavid Schipani

Cynthia Barnes-BoydNancy Tartt

Jerry KrishnanJerry BaumanSonja BooneKevin GibbsHelene GussinBinoy JoeseNicole KazeeJerry KrishnanStephanie LewisAmy SagenAmelia MutsoMaciej Grabarek

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Goals of UNISON Health

• Understand the health needs of the diverse community served by the UI Health System

• Use this information to improve health care for those who need it the most

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UNISON HealthWhat? In-person, in home surveys of health-related behaviors, healthcare access and utilization, health conditions and biometric measurements

Where? 24 community areas served by UI

Health

Who? (n = 890 participants)Stratum 1: 454 randomly selected adult community residents

Stratum 2 HTN: 139 UI Health adult patients with uncontrolled hypertension

Stratum 3 DM: 147 UI Health adult patients with uncontrolled diabetes

Stratum 4 asthma: 150 caregivers of UI Health pediatric patients with uncontrolled asthma

When? November 2013 - June 2014

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Pediatric asthma results1

DemographicsCharacteristics n = 150

Age, mean 7.7 years

Boys 59%

Race/Ethnicity

Non-Hispanic Black 63%

Hispanic 34%

Other 3%

Insured 100%

Public insurance 85%

Private insurance 14%

Unknown 1%

Below or equal to 138% FPL 77%

Health conditions

Born premature2 23%

Sickle cell anemia3 5%

1Children 2 - 17 years old with at least 1 UI Health ED visit Aug 2012 - Jul 2013 2Normal prevalence of sickle cell anemia: 0.2% African-American population, Total U.S. population 1 in 70,000-100,0003Prevalence of premature births in U.S. in 2013 was 11.4% 5

Weekly fast food consumption

65%

Obese50%

Overweight14%

Healthy Weight

28%

Underweight8% Weight

Gaps Identified1: All participants

Medication Adherence

Adherence (n = 149) Past 2 Weeks

Prescribed Inhaled Corticosteroid 99%

Used everyday 39%

Used > 1 day, < 14 days 22%

Never used 39%

Prescribed Montelukast 96%

Used everyday 29%

Used > 1 day, < 14 days 8%

Never used 59%

Home Environmental Modification

Home EnvironmentModifications

n = 149

Sheets washed in hot water 36%

Dehumidifier used 35%

Mattress cover used 30%

Air cleaner or purifier used 23%

Pillow cover used 22%

1Children 2 - 17 years old with at least 1 UI Health ED visit Aug 2012 - Jul 2013 6

Healthcare UtilizationAccess to care and utilization Past 12

months

Seen a doctor 99%

Has primary doctor/nurse 88%

Gone to hospital/ER 82%

Received flu vaccine 75%

Self-management education

How to usean inhaler 97%

How to usea spacer 91%

Given anaction plan 71%

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Taking asthma medications as prescribed keeps my child from getting sicker…

Extremely sure 31%

Very sure 46%

Moderately sure 14%

Somewhat sure 5%

Not at all sure 2%

Outcome expectancy

21%

Gaps Identified1: All participants

1Children 2 - 17 years old with at least 1 UI Health ED visit Aug 2012 - Jul 2013

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Demographics1: Uncontrolled asthma

1Children 2 - 17 years old with at least 1 UI Health ED visit Aug 2012 - Jul 2013

Characteristics Uncontrolled(n = 62)

Controlled (n = 88)

Comparison

Race/Ethnicity 0.03

Non-Hispanic Black 76% 54%

Hispanic 21% 43%

Other 2% 3%

Insurance <0.01

Public insurance 91% 81%

Private insurance 5% 20%

Obesity 52% 45%

Uncontrolled42%Controlled

58%

Asthma Control

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Characteristics1: Uncontrolled asthma

1Children 2 - 17 years old with at least 1 UI Health ED visit Aug 2012 - Jul 2013

Health conditions Uncontrolled(n = 63)

Controlled (n = 87)

Comparison

Allergic conditions

Eczema or skin allergy 56% 29% <0.01

Respiratory allergy 41% 24% 0.04

Food or digestive allergy 23% 12% 0.1

Other health conditions

Speech or language problems 26% 11% 0.02

Epilepsy or seizure disorder 7% 1% <0.01

Age at asthma diagnosis <0.001

< 5 years old 94% 73%

≥ 5 years old 6% 25%

Pre-paid or pay-as-you go phones

55%

Where do children with uncontrolled asthma live?

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Motivation

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PCORI contract # AS 1307-05420 Clinicaltrials.gov identifier: NCT 02319967

Study period: 03/01/2014-02/28/2017

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Who is the target audience for

discharge instructions in the ER for a child

with asthma?

• ER doctor

• ER nurse

• Child

• Caregiver

• Outpatient physician

– Pulmonologist /allergist

– Primary care

• Family members

• School nurse, teacher

• Daycare

• Others

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PCORI contract # AS 1307-05420 Clinicaltrials.gov identifier: NCT 02319967

Study period: 03/01/2014-02/28/2017

CHICAGO Action Plan after ED discharge (CAPE)

Example of a discharge instructions given to caregivers in the ED

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CHICAGO Action Plan after ED discharge (CAPE)A ‘stakeholder-balanced’ communication tool

Erwin K et al. J Compar Eff Res 201617

Erwin K et al. J Compar Eff Res 201618

Erwin K et al. J Compar Eff Res 2016 19

Erwin K et al. J Compar Eff Res 2016 20

Erwin K et al. J Compar Eff Res 2016 21

CHICAGO II:Create an Asthma Care Implementation Program (ACIP) based on a community needs assessment

1. Medical care

e.g., address practitioner’s adherence to asthma guidelines

2. Family and child

e.g., address self-management behaviors; social context of family and cultural perceptions of disease and healthcare seeking; family support; psychosocial factors such as depression and stress

3. Home

e.g., address exposure to allergens, irritants and pollutants

4. CommunityRefers to organization who primary purpose is not healthcare delivery.

e.g., school and child care environment; peer and community levels of health literacy, asthma education, programs/policies to support asthma self-management

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Collaborators in CHICAGO II

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Amelia Mutso

amutso@uic.edu

312-355-3033

PI: Jerry Krishnan, MD, PhD

Associate Vice President for Population Health

Office of the Vice Chancellor of Health Affairs

Interested in becoming involved in this city-wide initiative?

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