Asthma is the most common pediatric chronic disease, affecting more than 10% of American children (>7 million children <18 years)1 and disproportionately impacting urban, minority, and disadvantaged children.2 Despite the evidence-based guidelines for standardized care from the NIH,3 overall morbidity among youth with asthma, whether measured by attack rates, emergency department (ED) visits, or hospitalizations, has not significantly decreased in the last decade.4 Striking disparities persist among youth with asthma, as socio- economically disadvantaged, urban, and minority children throughout the United States incur a disproportionate share of asthma-related morbidity.2,5 The overall ED visit rate for asthma, for example, among non-Hispanic African Americans (AAs) aged 0-17 years is 4.1 times greater than that among non-Hispanic whites, while the ED visit rate among Hispanics in the same age group is 1.8 times greater than non-Hispanic whites. Similarly, the asthma death rate among non-Hispanic AAs aged 0-17 years is 7.3 times greater than that among non-Hispanic whites, while the death rate among Hispanics in the same age group is 1.2 times greater than non-Hispanic whites.5 In a recent study to prioritize comparative effectiveness research in hospital pediatrics, asthma ranked as the #1 leading non-surgical diagnose for pediatric hospital admission, totaling costs of $570 million annually.6 Of striking importance for the health care system is that asthma is also in the top diagnoses for all-cause readmissions, with 80% of these asthma readmissions deemed potentially preventable readmissions.7 In this career training award, with a strong mentorship team, I propose a highly patient-centered approach to identifying and improving optimal outcomes for patients and families transitioning home after inpatient admissions for asthma exacerbations. Using the care coordination framework proposed by the Agency of Healthcare Research and Quality (AHRQ) in June 2014,8 my mentors and I will utilize principles of patient-centered outcomes research (PCOR) and comparative effectiveness research (CER) to design and pilot a program of community health worker (CHW)-facilitated transition-to-home focusing on the changeover of care from inpatient to outpatient for patients hospitalized with asthma exacerbation. This project is highly significant (addressing a vulnerable transition for patients admitted with a common and costly pediatric chronic illness with high rate of preventable readmissions) and highly innovative (using a qualitative approach to identify stakeholders' perspectives to refine AHRQ's care coordination framework to improve the transition from hospital to home by utilizing CHW and pilot testing feasibility and acceptability, and patient-centered outcomes). Our overall aim is to develop and evaluate a patient-centered transition-to-home plan leveraging CHWs to target high risk pediatric patients requiring hospital admission for asthma exacerbations. Our hypothesis is that CHWs will improve patient-centered outcomes during the transition from inpatient to outpatient care.

Public Health Relevance

This project will design and pilot a community health worker (CHW)-facilitated transition-to-home plan for patients hospitalized with asthma exacerbations by utilizing the framework for care coordination proposed by Agency of Healthcare Quality and Research (AHRQ). Our overall aim is to develop and evaluate a patient-centered transition-to-home plan leveraging CHWs to target high risk pediatric patients requiring hospital admission for asthma exacerbations. Our hypothesis is that CHWs will improve patient-centered outcomes during the transition from inpatient to outpatient care.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Clinical Investigator Award (CIA) (K08)
Project #
5K08HS024554-02
Application #
9233021
Study Section
HSR Health Care Research Training SS (HCRT)
Program Officer
Willis, Tamara
Project Start
2016-03-01
Project End
2021-02-28
Budget Start
2017-03-01
Budget End
2018-02-28
Support Year
2
Fiscal Year
2017
Total Cost
Indirect Cost
Name
Children's Research Institute
Department
Type
DUNS #
143983562
City
Washington
State
DC
Country
United States
Zip Code
20010
Parikh, Kavita; Keller, Susan; Ralston, Shawn (2018) Inpatient Quality Improvement Interventions for Asthma: A Meta-analysis. Pediatrics 141:
Kaiser, Sunitha V; Rodean, Jonathan; Bekmezian, Arpi et al. (2018) Effectiveness of Pediatric Asthma Pathways for Hospitalized Children: A Multicenter, National Analysis. J Pediatr 197:165-171.e2
Leyenaar, JoAnna K; Andrews, Christine B; Tyksinski, Emily R et al. (2018) Facilitators of interdepartmental quality improvement: a mixed-methods analysis of a collaborative to improve pediatric community-acquired pneumonia management. BMJ Qual Saf :
Kaiser, Sunitha V; Rodean, Jonathan; Bekmezian, Arpi et al. (2018) Rising utilization of inpatient pediatric asthma pathways. J Asthma 55:196-207
Parikh, Kavita; Hall, Matt; Kenyon, Chén C et al. (2018) Impact of Discharge Components on Readmission Rates for Children Hospitalized with Asthma. J Pediatr 195:175-181.e2
Parikh, Kavita; Paul, Jahmeilia; Fousheé, Naja et al. (2018) Barriers and Facilitators to Asthma Care After Hospitalization as Reported by Caregivers, Health Providers, and School Nurses. Hosp Pediatr 8:706-717
Parikh, Kavita; Berry, Jay; Hall, Matt et al. (2017) Racial and Ethnic Differences in Pediatric Readmissions for Common Chronic Conditions. J Pediatr 186:158-164.e1
Parikh, Kavita; Garber, Matthew D (2017) Getting an ""A"": Report Cards for Reducing Health Care Waste. Hosp Pediatr 7:697-699