Shared decision making and time to exacerbation in children with asthma

Area of Science:

• Pediatric Pulmonology
• Health Services Research
• Shared Decision Making

Background:

• Shared decision making (SDM) shows promise for chronic disease management but lacks evidence for delaying asthma exacerbations.
• Asthma exacerbations significantly impact children's health and healthcare utilization.

Purpose of the Study:

• To evaluate the impact of a real-world SDM intervention on time to asthma exacerbation in children.
• To assess if SDM implementation by providers can reduce asthma-related events in pediatric patients.

Main Methods:

• Prospective cohort study in primary care practices serving vulnerable populations (2011-2013).
• Matched 100 pairs of children (aged 2-17) receiving SDM versus usual care using propensity scores.
• Compared time to asthma exacerbation (hospitalization, ED visit, oral steroid prescription) using survival analysis.

Main Results:

• Kaplan-Meier curves indicated longer exacerbation-free time in the SDM group (p = 0.005).
• The risk of exacerbation was marginally significant between groups (HR = 0.56, p = 0.08).
• The study included 746 children, with 100 matched pairs in the final analysis.

Conclusions:

• SDM intervention was effective in delaying asthma exacerbations in children.
• Clinicians should consider SDM to incorporate patient preferences and improve asthma control, leading to longer exacerbation-free periods.