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Amjad S, Tromburg C, Adesunkanmi M, Mawa J, Mahbub N, Campbell S, Chari R, Rowe BH, Ospina MB. Social Determinants of Health and Pediatric Emergency Department Outcomes: A Systematic Review and Meta-Analysis of Observational Studies. Ann Emerg Med 2024; 83:291-313. [PMID: 38069966 DOI: 10.1016/j.annemergmed.2023.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 10/03/2023] [Accepted: 10/20/2023] [Indexed: 03/24/2024]
Abstract
STUDY OBJECTIVE Social determinants of health contribute to disparities in pediatric health and health care. Our objective was to synthesize and evaluate the evidence on the association between social determinants of health and emergency department (ED) outcomes in pediatric populations. METHODS This review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity Extension guidelines. Observational epidemiological studies were included if they examined at least 1 social determinant of health from the PROGRESS-Plus framework in relation to ED outcomes among children <18 years old. Effect direction plots were used for narrative results and pooled odds ratios (pOR) with 95% confidence intervals (CI) for meta-analyses. RESULTS Fifty-eight studies were included, involving 17,275,090 children and 103,296,839 ED visits. Race/ethnicity and socioeconomic status were the most reported social determinants of health (71% each). Black children had 3 times the odds of utilizing the ED (pOR 3.16, 95% CI 2.46 to 4.08), whereas visits by Indigenous children increased the odds of departure prior to completion of care (pOR 1.58, 95% CI 1.39 to 1.80) compared to White children. Public insurance, low income, neighborhood deprivation, and proximity to an ED were also predictors of ED utilization. Children whose caregivers had a preferred language other than English had longer length of stay and increased hospital admission. CONCLUSION Social determinants of health, particularly race, socioeconomic deprivation, proximity to an ED, and language, play important roles in ED care-seeking patterns of children and families. Increased utilization of ED services by children from racial minority and lower socioeconomic status groups may reflect barriers to health insurance and access to health care, including primary and subspecialty care, and/or poorer overall health, necessitating ED care. An intersectional approach is needed to better understand the trajectories of disparities in pediatric ED outcomes and to develop, implement, and evaluate future policies.
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Affiliation(s)
- Sana Amjad
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Courtney Tromburg
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Adesunkanmi
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Jannatul Mawa
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Nazif Mahbub
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Sandra Campbell
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | - Radha Chari
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Brian H Rowe
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Maria B Ospina
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada; Department of Public Health Sciences, Queen's University; Kingston, Ontario, Canada.
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Kasten-Arias C, Hodes T, Marino M, Kaufmann J, Lucas JA, Estela Vasquez Guzman C, Giebultowicz S, Chan B, Heintzman J. Healthcare utilization for asthma exacerbation among children of migrant and seasonal farmworkers. Prev Med Rep 2024; 38:102598. [PMID: 38283959 PMCID: PMC10821615 DOI: 10.1016/j.pmedr.2024.102598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/14/2023] [Accepted: 01/05/2024] [Indexed: 01/30/2024] Open
Abstract
Latino children of Migrant and Seasonal Farmworkers (MSFWs) with asthma are at risk for poor health outcomes due to medical access barriers. We compared differences in acute care utilization for asthma exacerbations among migrant and non-migrant Latino and non-Hispanic white (NHW) children at U.S. community health centers. A retrospective observational study utilizing electronic health record data from the ADVANCE Clinical Research Network of United States community health centers included 13,423 children ages 3-17 with a primary care visit between 2005 and 2017 from eight states. Emergency department (ED) and hospitalization data came from Oregon Medicaid claims. Outcomes included acute clinic visits, ED visits, and hospitalizations for asthma exacerbation. Regression analyses adjusted for patient-level covariates. Latino children had higher odds of acute clinic visits for asthma exacerbation compared to NHW children (MSFW odds ratio [OR] = 1.17, 95 % CI = 1.03-1.33; without migrant status OR = 1.13, 95 % CI = 1.03-1.23). MSFW children using Oregon Medicaid had fewer ED visits (rate ratio [RR] = 0.72, 95 % CI = 0.52-0.99) and hospitalizations (RR = 0.47, 95 % CI = 0.26-0.86) compared to NHW children. Increased community health center visits may help mitigate disparities in acute asthma care for MSFW children.
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Affiliation(s)
| | - Tahlia Hodes
- Oregon Health & Science University, Department of Family Medicine, Portland OR, USA
| | - Miguel Marino
- Oregon Health & Science University, Department of Family Medicine, Portland OR, USA
| | - Jorge Kaufmann
- Oregon Health & Science University, Department of Family Medicine, Portland OR, USA
| | - Jennifer A. Lucas
- Oregon Health & Science University, Department of Family Medicine, Portland OR, USA
| | | | | | - Brian Chan
- OCHIN, Inc. Portland, OR, USA
- Oregon Health & Science University, Department of Medicine, Division of General Internal Medicine & Geriatrics, Portland OR, USA
| | - John Heintzman
- Oregon Health & Science University, Department of Family Medicine, Portland OR, USA
- OCHIN, Inc. Portland, OR, USA
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Akin-Imran A, Bajpai A, McCartan D, Heaney LG, Kee F, Redmond C, Busby J. Ethnic variation in asthma healthcare utilisation and exacerbation: systematic review and meta-analysis. ERJ Open Res 2023; 9:00591-2022. [PMID: 37143831 PMCID: PMC10152257 DOI: 10.1183/23120541.00591-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/10/2023] [Indexed: 05/06/2023] Open
Abstract
Background Patients from ethnic minority groups (EMGs) frequently report poorer asthma outcomes; however, a broad synthesis summarising ethnic disparities is yet to be undertaken. What is the magnitude of ethnic disparities in asthma healthcare utilisation, exacerbations and mortality? Methods MEDLINE, Embase and Web of Science databases were searched for studies reporting ethnic variation in asthma healthcare outcomes (primary care attendance, exacerbation, emergency department (ED) visits, hospitalisation, hospital readmission, ventilation/intubation and mortality) between White patients and those from EMGs. Estimates were displayed using forest plots and random-effects models were used to calculate pooled estimates. We conducted subgroup analyses to explore heterogeneity, including by specific ethnicity (Black, Hispanic, Asian and other). Results 65 studies, comprising 699 882 patients, were included. Most studies (92.3%) were conducted in the United States of America (USA). Patients from EMGs had evidence suggestive of lower levels of primary care attendance (OR 0.72, 95% CI 0.48-1.09), but substantially higher ED visits (OR 1.74, 95% CI 1.53-1.98), hospitalisations (OR 1.63, 95% CI 1.48-1.79) and ventilation/intubation (OR 2.67, 95% CI 1.65-4.31) when compared to White patients. In addition, we found evidence suggestive of increased hospital readmissions (OR 1.19, 95% CI 0.90-1.57) and exacerbation rates (OR 1.10, 95% CI 0.94-1.28) among EMGs. No eligible studies explored disparities in mortality. ED visits were much higher among Black and Hispanic patients, while Asian and other ethnicities had similar rates to White patients. Conclusions EMGs had higher secondary care utilisation and exacerbations. Despite the global importance of this issue, the majority of studies were performed in the USA. Further research into the causes of these disparities, including whether these vary by specific ethnicity, is required to aid the design of effective interventions.
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Affiliation(s)
- AbdulQadr Akin-Imran
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Achint Bajpai
- University of Central Lancashire, University of Central Lancashire Faculty of Clinical and Biomedical Sciences, Preston, UK
| | - Dáire McCartan
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Liam G. Heaney
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Frank Kee
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Charlene Redmond
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - John Busby
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
- Corresponding author: John Busby ()
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Cushman GK, Koinis-Mitchell D, Alsina M, Barker D, Drew L, DeCesare C, Yeo AJ, Durkin K, Elwy AR, Jandasek B, Pearlman DN, Vivier P, McQuaid EL. Design of a community-based, Hybrid Type II effectiveness-implementation asthma intervention study: The Rhode Island Asthma Integrated Response (RI-AIR) program. Contemp Clin Trials 2023; 129:107204. [PMID: 37088129 PMCID: PMC11157426 DOI: 10.1016/j.cct.2023.107204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Pediatric asthma is among the most common health conditions and disproportionately impacts Black and Latino children. Gaps in asthma care exist and may contribute to racial and ethnic inequities. The Rhode Island Asthma Integrated Response (RI-AIR) program was developed to address current limitations in care. The aims of the RI-AIR Hybrid Type II effectiveness-implementation trial were to: a) simultaneously evaluate the effectiveness of RI-AIR on individual-level and community-level outcomes; b) evaluate implementation strategies used to increase uptake of RI-AIR. In this manuscript, we outline the design and methods used to implement RI-AIR. METHODS School-based areas (polygons) with the highest asthma-related urgent healthcare utilization in Greater Providence, R.I., were identified using geospatial mapping. Families with eligible children (2-12 years) living in one of the polygons received evidence-based school- and/or home-based asthma management interventions, based on asthma control level. School-based interventions included child and caregiver education programs and school staff trainings. Home-based interventions included individualized asthma education, home-environmental assessments, and strategies and supplies for trigger remediation. Implementation strategies included engaging school nurse teachers as champions, tailoring interventions to school preferences, and engaging families for input. RESULTS A total of 6420 children were screened throughout the study period, 811 were identified as eligible, and 433 children were enrolled between November 2018 and December 2021. CONCLUSIONS Effective implementation of pediatric asthma interventions is essential to decrease health inequities and improve asthma management. The RI-AIR study serves as an example of a multi-level intervention to improve outcomes and reduce disparities in pediatric chronic disease. CLINICAL TRIALS REGISTRATION NUMBER NCT03583814.
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Affiliation(s)
- Grace K Cushman
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA; Bradley-Hasbro Children's Research Center, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA
| | - Daphne Koinis-Mitchell
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA; Bradley-Hasbro Children's Research Center, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA; Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Miosotis Alsina
- Bradley-Hasbro Children's Research Center, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA
| | - David Barker
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA; Bradley-Hasbro Children's Research Center, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA
| | - Linnea Drew
- Bradley-Hasbro Children's Research Center, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA
| | - Catherine DeCesare
- Bradley-Hasbro Children's Research Center, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA
| | - Anna J Yeo
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA; Bradley-Hasbro Children's Research Center, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA; Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Kristine Durkin
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA; Bradley-Hasbro Children's Research Center, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA
| | - A Rani Elwy
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Barbara Jandasek
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA; Bradley-Hasbro Children's Research Center, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA; Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Deborah N Pearlman
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Patrick Vivier
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Elizabeth L McQuaid
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA; Bradley-Hasbro Children's Research Center, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA; Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA.
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Delgado-Martinez R, Barry MF, Porras-Javier L, Thompson LR, Howard BJ, Sturner R, Halterman JS, Szilagyi PG, Okelo SO, Dudovitz RN. What Parents Want Doctors to Know: Responses to an Open-Ended Item on an Asthma Questionnaire. Acad Pediatr 2022; 22:657-666. [PMID: 34800723 DOI: 10.1016/j.acap.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Unstructured parental comments could solicit important information about children's asthma, yet are rarely captured in clinical asthma questionnaires. This mixed-methods study describes parents' written responses to an open-ended question in a validated asthma questionnaire. METHODS The Pediatric Asthma Control and Communication Instrument (PACCI) asthma questionnaire was administered to parents of children with asthma symptoms presenting to 48 pediatric primary care offices (PPCP), 1 pediatric pulmonology office, and 1 emergency department (ED). Responses to the question, "Please write down any concern or anything else you would like your doctor to know about your child's asthma" were analyzed using a phenomenological approach until thematic saturation was achieved for each site. Logistic regressions tested whether sociodemographic and clinical characteristics were associated with responding to the open-ended question. RESULTS Of 7,988 parents who completed the PACCI, 954 (12%) responded to the open-ended question-2% in PPCP, 31% in the ED, and 50% in the pulmonary setting. More severe asthma was associated with higher odds of responding (odds ratio, 2.01; 95% confidence interval, 1.42-2.84). Based on responses provided, we identified 3 communication types: 1) clarifying symptoms, 2) asking questions, and 3) communicating distress. Responses also covered 5 asthma-related themes: 1) diagnostic uncertainty, 2) understanding asthma etiology and prognosis, 3) medication management, 4) impact on child function, and 5) personal asthma characteristics. CONCLUSION Parents of children with severe asthma provided clarifying details, asked questions, and relayed health concerns and distress. None of these topics may be easily captured by closed-ended asthma questionnaires.
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Affiliation(s)
- Roxana Delgado-Martinez
- Department of Pediatrics, The David Geffen School of Medicine at UCLA (R Delgado-Martinez, M Venegas, F Barry, L Porras-Javier, PG Szilagyi, SO Okelo, and RN Dudovitz), Los Angeles, Calif.
| | - Melanie Frances Barry
- Department of Pediatrics, The Johns Hopkins University School of Medicine (BJ Howard and R Sturner), Baltimore, Md
| | - Lorena Porras-Javier
- Department of Pediatrics, The David Geffen School of Medicine at UCLA (R Delgado-Martinez, M Venegas, F Barry, L Porras-Javier, PG Szilagyi, SO Okelo, and RN Dudovitz), Los Angeles, Calif
| | - Lindsey R Thompson
- Kaiser Permanente Bernard J. Tyson School of Medicine (LR Thompson), Pasadena, Calif
| | - Barbara J Howard
- Department of Pediatrics, The Johns Hopkins University School of Medicine (BJ Howard and R Sturner), Baltimore, Md
| | - Raymond Sturner
- Department of Pediatrics, The Johns Hopkins University School of Medicine (BJ Howard and R Sturner), Baltimore, Md
| | - Jill S Halterman
- Department of Pediatrics, University of Rochester School of Medicine (JS Halterman), Rochester, NY
| | - Peter G Szilagyi
- Department of Pediatrics, The David Geffen School of Medicine at UCLA (R Delgado-Martinez, M Venegas, F Barry, L Porras-Javier, PG Szilagyi, SO Okelo, and RN Dudovitz), Los Angeles, Calif
| | - Sande O Okelo
- Department of Pediatrics, The David Geffen School of Medicine at UCLA (R Delgado-Martinez, M Venegas, F Barry, L Porras-Javier, PG Szilagyi, SO Okelo, and RN Dudovitz), Los Angeles, Calif
| | - Rebecca N Dudovitz
- Department of Pediatrics, The David Geffen School of Medicine at UCLA (R Delgado-Martinez, M Venegas, F Barry, L Porras-Javier, PG Szilagyi, SO Okelo, and RN Dudovitz), Los Angeles, Calif
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Banta JE, Ramadan M, Alhusseini N, Aloraini K, Modeste N. Socio-demographics and asthma prevalence, management, and outcomes among children 1-11 years of age in California. Glob Health Res Policy 2021; 6:17. [PMID: 34039445 PMCID: PMC8157798 DOI: 10.1186/s41256-021-00199-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 05/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background Asthma disproportionately affects minority and low-income children. We examined asthma prevalence, management and outcomes, focusing on race/ethnicity and acculturation of parents (particularly English language proficiency). Methods This cross-sectional, correlational analysis used a de-identified population-based survey, the California Health Interview Survey, for years 2001–2015. Survey-weighted analysis with SAS 9.4 was used to determine asthma prevalence among children 1 to 11 years of age. Descriptive analysis was conducted, adjusting for survey design and combination of multiple years of data. The Pearson test, using design-based F values was used to determine statistically significant differences between those having/not having a doctor diagnosis of asthma. Multivariable logistic regression, with jackknife approach to obtain confidence intervals, was used to examine associations of child and parental characteristics with asthma prevalence, management, and outcomes. Results The 61,625 completed surveys represented an estimated annual population of 5.7 million children, of which 12.9 % had asthma. There were significant (p < 0.001) differences by age, gender, race, and language proficiency, with higher asthma prevalence for children 6 to 11 years of age (15.5 %), males (15.3 %), African Americans (19.5 %), and parents speaking English very well (14.1 %). Compared to children whose parents spoke English very well, those whose parents spoke English not well or not at all were less likely to achieve optimal asthma management, i.e. to have received a management plan from doctor (OR 0.30; 95 % Confidence Interval 0.20–0.46)), to be currently taking medication to control asthma (OR 0.52; 95 % CI 0.36–0.74)), or to be not confident in ability to control asthma (OR 3.10; 95 % CI 1.49–6.42). Children whose parents spoke English fairly well rather than very well had worse outcomes, i.e. were more likely to have an emergency room visit in past 12 months (OR 1.92; 95 % CI 1.03–3.61) and were more likely to miss school due to asthma in past 12 months (OR 0.71; 1.01–2.94). Conclusions Socio-demographics had a limited role in explaining differences across a handful of asthma management and outcome measures in California. Parental English language proficiency had the most consistent influence, underscoring the need for culturally and linguistically competent care.
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Affiliation(s)
- Jim E Banta
- Loma Linda University School of Public Health, 24951 Circle Dr, CA, 92354, Loma Linda, USA.
| | - Majed Ramadan
- Loma Linda University School of Public Health, 24951 Circle Dr, CA, 92354, Loma Linda, USA
| | - Noara Alhusseini
- College of Medicine, Alfaisal University, 7746 Ibrahim Alziady St., Alwurud District, 12253 2499, Riyadh, Saudi Arabia
| | - Khaled Aloraini
- Loma Linda University School of Public Health, 24951 Circle Dr, CA, 92354, Loma Linda, USA
| | - Naomi Modeste
- Loma Linda University School of Public Health, 24951 Circle Dr, CA, 92354, Loma Linda, USA
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Giannouchos TV, Washburn DJ, Gary JC, Foster MJ. Frequent emergency department use in the paediatric population: A systematic literature review. J Eval Clin Pract 2021; 27:193-203. [PMID: 32141125 DOI: 10.1111/jep.13382] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/07/2020] [Accepted: 02/14/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We systematically reviewed the literature on paediatric frequent emergency department (ED) users to identify and to synthesize characteristics and factors associated with frequent ED utilization among this population in the United States. METHODS We searched Medline (Ovid), CINAHL (Ebsco), and Embase (Ovid) to identify all relevant studies after 1990. We focused on US studies analysing paediatric frequent ED (PFED) users excluding those focused on specific subgroups. Two reviewers independently selected articles and extracted data on predisposing, enabling, behavioural, need and reinforcing factors. RESULTS Fifteen studies met the inclusion criteria. PFED users comprised 3% to 14% of all paediatric ED users and accounted for 9% to 42% of all paediatric ED visits in 11 studies that defined frequent use as four to six ED visits per year. Most PFED users were less than 5 years old who had public insurance coverage and a regular provider. Public insurance compared to private residency in disadvantaged areas, having at least one chronic or complex condition and a history of hospitalization, were associated with frequent use. Children who had a regular primary care provider were less likely to exhibit frequent ED use. CONCLUSIONS Minimizing unnecessary ED visits by frequent utilizers is a quality improvement and cost-saving priority for health systems. Our findings indicate that many PFED users have greater healthcare needs and face barriers accessing care in a timely manner, even though some have regular providers. To better address the needs of this vulnerable group, health systems should focus on educating caregivers and expanding access to providers in other settings.
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Affiliation(s)
- Theodoros V Giannouchos
- School of Public Health, Department of Health Policy and Management, Texas A&M University, College Station, Texas, USA.,Population Informatics Lab, Texas A&M University, College Station, Texas, USA
| | - David J Washburn
- School of Public Health, Department of Health Policy and Management, Texas A&M University, College Station, Texas, USA
| | - Jodie C Gary
- Health Science Center College of Nursing, Texas A&M University, Bryan, Texas, USA
| | - Margaret J Foster
- Medical Sciences Library, Texas A&M University, College Station, Texas, USA
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Lewis LM, Mirabelli MC, Beavers SF, Kennedy CM, Shriber J, Stearns D, Morales González JJ, Santiago MS, Félix IM, Ruiz-Serrano K, Dirlikov E, Lozier MJ, Sircar K, Flanders WD, Rivera-García B, Irizarry-Ramos J, Bolaños-Rosero B. Characterizing environmental asthma triggers and healthcare use patterns in Puerto Rico. J Asthma 2020; 57:886-897. [PMID: 31187658 PMCID: PMC8225466 DOI: 10.1080/02770903.2019.1612907] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 03/15/2019] [Accepted: 04/24/2019] [Indexed: 10/26/2022]
Abstract
Objective: Asthma carries a high burden of disease for residents of Puerto Rico. We conducted this study to better understand asthma-related healthcare use and to examine potential asthma triggers.Methods: We characterized asthma-related healthcare use in 2013 by demographics, region, and date using outpatient, hospital, and emergency department (ED) insurance claims with a primary diagnostic ICD-9-CM code of 493.XX. We examined environmental asthma triggers, including outdoor allergens (i.e., mold and pollen), particulate pollution, and influenza-like illness. Analyses included descriptive statistics and Poisson time-series regression.Results: During 2013, there were 550,655 medical asthma claims reported to the Puerto Rico Healthcare Utilization database, representing 148 asthma claims/1,000 persons; 71% of asthma claims were outpatient visits, 19% were hospitalizations, and 10% were ED visits. Females (63%), children aged ≤9 years (77% among children), and adults aged ≥45 years (80% among adults) had the majority of asthma claims. Among health regions, Caguas had the highest asthma claim-rate at 142/1,000 persons (overall health region claim-rate = 108). Environmental exposures varied across the year and demonstrated seasonal patterns. Metro health region regression models showed positive associations between increases in mold and particulate matter <10 microns in diameter (PM10) and outpatient asthma claims.Conclusions: This study provides information about patterns of asthma-related healthcare use across Puerto Rico. Increases in mold and PM10 were associated with increases in asthma claims. Targeting educational interventions on exposure awareness and reduction techniques, especially to persons with higher asthma-related healthcare use, can support asthma control activities in public health and clinical settings.
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Affiliation(s)
- Lillianne M. Lewis
- Centers for Disease Control and Prevention, Asthma and Community Health Branch, National Center for Environmental Health, Atlanta, GA, USA
- Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, GA, USA
| | - Maria C. Mirabelli
- Centers for Disease Control and Prevention, Asthma and Community Health Branch, National Center for Environmental Health, Atlanta, GA, USA
| | - Suzanne F. Beavers
- Centers for Disease Control and Prevention, Asthma and Community Health Branch, National Center for Environmental Health, Atlanta, GA, USA
| | - Caitlin M. Kennedy
- Centers for Disease Control and Prevention, Lead Poisoning Prevention and Environmental Health Tracking Branch, National Center for Environmental Health, Atlanta, GA, USA
| | - Jennifer Shriber
- Centers for Disease Control and Prevention, Lead Poisoning Prevention and Environmental Health Tracking Branch, National Center for Environmental Health, Atlanta, GA, USA
| | - Dorothy Stearns
- Centers for Disease Control and Prevention, Asthma and Community Health Branch, National Center for Environmental Health, Atlanta, GA, USA
| | | | - Marimer Soto Santiago
- Puerto Rico Department of Health, Office of Epidemiology and Investigation, San Juan, Puerto Rico, USA
| | - Ibis Montalvo Félix
- Puerto Rico Department of Health, Puerto Rico Asthma Program, Division for the Prevention and Control of Chronic Diseases, San Juan, Puerto Rico, USA
| | - Krystel Ruiz-Serrano
- Puerto Rico Department of Health, Puerto Rico Asthma Program, Division for the Prevention and Control of Chronic Diseases, San Juan, Puerto Rico, USA
| | - Emilio Dirlikov
- Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, GA, USA
- Puerto Rico Department of Health, Office of Epidemiology and Investigation, San Juan, Puerto Rico, USA
| | - Matthew J. Lozier
- Centers for Disease Control and Prevention, Dengue Branch, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA, USA
| | - Kanta Sircar
- Centers for Disease Control and Prevention, Asthma and Community Health Branch, National Center for Environmental Health, Atlanta, GA, USA
| | - W. Dana Flanders
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Brenda Rivera-García
- Puerto Rico Department of Health, Office of Epidemiology and Investigation, San Juan, Puerto Rico, USA
| | - Jessica Irizarry-Ramos
- Puerto Rico Department of Health, Puerto Rico Asthma Program, Division for the Prevention and Control of Chronic Diseases, San Juan, Puerto Rico, USA
| | - Benjamin Bolaños-Rosero
- Department of Microbiology, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, USA
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Dowell JA, Ruiz Z. Visto, Pero No Escuchado: A Qualitative Arm of a Mixed-Methods Study of Puerto Rican Children With Asthma. HISPANIC HEALTH CARE INTERNATIONAL 2020; 18:150-157. [PMID: 31910679 DOI: 10.1177/1540415319899105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Communication among health care providers, caregivers, and children with asthma is challenging and sometimes may exclude the child. This may result in delay in recognizing and responding appropriately to asthma symptoms. The purpose was to conduct focus groups among Puerto Rican children with asthma on communication with their health care provider about their asthma symptoms. METHOD The qualitative arm (focus groups) of a mixed-method explanatory sequential study that was used to view communication with their health care provider through the lens of a group of Puerto Rican children. The sample included Puerto Rican children ages 8 to 12 years with asthma (N = 23). The goal was to develop a child illness representation questionnaire. RESULTS The perspective of children with asthma provided enriched information to influence the development of instrument subscale on communication. The children were often not heard during a clinical visit. Most of the children express fear of their health care provider. CONCLUSIONS Although this was a small sample, there were indications that children would like to opportunity to tell the story about their experience with having asthma. Further research will lead to the next step toward developing and computing a reliable measure that includes the child in a discussion during a clinical visit.
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Children with Asthma and Communication with Healthcare Provider: Instrument Development. J Pediatr Nurs 2020; 50:81-88. [PMID: 31783339 DOI: 10.1016/j.pedn.2019.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 11/08/2019] [Accepted: 11/09/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE Communication among healthcare providers, caregivers and children with asthma is challenging and sometimes may exclude the child. This may result in delay in recognizing and responding appropriately to asthma symptoms. The purpose was to test an instrument's subscale for content validity related to communication with the healthcare provider by examining age appropriateness, readability and clarity for children with asthma. DESIGN AND METHODS This was a mixed method explanatory sequential design to examine age appropriateness, readability and clarity for a 15-item subscale of an instrument for children. The qualitative arm (focus groups) was used to enrich the questionnaire. The sample included children ages 8 to 12 with asthma (N = 25). RESULTS The perspective of children with asthma provided enriched information to influence the development of instrument subscale on communication. CONCLUSIONS The subscale revealed internal consistency with Cronbach Alpha 0.85. One of the children reported that using the term "provider" was clearer as oppose to healthcare provider. Children participating in the study found readable and clear. A readability analysis revealed the items were readable at a 6th grade level. PRACTICE IMPLICATION Although the instrument is designed for primary care providers (physicians, nurse practitioners, physician assistants), the information gained from this pilot increases understanding about including the child in a triadic discussion. Further research will lead to next step toward computing reliability of the full measure and a factor analysis.
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11
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Ardura-Garcia C, Arias E, Hurtado P, Bonnett LJ, Sandoval C, Maldonado A, Workman LJ, Platts-Mills TAE, Cooper PJ, Blakey JD. Predictors of severe asthma attack re-attendance in Ecuadorian children: a cohort study. Eur Respir J 2019; 54:1802419. [PMID: 31515399 PMCID: PMC6860994 DOI: 10.1183/13993003.02419-2018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 08/11/2019] [Indexed: 01/23/2023]
Abstract
Asthma is a common cause of emergency care attendance in low- and middle-income countries (LMICs). While few prospective studies of predictors for emergency care attendance have been undertaken in high-income countries, none have been performed in a LMIC.We followed a cohort of 5-15-year-old children treated for asthma attacks in emergency rooms of public health facilities in Esmeraldas City, Ecuador. We collected blood and nasal wash samples, and performed spirometry and exhaled nitric oxide fraction measurements. We explored potential predictors for recurrence of severe asthma attacks requiring emergency care over 6 months' follow-up.We recruited 283 children of whom 264 (93%) were followed-up for ≥6 months or until their next asthma attack. Almost half (46%) had a subsequent severe asthma attack requiring emergency care. Predictors of recurrence in adjusted analyses were (adjusted OR, 95% CI) younger age (0.87, 0.79-0.96 per year), previous asthma diagnosis (2.2, 1.2-3.9), number of parenteral corticosteroid courses in previous year (1.3, 1.1-1.5), food triggers (2.0, 1.1-3.6) and eczema diagnosis (4.2, 1.02-17.6). A parsimonious Cox regression model included the first three predictors plus urban residence as a protective factor (adjusted hazard ratio 0.69, 95% CI 0.50-0.95). Laboratory and lung function tests did not predict recurrence.Factors independently associated with recurrent emergency attendance for asthma attacks were identified in a low-resource LMIC setting. This study suggests that a simple risk-assessment tool could potentially be created for emergency rooms in similar settings to identify higher-risk children on whom limited resources might be better focused.
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Affiliation(s)
- Cristina Ardura-Garcia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Erick Arias
- Fundación Ecuatoriana Para Investigación en Salud, Quito, Ecuador
| | - Paola Hurtado
- Fundación Ecuatoriana Para Investigación en Salud, Quito, Ecuador
| | - Laura J Bonnett
- Dept of Biostatistics, University of Liverpool, Liverpool, UK
| | - Carlos Sandoval
- Fundación Ecuatoriana Para Investigación en Salud, Quito, Ecuador
| | - Augusto Maldonado
- Colegio de Ciencias de la Salud, Universidad San Francsico de Quito, Quito, Ecuador
| | - Lisa J Workman
- Asthma and Allergic Diseases Center, University of Virginia, Charlottesville, VA, USA
| | | | - Philip J Cooper
- Fundación Ecuatoriana Para Investigación en Salud, Quito, Ecuador
- Facultad de Ciencias Medicas, de la Salud y la Vida, Universidad Internacional del Ecuador, Quito, Ecuador
- Institute of Infection and Immunity, St George's University of London, London, UK
- Both authors contributed equally
| | - John D Blakey
- Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
- Medical School, Curtin University, Perth, Australia
- Both authors contributed equally
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Ardura-Garcia C, Stolbrink M, Zaidi S, Cooper PJ, Blakey JD. Predictors of repeated acute hospital attendance for asthma in children: A systematic review and meta-analysis. Pediatr Pulmonol 2018; 53:1179-1192. [PMID: 29870146 PMCID: PMC6175073 DOI: 10.1002/ppul.24068] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/15/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Asthma attacks are common and have significant physical, psychological, and financial consequences. Improving the assessment of a child's risk of subsequent asthma attacks could support front-line clinicians' decisions on augmenting chronic treatment or specialist referral. We aimed to identify predictors for emergency department (ED) or hospital readmission for asthma from the published literature. METHODS We searched MEDLINE, EMBASE, AMED, PsycINFO, and CINAHL with no language, location, or time restrictions. We retrieved observational studies and randomized controlled trials (RCT) assessing factors (personal and family history, and biomarkers) associated with the risk of ED re-attendance or hospital readmission for acute childhood asthma. RESULTS Three RCTs and 33 observational studies were included, 31 from Anglophone countries and none from Asia or Africa. There was an unclear or high risk of bias in 14 of the studies, including 2 of the RCTs. Previous history of emergency or hospital admissions for asthma, younger age, African-American ethnicity, and low socioeconomic status increased risk of subsequent ED and hospital readmissions for acute asthma. Female sex and concomitant allergic diseases also predicted hospital readmission. CONCLUSION Despite the global importance of this issue, there are relatively few high quality studies or studies from outside North America. Factors other than symptoms are associated with the risk of emergency re-attendance for acute asthma among children. Further research is required to better quantify the risk of future attacks and to assess the role of commonly used biomarkers.
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Affiliation(s)
| | | | - Seher Zaidi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Philip J Cooper
- Facultad de Ciencias Medicas, de la Salud y la Vida, Universidad Internacional del Ecuador, Quito, Ecuador.,Institute of Infection and Immunity, St George's University of London, London, UK
| | - John D Blakey
- Respiratory Medicine, Royal Liverpool Hospital, Liverpool, UK.,Health Services Research, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
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13
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Agnihotri NT, Pade KH, Vangala S, Thompson LR, Wang VJ, Okelo SO. Predictors of prior asthma specialist care among pediatric patients seen in the emergency department for asthma. J Asthma 2018; 56:816-822. [PMID: 29972331 DOI: 10.1080/02770903.2018.1493600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Asthma guidelines recommend specialist care for patients experiencing poor asthma outcomes during emergency department (ED) visits. The prevalence and predictors of asthma specialist care among an ED population seeking pediatric asthma care are unknown. Objective: To examine, in an ED population, factors associated with prior asthma specialist use based on parental reports of prior asthma morbidity and asthma care. Methods: Parents of children ages 0 to 17 years seeking ED asthma care were surveyed regarding socio-demographics, asthma morbidity, asthma management and current asthma specialist care status. We compared prior asthma care and morbidity between those currently cared for by an asthma specialist versus not. Multivariable logistic regression models to predict factors associated with asthma specialist use were adjusted for parent education and insurance type. Results: Of 150 children (62% boys, mean age 4.7 years, 69% Hispanic), 22% reported asthma specialist care, 75% did not see a specialist and for 3% specialist status was unknown. Care was worse for those not seeing a specialist, including under-use of controller medications (24% vs. 64%, p < 0.001) and asthma action plans (20% vs. 62%, p < 0.001). Multivariable logistic regression revealed that lack of recommendation by the primary care physician reduced the odds of specialist care (OR 0.01, 95% CI <0.01, 0.05, p < 0.001). Conclusions: Asthma specialist care was infrequent among this pediatric ED population, consistent with the sub-optimal chronic asthma care we observed. Prospective trials should further investigate if systematic referral to asthma specialists during/after an ED encounter would improve asthma outcomes.
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Affiliation(s)
- Neha T Agnihotri
- a Department of Internal Medicine and Pediatrics, The David Geffen School of Medicine at UCLA , Los Angeles , CA , USA
| | - Kathryn H Pade
- b Division of Emergency & Transport Medicine, Children's Hospital Los Angeles, University of Southern California , Los Angeles , CA , USA
| | - Sitaram Vangala
- c Division of General Internal Medicine and Health Services Research, The David Geffen School of Medicine at UCLA , Los Angeles , CA , USA
| | - Lindsey R Thompson
- d Department of Pediatrics, The David Geffen School of Medicine at UCLA , Los Angeles , CA , USA
| | - Vincent J Wang
- b Division of Emergency & Transport Medicine, Children's Hospital Los Angeles, University of Southern California , Los Angeles , CA , USA
| | - Sande O Okelo
- d Department of Pediatrics, The David Geffen School of Medicine at UCLA , Los Angeles , CA , USA
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14
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Buelo A, McLean S, Julious S, Flores-Kim J, Bush A, Henderson J, Paton JY, Sheikh A, Shields M, Pinnock H. At-risk children with asthma (ARC): a systematic review. Thorax 2018; 73:813-824. [PMID: 29871982 PMCID: PMC6109248 DOI: 10.1136/thoraxjnl-2017-210939] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 04/12/2018] [Accepted: 04/16/2018] [Indexed: 01/15/2023]
Abstract
Introduction Asthma attacks are responsible for considerable morbidity and may be fatal. We aimed to identify and weight risk factors for asthma attacks in children (5–12 years) in order to inform and prioritise care. Methods We systematically searched six databases (May 2016; updated with forward citations January 2017) with no language/date restrictions. Two reviewers independently selected studies for inclusion, assessed study quality and extracted data. Heterogeneity precluded meta-analysis. Weighting was undertaken by an Expert Panel who independently assessed each variable for degree of risk and confidence in the assessment (based on study quality and size, effect sizes, biological plausibility and consistency of results) and then achieved consensus by discussion. Assessments were finally presented, discussed and agreed at a multidisciplinary workshop. Results From 16 109 records, we included 68 papers (28 cohort; 4 case-control; 36 cross-sectional studies). Previous asthma attacks were associated with greatly increased risk of attack (ORs between 2.0 and 4.1). Persistent symptoms (ORs between 1.4 and 7.8) and poor access to care (ORs between 1.2 and 2.3) were associated with moderately/greatly increased risk. A moderately increased risk was associated with suboptimal drug regimen, comorbid atopic/allergic disease, African-American ethnicity (USA), poverty and vitamin D deficiency. Environmental tobacco smoke exposure, younger age, obesity and low parental education were associated with slightly increased risk. Discussion Assessment of the clinical and demographic features identified in this review may help clinicians to focus risk reduction management on the high-risk child. Population level factors may be used by health service planners and policymakers to target healthcare initiatives. Trial registration number CRD42016037464.
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Affiliation(s)
- Audrey Buelo
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Susannah McLean
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Steven Julious
- Medical Statistics Group, ScHARR, University of Sheffield, Sheffield, UK
| | - Javier Flores-Kim
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Andy Bush
- Department of Paediatric Respiratory Medicine, Imperial College and Royal Brompton Hospital, London, UK
| | - John Henderson
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - James Y Paton
- School of Medicine, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Michael Shields
- Centre for Experimental Medicine, Queen's University, Belfast, UK
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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Martin SR, Boergers J, Kopel SJ, McQuaid EL, Seifer R, LeBourgeois M, Klein RB, Esteban CA, Fritz GK, Koinis-Mitchell D. Sleep Hygiene and Sleep Outcomes in a Sample of Urban Children With and Without Asthma. J Pediatr Psychol 2017; 42:825-836. [PMID: 28369539 PMCID: PMC5896601 DOI: 10.1093/jpepsy/jsx052] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/27/2017] [Accepted: 01/28/2017] [Indexed: 01/07/2023] Open
Abstract
Objective To assess sleep hygiene and the sleep environment of urban children with and without asthma, and examine the associations among urban stressors, sleep hygiene, and sleep outcomes. Methods Urban children, 7-9 years old, with (N = 216) and without (N = 130) asthma from African American, Latino, or non-Latino White backgrounds were included. Level of neighborhood risk was used to describe urban stress. Parent-reported sleep hygiene and daytime sleepiness data were collected using questionnaires. Sleep duration and efficiency were assessed via actigraphy. Results Higher neighborhood risk, not asthma status, was associated with poorer sleep hygiene. Controlling for neighborhood risk, sleep hygiene was related to daytime sleepiness. Asthma status, not sleep hygiene, was related to sleep efficiency. In children with asthma, poorer sleep hygiene was associated with shorter sleep duration. Conclusion Considering urban stressors when treating pediatric populations is important, as factors related to urban stress may influence sleep hygiene practices and sleep outcomes.
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Affiliation(s)
- Sarah R. Martin
- Bradley/Hasbro Children’s Research Center
- Alpert Medical School, Brown University
| | - Julie Boergers
- Bradley/Hasbro Children’s Research Center
- Alpert Medical School, Brown University
| | - Sheryl J. Kopel
- Bradley/Hasbro Children’s Research Center
- Alpert Medical School, Brown University
| | - Elizabeth L. McQuaid
- Bradley/Hasbro Children’s Research Center
- Alpert Medical School, Brown University
| | - Ronald Seifer
- Bradley/Hasbro Children’s Research Center
- Alpert Medical School, Brown University
| | | | | | - Cynthia A. Esteban
- Alpert Medical School, Brown University
- Hasbro Children’s Hospital/Rhode Island Hospital
| | - Gregory K. Fritz
- Bradley/Hasbro Children’s Research Center
- Alpert Medical School, Brown University
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Das LT, Abramson EL, Stone AE, Kondrich JE, Kern LM, Grinspan ZM. Predicting frequent emergency department visits among children with asthma using EHR data. Pediatr Pulmonol 2017; 52:880-890. [PMID: 28557381 DOI: 10.1002/ppul.23735] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/24/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE For children with asthma, emergency department (ED) visits are common, expensive, and often avoidable. Though several factors are associated with ED use (demographics, comorbidities, insurance, medications), its predictability using electronic health record (EHR) data is understudied. METHODS We used a retrospective cohort study design and EHR data from one center to examine the relationship of patient factors in 1 year (2013) and the likelihood of frequent ED use (≥2 visits) in the following year (2014), using bivariate and multivariable statistics. We applied and compared several machine-learning algorithms to predict frequent ED use, then selected a model based on accuracy, parsimony, and interpretability. RESULTS We identified 2691 children. In bivariate analyses, future frequent ED use was associated with demographics, co-morbidities, insurance status, medication history, and use of healthcare resources. Machine learning algorithms had very good AUC (area under the curve) values [0.66-0.87], though fair PPV (positive predictive value) [48-70%] and poor sensitivity [16-27%]. Our final multivariable logistic regression model contained two variables: insurance status and prior ED use. For publicly insured patients, the odds of frequent ED use were 3.1 [2.2-4.5] times that of privately insured patients. Publicly insured patients with 4+ ED visits and privately insured patients with 6+ ED visits in a year had ≥50% probability of frequent ED use the following year. The model had an AUC of 0.86, PPV of 56%, and sensitivity of 23%. CONCLUSION Among children with asthma, prior frequent ED use and insurance status strongly predict future ED use.
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Affiliation(s)
- Lala T Das
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York
| | - Erika L Abramson
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York.,Department of Pediatrics, Weill Cornell Medicine, New York, New York.,New York Presbyterian Hospital, New York, New York
| | - Anne E Stone
- Department of Pediatrics, Weill Cornell Medicine, New York, New York.,New York Presbyterian Hospital, New York, New York
| | - Janienne E Kondrich
- Department of Pediatrics, Weill Cornell Medicine, New York, New York.,New York Presbyterian Hospital, New York, New York
| | - Lisa M Kern
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York.,New York Presbyterian Hospital, New York, New York.,Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Zachary M Grinspan
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York.,Department of Pediatrics, Weill Cornell Medicine, New York, New York.,New York Presbyterian Hospital, New York, New York
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Lin SX, Younge RG, Kleinman LC. Does receiving care in a medical home reduce racial/ethnic disparities in ED visits among children with asthma in the United States? J Child Health Care 2017; 21:25-35. [PMID: 27422845 DOI: 10.1177/1367493516656825] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Evidence has shown the implementation of medical home model improves care quality and outcomes. However, it is not clear whether receiving care from a medical home has any impact on racial/ethnic disparities in emergency department (ED) use by children with asthma. This study using the US National Survey of Children with Special Health Care Needs, 2009-2010, estimated racial/ethnic disparities in ED use. Generalized liner models were used to examine factors associated with ED use. Racial/ethnic differences in ED use were attenuated after adjusting for socio-economic variables. Ratios of prevalence ratios were calculated to examine the effect modification of medical home on ED use associated with race/ethnicity. The adjusted prevalence ratio of ED use of the Black to non-Hispanic White was 1.51 (95% confidence interval (CI): 1.36-1.67) with medical home and 1.35 (95% CI: 1.24-1.47) without medical home. Among those with care from a medical home Latino children had higher ED use compared with White children. There is no evidence that the self-reported care from a medical home narrows the gaps in ED use between non-Hispanic White and Black or Latino children with asthma.
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Affiliation(s)
- Susan X Lin
- 1 Center for Family and Community Medicine, Columbia University Medical Center, New York, NY, USA
| | - Richard G Younge
- 1 Center for Family and Community Medicine, Columbia University Medical Center, New York, NY, USA
| | - Lawrence C Kleinman
- 2 Departments of Pediatrics and Population Health Sciences and Policy , Icahn School of Medicine at Mount Sinai, New York, NY, USA.,3 Center for Child Health and Policy and Department of Pediatrics UH Rainbow Babies & Children's Hospital and Case Western Reserve University, Cleveland, OH, USA
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18
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Everhart RS, Miadich SA, Leibach GG, Borschuk AP, Koinis-Mitchell D. Acculturation and quality of life in urban, African American caregivers of children with asthma. J Asthma 2016; 53:983-8. [PMID: 27115558 DOI: 10.3109/02770903.2016.1167904] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Racial/ethnic minority caregivers of children with asthma are at risk for low levels of quality of life (QOL). Limited research has identified factors that contribute to lower QOL among African American caregivers. This study examined associations between acculturation (e.g., engaging in values/beliefs traditional of one's culture versus adopting mainstream cultural views) and caregiver QOL in low-income, urban African American families of children (7-12 years) with persistent asthma. We also investigated the association between caregiver QOL and child emergency department (ED) use. METHODS Fifty-five caregivers and their children completed interview-based questionnaires in a single research session. Caregivers completed the Pediatric Asthma Caregiver Quality of Life Questionnaire (PACQLQ), the African American Acculturation Scale-Revised (AAAS-R), and reported on child asthma variables. Children completed items assessing asthma control. RESULTS Higher overall QOL and emotional function subscale scores were associated with more traditional African American religious beliefs/practices (r = .288, p = .033; r = .333, p = .013). Higher emotional function subscale scores were associated with more traditional values of African American families (r = .306, p = .023). Lower QOL was found among caregivers of children who had visited the ED three or more times in the last year. CONCLUSIONS Less acculturation tied to religious beliefs/practices and family values (as measured by the AAAS-R) may serve a protective role in reducing the burden low-income, urban African American caregivers experience in managing child asthma. This study is the first of its kind to study acculturation in African American caregivers of children with asthma.
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Affiliation(s)
- Robin S Everhart
- a Virginia Commonwealth University , Department of Psychology , Richmond , VA , USA
| | - Samantha A Miadich
- a Virginia Commonwealth University , Department of Psychology , Richmond , VA , USA
| | - Gillian G Leibach
- a Virginia Commonwealth University , Department of Psychology , Richmond , VA , USA
| | - Adrienne P Borschuk
- a Virginia Commonwealth University , Department of Psychology , Richmond , VA , USA
| | - Daphne Koinis-Mitchell
- b Bradley/Hasbro Children's Research Center, Alpert Medical School of Brown University , Providence , RI , USA
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Canino G, Shrout PE, Vila D, Ramírez R, Rand C. Effectiveness of a multi-level asthma intervention in increasing controller medication use: a randomized control trial. J Asthma 2016; 53:301-10. [PMID: 26786240 DOI: 10.3109/02770903.2015.1057846] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Poor self-management by families is an important factor in explaining high rates of asthma morbidity in Puerto Rico, and for this reason we previously tested a family intervention called CALMA that was found effective in improving most asthma outcomes, but not effective in increasing the use of controller medications. CALMA-plus was developed to address this issue by adding to CALMA, components of provider training and screening for asthma in clinics. METHODS Study participants were selected from claims Medicaid data in San Juan, Puerto Rico. After screening, 404 children in eight clinics were selected after forming pairs of clinics and randomizing the clinics) to CALMA-only or CALMA-plus. RESULTS For all three primary outcomes at 12 months, the mean differences between treatment arms were small but in the predicted direction. However, after adjusting for clinic variation, the study failed to demonstrate that the CALMA-plus intervention was more efficacious than the CALMA-only intervention for increasing controller medication use, or decreasing asthma symptoms. Both groups had lower rates of asthma symptoms and service utilization, consistent with previous results of the CALMA-only intervention. CONCLUSIONS Compliance of providers with the intervention and training, small number of clinics available and the multiple barriers experienced by providers for medicating may have been related to the lack of difference observed between the groups. Future interventions should respond to the limitations of the present study design and provide more resources to providers that will increase provider participation in training and implementation of the intervention.
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Affiliation(s)
- Glorisa Canino
- a Behavioral Sciences Institute, University of Puerto Rico, Medical Sciences Campus , San Juan , Puerto Rico
| | - Patrick E Shrout
- b Department of Psychology , New York University , New York , NY , USA , and
| | - Doryliz Vila
- a Behavioral Sciences Institute, University of Puerto Rico, Medical Sciences Campus , San Juan , Puerto Rico
| | - Rafael Ramírez
- a Behavioral Sciences Institute, University of Puerto Rico, Medical Sciences Campus , San Juan , Puerto Rico
| | - Cynthia Rand
- c The Johns Hopkins School of Medicine , Baltimore , MD , USA
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20
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Hasegawa K, Stoll SJ, Ahn J, Kysia RF, Sullivan AF, Camargo CA. Association of Insurance Status with Severity and Management in ED Patients with Asthma Exacerbation. West J Emerg Med 2016; 17:22-7. [PMID: 26823926 PMCID: PMC4729414 DOI: 10.5811/westjem.2015.11.28715] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 11/02/2015] [Accepted: 11/17/2015] [Indexed: 02/07/2023] Open
Abstract
Introduction Previous studies have demonstrated an association of low socioeconomic status with frequent asthma exacerbations. However, there have been no recent multicenter efforts to examine the relationship of insurance status – a proxy for socioeconomic status – with asthma severity and management in adults. The objective is to investigate chronic and acute asthma management disparities by insurance status among adults requiring emergency department (ED) treatment in the United States. Methods We conducted a multicenter chart review study (48 EDs in 23 U.S. states) on ED patients, aged 18–54 years, with acute asthma between 2011 and 2012. Each site underwent training (lecture, practice charts, certification) before reviewing randomly selected charts. We categorized patients into three groups based on their primary health insurance: private, public, and no insurance. Outcome measures were chronic asthma severity (as measured by ≥2 ED visits in one-year period) and management prior to the index ED visit, acute asthma management in the ED, and prescription at ED discharge. Results The analytic cohort comprised 1,928 ED patients with acute asthma. Among these, 33% had private insurance, 40% had public insurance, and 27% had no insurance. Compared to patients with private insurance, those with public insurance or no insurance were more likely to have ≥2 ED visits during the preceding year (35%, 49%, and 45%, respectively; p<0.001). Despite the higher chronic severity, those with no insurance were less likely to have guideline-recommended chronic asthma care – i.e., lower use of inhaled corticosteroids (ICS [41%, 41%, and 29%; p<0.001]) and asthma specialist care (9%, 10%, and 4%; p<0.001). By contrast, there were no significant differences in acute asthma management in the ED – e.g., use of systemic corticosteroids (75%, 79%, and 78%; p=0.08) or initiation of ICS at ED discharge (12%, 12%, and 14%; p=0.57) – by insurance status. Conclusion In this multicenter observational study of ED patients with acute asthma, we found significant discrepancies in chronic asthma severity and management by insurance status. By contrast, there were no differences in acute asthma management among the insurance groups.
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Affiliation(s)
- Kohei Hasegawa
- Massachusetts General Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Samantha J Stoll
- North Shore Medical Center, Department of Emergency Medicine, Salem, Massachusetts
| | - Jason Ahn
- Massachusetts General Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Rashid F Kysia
- John H. Stroger Jr. Hospital of Cook County, Department of Emergency Medicine, Chicago, Illinois
| | - Ashley F Sullivan
- Massachusetts General Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Carlos A Camargo
- Massachusetts General Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
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Dowell JA. Experiences, Functioning and Needs of Low-Income African American Mothers of Children With Asthma. J Pediatr Nurs 2015; 30:842-9. [PMID: 25936997 DOI: 10.1016/j.pedn.2015.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 04/09/2015] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED The purpose of this proposed study was to explore experiences, needs and functioning of low-income, African American caregivers of children with asthma in order to better understand symptom management. METHOD A qualitative, descriptive design was used. A purposive sampling technique was used to screen 32 caregivers of children with asthma, and 15 caregivers agreed to participate. RESULTS Three main themes were identified: managing the symptoms; cultural beliefs and values; and culturally competent health care provider. CONCLUSION For the caregivers culture disparity is not just about access to health services but instead the healthcare providers' understanding of the complexity of symptoms management.
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Affiliation(s)
- Jo Ann Dowell
- Ohio State University College of Nursing, Columbus, Ohio.
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22
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Koinis-Mitchell D, Kopel SJ, Boergers J, McQuaid EL, Esteban CA, Seifer R, Fritz GK, Beltran AJ, Klein RB, LeBourgeois M. Good Sleep Health in Urban Children With Asthma: A Risk and Resilience Approach. J Pediatr Psychol 2015; 40:888-903. [PMID: 25991645 DOI: 10.1093/jpepsy/jsv046] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 04/22/2015] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To identify children demonstrating "good" sleep health in a sample of urban children with persistent asthma; to compare sociocontextual, asthma clinical characteristics, and sleep behaviors in children with "good" versus "poor" sleep health; and to examine protective effects of family-based health behaviors on sleep health. METHODS Participants were 249 Black (33%), Latino (51%) and non-Latino White (16%) children with asthma, ages 7-9 years, and their primary caregivers. RESULTS 32 percent of children had "good" sleep health. Well-controlled asthma and better lung function were more likely in this group. In the context of urban risks, sleep hygiene appeared to be a protective factor associated with better sleep quality. The protective effect of asthma management functioned differently by ethnic group. CONCLUSIONS This study identifies protective processes that may guard against urban risks to optimize sleep health in children with asthma. Intervention programs can be tailored to consider specific supports that enhance sleep health in this high-risk group.
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Affiliation(s)
- Daphne Koinis-Mitchell
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University and
| | - Sheryl J Kopel
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University and
| | - Julie Boergers
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University and
| | - Elizabeth L McQuaid
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University and
| | - Cynthia A Esteban
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University and
| | - Ronald Seifer
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University and
| | - Gregory K Fritz
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University and
| | - Alvaro J Beltran
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University and
| | - Robert B Klein
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University and
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Chen BK, Hibbert J, Cheng X, Bennett K. Travel distance and sociodemographic correlates of potentially avoidable emergency department visits in California, 2006-2010: an observational study. Int J Equity Health 2015; 14:30. [PMID: 25889646 PMCID: PMC4391132 DOI: 10.1186/s12939-015-0158-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 02/26/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Use of the hospital emergency department (ED) for medical conditions not likely to require immediate treatment is a controversial topic. It has been faulted for ED overcrowding, increased expenditures, and decreased quality of care. On the other hand, such avoidable ED utilization may be a manifestation of barriers to primary care access. METHODS A random 10% subsample of all ED visits with unmasked variables, or approximately 7.2% of all ED visits in California between 2006 and 2010 are used in the analysis. Using panel data methods, we employ linear probability and fractional probit models with hospital fixed effects to analyze the associations between avoidable ED utilization in California and observable patient characteristics. We also test whether shorter estimated road distances to the hospital ED are correlated with non-urgent ED utilization, as defined by the New York University ED Algorithm. We then investigate whether proximity of a Federally Qualified Health Center (FQHC) is correlated with reductions in non-urgent ED utilization among Medicaid patients. RESULTS We find that relative to the reference group of adults aged 35-64, younger patients generally have higher scores for non-urgent conditions and lower scores for urgent conditions. However, elderly patients (≥65) use the ED for conditions more likely to be urgent. Relative to male and white patients, respectively, female patients and all identified racial and ethnic minorities use the ED for conditions more likely to be non-urgent. Patients with non-commercial insurance coverage also use the ED for conditions more likely to be non-urgent. Medicare and Medicaid patients who live closer to the hospital ED have higher probability scores for non-emergent visits. However, among Medicaid enrollees, those who live in zip codes with an FQHC within 0.5 mile of the zip code population centroid visit the ED for medical conditions less likely to be non-emergent. CONCLUSIONS These patterns of ED utilization point to potential barriers to care among historically vulnerable groups, observable even when using rough estimates of travel distances and avoidable ED utilization.
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Affiliation(s)
- Brian K Chen
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 915 Greene Street Suite 354, Columbia, SC, 29208, USA.
| | - James Hibbert
- Center for Research in Nutrition and Health Disparities, University of South Carolina, 921 Assembly Street #230, Columbia, SC, 29208, USA.
| | - Xi Cheng
- Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
| | - Kevin Bennett
- Family and Preventive Medicine, University of South Carolina School of Medicine, 3209 Colonial Dr., Columbia, SC, 29203, USA.
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Everhart RS, Fedele DA, Miadich SA, Koinis-Mitchell D. Caregiver quality of life in pediatric asthma: associations with beliefs and concerns about medications and emergency department use. Clin Pediatr (Phila) 2015; 54:249-56. [PMID: 25238776 DOI: 10.1177/0009922814551134] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine caregiver quality of life (QOL) related to pediatric asthma among families from Latino, African American, and non-Latino white (NLW) backgrounds. METHODS In all, 94 children with persistent asthma (6-15 years) and their primary caregivers completed interview-administered questionnaires. RESULTS Overall QOL and subscale scores differed across race/ethnicity, with NLW caregivers reporting higher QOL. Caregivers who expressed more concerns about their child's medications and more beliefs in the necessity of asthma medications had lower QOL. In African American and Latino families, caregiver QOL mediated the association between beliefs about the necessity of asthma medications and child emergency department (ED) use. CONCLUSIONS Caregiver beliefs and concerns related to child asthma medications may begin to explain differences in caregiver QOL across NLW, Latino, and African American caregivers. Caregiver QOL may be a mechanism by which caregiver beliefs and concerns about asthma medications are associated with child ED use.
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25
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Riera A, Ocasio A, Tiyyagura G, Krumeich L, Ragins K, Thomas A, Trevino S, Vaca FE. Latino caregiver experiences with asthma health communication. QUALITATIVE HEALTH RESEARCH 2015; 25:16-26. [PMID: 25185159 DOI: 10.1177/1049732314549474] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In this article, we analyze qualitative data from a purposeful sample of limited English proficiency (LEP) asthma health caregivers. We used ethnically concordant, semistructured, in-depth Spanish-language interviews and a follow-up focus group to explore issues related to communication during pediatric asthma encounters in medical settings. Inductive coding of Spanish transcripts by a bilingual research team was performed until thematic saturation was reached. Several key findings emerged. LEP caregivers encountered significant asthma burdens related to emotional stress, observed physical changes, and communication barriers. Language-discordant communication and the use of ad hoc interpreters were common. This finding is complex, and was influenced by perceptions of interpreter availability, delays in care, feelings of mistrust toward others, and individual emotional responses. Language-concordant education and suitable action plans were valued and desired. We discuss a revealing depiction of the LEP caregiver experience with asthma health communication and recommend areas for further inquiry.
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Affiliation(s)
| | - Agueda Ocasio
- Junta for Progressive Action, New Haven, Connecticut, USA
| | | | | | - Kyle Ragins
- Yale University, New Haven, Connecticut, USA
| | - Anita Thomas
- University of Washington, Seattle, Washington, USA
| | - Sandra Trevino
- Junta for Progressive Action, New Haven, Connecticut, USA
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26
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Riera A, Ocasio A, Goncalves P, Krumeich L, Katz KH, Trevino S, Vaca FE. Findings from a community-based asthma education fair for Latino caregivers. J Asthma 2014; 52:71-80. [PMID: 25019349 DOI: 10.3109/02770903.2014.944982] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess limited English proficiency (LEP) asthma caregiver quality of life (QoL), skills retention and healthcare utilization after an asthma education fair (AEF). METHODS A language concordant AEF was conducted at a Latino community center. LEP caregivers of children 1-12 years old and an established asthma diagnosis participated in three skill stations: (a) medication recognition and administration, (b) peak flow use (if child ≥ 5 years) and (c) action plan dissemination. Spacers, peak flow meters and individualized action plans were distributed. A validated, pediatric asthma caregiver quality of life questionnaire (PACQLQ-Spanish version) was administered. Baseline data was compared to follow-up interview data at three and six months after the AEF. Mean PACQLQ scores were analyzed with Wilcoxon signed-rank test and nominal paired data with McNemar's test. RESULTS We analyzed data from 18 caregivers able to speak English well (22%), not well (28%) or not at all (50%). After three months, improved caregiver QoL was experienced (51 vs. 72, p<0.01). No differences were observed in medication recognition, spacer and peak flow use or peak flow interpretation. After six months, mean school days missed due to asthma decreased (4.1 vs. 0.4, p<0.01). Mean clinic visits, emergency department visits and hospitalizations remained unchanged. CONCLUSIONS Implementation of a community-based AEF with action plan administration can be beneficial for LEP caregivers and their children. QoL improvements to emotional wellbeing and activity limitations were observed, and lower rates of school absenteeism were reported. Caregiver ability to accurately identify medications was not enhanced.
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Affiliation(s)
- Antonio Riera
- Pediatric Emergency Medicine, Yale University School of Medicine , New Haven, CT , USA
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27
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Rosser FJ, Forno E, Cooper PJ, Celedón JC. Asthma in Hispanics. An 8-year update. Am J Respir Crit Care Med 2014; 189:1316-27. [PMID: 24881937 PMCID: PMC4098086 DOI: 10.1164/rccm.201401-0186pp] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 04/05/2014] [Indexed: 01/25/2023] Open
Abstract
This review provides an update on asthma in Hispanics, a diverse group tracing their ancestry to countries previously under Spanish rule. A marked variability in the prevalence and morbidity from asthma remains among Hispanic subgroups in the United States and Hispanic America. In the United States, Puerto Ricans and Mexican Americans have high and low burdens of asthma, respectively (the "Hispanic Paradox"). This wide divergence in asthma morbidity among Hispanic subgroups is multifactorial, likely reflecting the effects of known (secondhand tobacco smoke, air pollution, psychosocial stress, obesity, inadequate treatment) and potential (genetic variants, urbanization, vitamin D insufficiency, and eradication of parasitic infections) risk factors. Barriers to adequate asthma management in Hispanics include economic and educational disadvantages, lack of health insurance, and no access to or poor adherence with controller medications such as inhaled corticosteroids. Although considerable progress has been made in our understanding of asthma in Hispanic subgroups, many questions remain. Studies of asthma in Hispanic America should focus on environmental or lifestyle factors that are more relevant to asthma in this region (e.g., urbanization, air pollution, parasitism, and stress). In the United States, research studies should focus on risk factors that are known to or may diverge among Hispanic subgroups, including but not limited to epigenetic variation, prematurity, vitamin D level, diet, and stress. Clinical trials of culturally appropriate interventions that address multiple aspects of asthma management in Hispanic subgroups should be prioritized for funding. Ensuring high-quality healthcare for all remains a pillar of eliminating asthma disparities.
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Affiliation(s)
- Franziska J. Rosser
- Division of Pediatric Pulmonary Medicine, Allergy and Immunology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erick Forno
- Division of Pediatric Pulmonary Medicine, Allergy and Immunology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Philip J. Cooper
- Laboratorio de Investigaciones FEPIS, Quinindé, Esmeraldas Province, Ecuador; and
- Institute of Infection and Immunity, St. George’s University of London, London, United Kingdom
| | - Juan C. Celedón
- Division of Pediatric Pulmonary Medicine, Allergy and Immunology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
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28
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Grineski SE, Collins TW, Chavez-Payan P, Jimenez AM, Clark-Reyna S, Gaines M, Kim YA. Social disparities in children's respiratory health in El Paso, Texas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:2941-57. [PMID: 24619157 PMCID: PMC3987014 DOI: 10.3390/ijerph110302941] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 02/24/2014] [Accepted: 03/03/2014] [Indexed: 11/16/2022]
Abstract
The objectives of this study were to assess prevalence of children’s respiratory health conditions and to measure and describe social disparities in children’s respiratory problems and access to health resources for asthma/wheezing management. Data were collected through a cross-sectional, observational mail survey of all primary caretakers of 4th and 5th grade children in El Paso Independent School District (El Paso, TX, USA). 6295 primary caretakers received surveys at their home address and 1904 surveys were completed and returned for a 30% response rate. El Paso children have high rates of asthma (17%) and allergies (51%). In terms of social disparities, children that are male, not poor, obese, Hispanic, born in El Paso, have a US-born caretaker, and have a caretaker who has lower levels Spanish proficiency have increased odds of respiratory problems. Among children with asthma and wheezing, disparities exist in access to care; those that are poor, with a Spanish-speaking caretaker, or with a foreign-born caretaker had increased odds of seeking care in urgent care center, emergency rooms and hospitals. Results have scholarly and practical implications for broader trends in terms of increasing prevalence of respiratory health problems across multiple scales (from El Paso to the US context to worldwide) and health disparities experienced within the rapidly growing US Hispanic population.
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Affiliation(s)
- Sara E Grineski
- Department of Sociology and Anthropology, University of Texas of El Paso, 500 West University Ave, El Paso TX 79968, USA.
| | - Timothy W Collins
- Department of Sociology and Anthropology, University of Texas of El Paso, 500 West University Ave, El Paso TX 79968, USA.
| | - Paola Chavez-Payan
- Department of Sociology and Anthropology, University of Texas of El Paso, 500 West University Ave, El Paso TX 79968, USA.
| | - Anthony M Jimenez
- Department of Sociology, University of Minnesota (Twin Cities), Social Science Building, 267 19th Ave. S., Minneapolis, MN 55455, USA.
| | - Stephanie Clark-Reyna
- Department of Sociology and Anthropology, University of Texas of El Paso, 500 West University Ave, El Paso TX 79968, USA.
| | - Marie Gaines
- Department of Social Work, Fayetteville State University, 1200 Murchison Rd, Fayetteville, NC 28301, USA.
| | - Young-an Kim
- Department of Criminology, Law and Society, University of California Irvine, 2340 Social Ecology II Irvine, CA 92697, USA.
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29
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Riera A, Navas-Nazario A, Shabanova V, Vaca FE. The impact of limited English proficiency on asthma action plan use. J Asthma 2013; 51:178-84. [PMID: 24147607 DOI: 10.3109/02770903.2013.858266] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The goal of this study was to compare rates of asthma action plan use by limited English proficiency (LEP) caregivers to English proficient (EP) caregivers. METHODS A cross-sectional bilingual survey was distributed at an urban, academic, pediatric emergency department (PED). Surveys were completed by adult caregivers of children with asthma who sought PED care for asthma related chief complaints. LEP was defined as caregiver ability to speak English less than "very well". Data were analyzed using Fisher's exact test and odds ratios (OR). RESULTS One hundred seven surveys were completed and analyzed. Fifty-one surveys (48%) were completed by LEP caregivers and 56 (52%) by EP caregivers. A 25% difference (p = .01) in action plan use rates between LEP caregivers (39%) and EP caregivers (64%) was observed. EP alone was associated with action plan use (OR 2.8 [95% CI 1.3-6.1]). Variables not associated with plan use included mother acting as caregiver (OR 2.1 [95% CI 0.7-7.0]), age of child >7 years (OR 1.0 [95% CI 0.5-2.4]), caregiver education ≥ associate degree (OR 1.4 [95% CI 0.6-3.0]), private insurance (OR 0.7 [95% CI 0.3-1.8]), White race (OR 0.7 [95% CI 0.2-2.2]), Latino ethnicity (OR 0.5 [95% CI 0.2-1.3]) and a federally qualified health center (OR 0.8 [95% CI 0.3-2.0]). The main caregiver reasons for plan use were feeling that a plan works/gets results, helps with symptom management and appreciation towards physician attentiveness when a plan is prescribed. The main caregiver reasons for non plan use were they were not informed/given an action plan or perceived the child's asthma as mild/well controlled. CONCLUSION Compared with EP caregivers, those with LEP experience disparate rates of asthma action plan use.
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Affiliation(s)
- Antonio Riera
- Depatment of Pediatric Emergency Medicine, Yale University , New Haven, CT , USA
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30
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Chapman R, Martin C, Smith T. Evaluation of staff cultural awareness before and after attending cultural awareness training in an Australian emergency department. Int Emerg Nurs 2013; 22:179-84. [PMID: 24412133 DOI: 10.1016/j.ienj.2013.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/31/2013] [Accepted: 11/02/2013] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Cultural awareness of emergency department staff is important to ensure delivery of appropriate health care to people from all ethnic groups. Cultural awareness training has been found to increase knowledge about other cultures and is widely used as a means of educating staff, however, debate continues as to the effectiveness of these programs. AIM To determine if an accredited cultural awareness training program affected emergency department staff knowledge, familiarity, attitude of and perception towards Australian Aboriginal and Torres Strait Islander people. METHOD One group pre-test and post-test intervention study compared the cultural awareness of 44 emergency department staff towards Aboriginal and Torres Strait Islander people before and after training. The cultural awareness training was delivered in six hours over three sessions and was taught by an accredited cultural awareness trainer. RESULTS The cultural awareness training changed perception but did not affect attitude towards Aboriginal and Torres Strait Islander people in this group. CONCLUSION Future strategies to improve staff cultural awareness need to be investigated, developed, implemented and evaluated.
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Affiliation(s)
- Rose Chapman
- Monash Health, Victoria, 135 David Street, Dandenong, Vic 3175, Australia; Australian Catholic University, 115 Victoria Parade, Fitzroy, Vic 3065, Australia.
| | - Catherine Martin
- Monash Health, Victoria, 135 David Street, Dandenong, Vic 3175, Australia; Australian Catholic University, 115 Victoria Parade, Fitzroy, Vic 3065, Australia
| | - Tammy Smith
- Monash Health, Victoria, 135 David Street, Dandenong, Vic 3175, Australia
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31
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Okelo SO, Eakin MN, Patino CM, Teodoro AP, Bilderback AL, Thompson DA, Loiaza-Martinez A, Rand CS, Thyne S, Diette GB, Riekert KA. The Pediatric Asthma Control and Communication Instrument asthma questionnaire: for use in diverse children of all ages. J Allergy Clin Immunol 2013; 132:55-62. [PMID: 23434285 DOI: 10.1016/j.jaci.2013.01.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 12/22/2012] [Accepted: 01/03/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND National Institutes of Health asthma guidelines recommend questionnaires to assess asthma control, but these questionnaires are not useable across the entire pediatric age spectrum and have not been validated among significant numbers of minority or Spanish-speaking children. OBJECTIVE We sought to evaluate a questionnaire designed to assess asthma control across a broad age range of minority and Spanish-speaking children cared for in an outpatient setting. METHODS Between July 1, 2007, and September 30, 2010, we collected information using the Pediatric Asthma Control and Communication Instrument (PACCI), the Asthma Control Test (ACT; or the childhood ACT for children 4-11 years old), the Pediatric Asthma Caregiver Quality of Life Questionnaire, and lung function and clinicians' ratings of asthma status among a population of children presenting for routine asthma specialist care. The PACCI measure of asthma control was validated by evaluating accuracy, internal reliability, and concurrent, discriminative, and known-groups validity. RESULTS We collected information on 265 English- and 52 Spanish-speaking children (mean age, 8.2 years; 58% male; 44% African American). Across all age groups and in both languages, PACCI control showed good internal reliability and strong concurrent, discriminative, and known-groups validity with ACT and Pediatric Asthma Caregiver Quality of Life Questionnaire scores and clinicians' ratings of asthma control. The accuracy of the PACCI in classifying children with uncontrolled asthma was good (area under the curve, 0.83; 95% CI, 0.79-0.88). CONCLUSIONS The PACCI accurately measures asthma control in English- and Spanish-speaking children. The PACCI should be useful to clinicians to assess and classify asthma according to National Institutes of Health asthma guidelines.
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Affiliation(s)
- Sande O Okelo
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
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32
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Meyerson KL. Asthma Network of West Michigan: a model of home-based case management for asthma. Nurs Clin North Am 2013; 48:177-84. [PMID: 23465451 DOI: 10.1016/j.cnur.2012.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Asthma remains a serious health risk in the United States, particularly among children from low-income families. This article presents an overview of the Asthma Network of West Michigan, the local asthma coalition serving West Michigan, and its intensive home-based case management model for individuals with uncontrolled asthma. The Asthma Network is believed to be the first grassroots asthma coalition in the nation to contract with health plans and obtain reimbursement for these services. The Asthma Network's program has had a positive impact on health care use as well as cost savings, and its model has been replicated in other communities.
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Affiliation(s)
- Karen L Meyerson
- Asthma Network of West Michigan, 359 South Division Avenue, Grand Rapids, MI 49503, USA.
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