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Impact of a self-monitoring application on pediatric asthma disparities
Flory L Nkoy1, Victoria L Wilkins1, Bernhard A Fassl1
1University of Utah, Salt Lake City, UT, United States.
Insights
The electronic-AsthmaTracker (e-AT) improved asthma control and quality of life for minority children, eliminating pre-existing disparities. Further research will examine its impact on oral steroid use and emergency department visits.
Area of Science:
- Pediatric Pulmonology
- Health Informatics
- Health Disparities Research
Background:
- Electronic AsthmaTracker (e-AT) is a self-monitoring tool previously shown to improve outcomes in children with asthma.
- This study investigates e-AT adherence and impact across diverse racial and ethnic subgroups.
- Understanding these impacts is crucial for equitable asthma management.
Purpose of the Study:
- To assess adherence to the e-AT tool among different race/ethnicity subgroups.
- To evaluate the impact of e-AT implementation on asthma control and quality of life (QOL) in these subgroups.
- To identify and address potential disparities in asthma care.
Main Methods:
- Secondary analysis of a prospective cohort study involving 318 children (ages 2-17) with persistent asthma.
- Utilized survival analysis for e-AT adherence and generalized estimating equation models for pre- and post-implementation outcomes.
- Compared outcomes between white, Hispanic, and other minority race/ethnicity subgroups.
Main Results:
- Hispanic children showed lower e-AT adherence (73%) and higher dropout risk compared to white children.
- Baseline disparities in QOL and asthma control were observed in Hispanic and 'other' minority groups compared to white children.
- Post-e-AT implementation, these disparities in QOL and asthma control disappeared by 3 months and persisted until study end.
Conclusions:
- Implementation of the e-AT tool led to improved asthma control and QOL among minority children.
- The e-AT effectively eliminated pre-existing disparities in QOL and asthma control between minority and white children.
- Further adequately powered studies are needed to investigate e-AT's impact on oral steroid use and emergency department/hospital admission disparities.
Objectives:
We previously reported improved outcomes after implementing the electronic-AsthmaTracker (e-AT), a self-monitoring tool for children with asthma, at 11 ambulatory pediatric clinics. This study assesses e-AT adherence and impact across race/ethnicity subgroups.
Study Design:
Secondary data analysis of a prospective cohort study of children ages 2-17 years with persistent asthma, enrolled from January 2014 to December 2015 to use the e-AT for 1 year. Survival analysis was used to compare e-AT use adherence and generalized estimating equation models to compare outcomes pre- and post e-AT initiation, between race/ethnicity subgroups.
Results:
Data from 318 children with baseline measurements were analyzed: 76.4 % white, 11.3 % Hispanic, 7.8 % "other", and 4.4 % unknown race/ethnicity subgroups. Mean e-AT adherence was 82 % (95 %CI: 79-84 %, reference) for whites, 73 % (64-81 %, p = 0.025) for Hispanics, and 78 % (69-86 %, p = 0.373) for other minorities. Compared to whites, Cox proportional hazard ratio for study dropout risk was 2.14 (1.31-3.77, p = 0.001) for Hispanics and 0.95 (0.60-1.50, p = 0.834) for other minorities. Disparities existed at baseline, with lower QOL (74.9 vs 80.6; p = 0.025) and asthma control (18.4 vs 19.7; p = 0.027) among Hispanics, compared to whites. After e-AT initiation, disparities disappeared at 3 months for QOL (87.2 vs 90.5; p = 0.159) and asthma control (23.1 vs 22.4; p = 0.063), persisting until study end. Disparities also existed at baseline, with lower QOL (74.6 vs. 80.6; p = 0.042) and asthma control (18.2 vs. 19.7, p = 0.024) among "other" minorities, compared to whites, and disappeared at 3 months for QOL (92.7 vs. 90.5, p = 0.432) and asthma control (22.7 vs 22.4; p = 0.518), persisting until study end. Subgroup analysis was underpowered to detect a difference in oral steroid use or ED/hospital admissions.
Conclusions:
Our study shows improved asthma control and QOL among minorities and disparity elimination after e-AT implementation. Future adequately powered studies will explore the impact on oral steroid and ED/hospital use disparities.
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