There are persistent disparities in the distribution of pediatric asthma morbidity. Populations at high risk for poor asthma control and repeated hospitalizations or emergency department (ED) visits often cluster within areas disproportionately impacted by asthma-relevant social and environmental risks. There is a fundamental gap, however, in the knowledge of how such risks can be identified and acted upon during inpatient pediatric asthma care. Much as marketers and political campaigns use geographic data to target resources, the contribution of the proposed research is to identify key geographic factors, or geomarkers, that could meaning- fully inform care and improve patient outcomes. The initial focus will be on geomarkers related to area-level, or neighborhood, poverty, housing quality, and health service access. The central hypothesis is that such geo- markers will predict asthma-related risk of readmission and ED revisit along with potentially modifiable patient characteristics. The rationale is that informed inpatient asthma care plans, aimed at reducing post-discharge morbidity, can be personalized from the moment a child arrives on the unit. Guided by strong preliminary data, this hypothesis will be tested with three specific aims: 1) Determine the extent to which geomarkers predict subsequent risk of readmission and ED revisit among hospitalized children with asthma;2) Examine the association between geomarkers and corresponding patient-level risks;and 3) Develop and pilot the feasibility of an intervention to personalize a patient's chronic asthma care via a geomarker-based identification strategy and a community health worker. The proposed research is innovative because it would make novel use of public data in ways that characterize and predict an individual's risk, efficiently informing assessments and actions to be initiated early in a patient encounter. This will be significant because if inpatient clinical care is more effective and targeted, families will see improved satisfaction and reduced subsequent morbidity. Summary: The proposed project will bring a place-based approach to inpatient pediatric asthma care. Dr. Beck's research and clinical training, pilot work investigating these methods, and experienced mentorship and advisory team make him ideally suited to pursue this line of research. This award will provide him with the training and research needed to be successful in a future, large-scale trial of a geographically-grounded intervention. Furthermore, this career development award will facilitate Dr. Beck's development into a nationally- recognized independent investigator and leader conducting research that improves child health outcomes by identifying and mitigating key social and environmental determinants of health.

Public Health Relevance

The proposed research is relevant to public health because greater insight into risks a pediatric asthma patient faces in their home neighborhood could help to more effectively target hospital- and community-based resources and reduce asthma-related morbidity. While this application focuses on pediatric inpatient asthma, the concepts learned through this grant, as well as the career development activities pursued by the investigator, will be readily applicable to other conditions that are similarly impacted by the social and environmental determinants of health. Thus, the proposed research is relevant to the part of NIH's mission that pertains to fostering creative and innovative research strategies aimed at ultimately improving health.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Mentored Patient-Oriented Research Career Development Award (K23)
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Allergy & Clinical Immunology-1 (AITC)
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Prograis, Lawrence J
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Cincinnati Children's Hospital Medical Center
United States
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Beck, Andrew F; Klein, Melissa D (2016) Moving From Social Risk Assessment and Identification to Intervention and Treatment. Acad Pediatr 16:97-8
Beck, Andrew F; Huang, Bin; Ryan, Patrick H et al. (2016) Areas with High Rates of Police-Reported Violent Crime Have Higher Rates of Childhood Asthma Morbidity. J Pediatr 173:175-182.e1
Jones, Margaret N; Brown, Courtney M; Widener, Michael J et al. (2016) Area-Level Socioeconomic Factors Are Associated With Noncompletion of Pediatric Preventive Services. J Prim Care Community Health 7:143-8
Beck, Andrew F; Florin, Todd A; Campanella, Suzanne et al. (2015) Geographic Variation in Hospitalization for Lower Respiratory Tract Infections Across One County. JAMA Pediatr 169:846-54
Beck, Andrew F; Huang, Bin; Kercsmar, Carolyn M et al. (2015) Allergen sensitization profiles in a population-based cohort of children hospitalized for asthma. Ann Am Thorac Soc 12:376-84
Beck, Andrew F; Bradley, Courtney L; Huang, Bin et al. (2015) The pharmacy-level asthma medication ratio and population health. Pediatrics 135:1009-17
Beck, Andrew F; Huang, Bin; Chundur, Raj et al. (2014) Housing code violation density associated with emergency department and hospital use by children with asthma. Health Aff (Millwood) 33:1993-2002