Hospitalizations for exacerbations of asthma and COPD can likely be prevented through effective use of therapies delivered through respiratory inhaler devices. One critical rate-limiting step to effective use is correct inhaler technique. Clinical guidelines recommend assessing and teaching inhaler technique in all settings. The hospitalized patient population is a particularly salient target for evaluating and correcting inhaler technique, as inpatients are at increased risk for poor outcomes, including rehospitalizations. Hospital resources are limited, and patients' ability to retain hospital-based education is likely to be incomplete, which would require post- discharge educational reinforcement. For these reasons, developing and testing portable, effective hospital- based educational strategies are warranted. I have spent the last several years establishing the effectiveness of an in-person Teach-to-Goal [TTG] strategy (rounds of assessment and demonstration until mastery is attained) to instruct hospitalized patients on correct inhaler technique. While we have found that TTG is more effective than simple verbal instructions, it has limitations for implementation. First, it is resource intensive and second, it lacks portabilit for post-discharge reinforcement. Therefore, in this proposal I aim to study whether interactive video-module education (VME) that includes rounds of self-assessment and video-based demonstration, is a non-inferior approach to in-person TTG. VME directly counters TTG's limitations as it is likely less resource-intensive and is portable for post-discharge reinforcemen. Therefore I will develop VME (Aim 1a) and then will test VME vs. TTG in a randomized clinical trial, stratified by diagnosis, since there are inherent different patient and disease characteristcs among patients with asthma and COPD (Aim 1b). Finally, underserved patients may not have access to post-discharge VME. I will therefore conduct an observational study using the Hospitalist Medicine Data Collection Infrastructure, to determine the proportion of patients with access to and willingness to use post-discharge VME (Aim 2). Therefore, with this K23 career development award proposal, I will bring my research experience together with my Mentor, Dr. David Meltzer, Co-Mentor, Dr. Jerry Krishnan, and an expert advisory team in the fields of obstructive lung diseases, comparative effectiveness research, and behavioral and educational interventions to begin to fill these gaps in knowledge and clinical practice. I will use these data to design an R-01 feasibility and cost-effectiveness study to determine the real-world effectiveness of VME to help transition patients from hospital to home with sufficient educational support, and to determine if clinical outcomes improve. This award would also allow me to seek additional training in advanced biostatistics, formal training in the development and assessment of educational strategies, and training in the design and implementation of complex behavioral clinical trials. These experiences will position me to become a leader in developing, evaluating and implementing high-quality interventions to improve patient self-management of obstructive lung disease to improve clinical outcomes.

Public Health Relevance

Improved respiratory inhaler technique may be a critical component of efforts to improve clinical outcomes and public health for patients with obstructive lung disease, including reduced hospitalizations and re- hospitalizations, decreased deaths and lower national and local costs. This proposal would allow for the development of novel and cutting edge interactive video-module education (VME) to compare to the current gold standard in-person teach-to-goal (TTG) strategy, while simultaneously determining the potential for use of VME to help transition patients' post-hospital discharge. The data from this proposal will be critical for the development of future R-01 studies to assess the feasibility, cost-effectiveness and impact on clinical and public health outcomes of VME vs. TTG hospital-based education for correct inhaler technique.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23HL118151-03
Application #
8867279
Study Section
Special Emphasis Panel (ZHL1)
Program Officer
Tigno, Xenia
Project Start
2013-07-22
Project End
2016-06-30
Budget Start
2015-07-01
Budget End
2016-06-30
Support Year
3
Fiscal Year
2015
Total Cost
Indirect Cost
Name
University of Chicago
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
005421136
City
Chicago
State
IL
Country
United States
Zip Code
60637
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Volerman, Anna; Ignoffo, Stacy; Hull, Ashley et al. (2017) Identification of students with asthma in Chicago schools: Missing the mark. Ann Allergy Asthma Immunol 118:739-740
Press, Valerie G; Hasegawa, Kohei; Heidt, Jonathan et al. (2017) Missed opportunities to transition from nebulizers to inhalers during hospitalization for acute asthma: A multicenter observational study. J Asthma 54:968-976
Afshar, Majid; Press, Valerie G; Robison, Rachel G et al. (2017) A computable phenotype for asthma case identification in adult and pediatric patients: External validation in the Chicago Area Patient-Outcomes Research Network (CAPriCORN). J Asthma :1-8
Thomas, Rachel M; Locke, Emily R; Woo, Deborah M et al. (2017) Inhaler Training Delivered by Internet-Based Home Videoconferencing Improves Technique and Quality of Life. Respir Care 62:1412-1422
Krishnan, Jerry A; Martin, Molly A; Lohff, Cortland et al. (2017) Design of a pragmatic trial in minority children presenting to the emergency department with uncontrolled asthma: The CHICAGO Plan. Contemp Clin Trials 57:10-22
Wu, Meng; Woodrick, Nicole M; Arora, Vineet M et al. (2017) Developing a Virtual Teach-To-Goalâ„¢ Inhaler Technique Learning Module: A Mixed Methods Approach. J Allergy Clin Immunol Pract 5:1728-1736

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