PRP197: Work in progress- Implementation of an Asthma Shared Decision Making Intervention in Pediatric Emergency Departments

Kelly Reeves, BSN, RN, UXC; Nirali Naik, PharmD, BCPS, AE-C; Hazel Tapp, PhD; Melinda Manning, BS; Katherine O'Hare, BSPH, MSW Student; Melanie Hogg, MS; Lindsay Shade, MHS, PA-C


Context: Asthma is a prevalent chronic disease that is difficult to manage and associated with marked disparities in outcomes. Among the most visible of these disparities is the higher rate of visits to the Emergency Department (ED) for uncontrolled asthma involving the most at-risk patients. One promising approach to addressing disparities is Shared Decision Making (SDM), a process by which the patient and provider jointly make a healthcare choice. SDM is associated with improved outcomes for patients; however, time constraints, workflow issues and availability of staff are noted implementation barriers. Use of healthcare Information Technology (IT) solutions may increase adoption of SDM.
Objective: This study aims to evaluate the implementation of Coach McLungs℠, an interactive SDM IT solution.
Design: The Consolidated Framework for Implementation Research (CFIR), is being used to identify barriers and facilitators to implementation. Researchers administer surveys to the clinical team and patients to inform implementation design, determine barriers and facilitators, and resource-needs to allow for real-time process adjustments within the ED. Key-informant interviews and analysis provide additional feedback to the stakeholder team to iterate the implementation process. Researchers track patient-centered outcomes including increased primary care, ED, and inpatient utilization over the duration of the study.
Setting: Two hospital based pediatric ED sites
Patients or Other Participants: Providers and pediatric patients age 7-17 and their caregivers
Instrument: Surveys and key informant interviews
Main Outcomes: 1) Evaluate the effectiveness of implementation using CFIR 2) Perception of SDM 3) Patient user satisfaction, knowledge and self-efficacy
Results to date: Analysis using a Likert scale CFIR survey confirmed 100% of ED providers from both healthcare systems (Site 1 N = 17; Site 2 N=4) agreed that Coach McLungs℠ improves patient education and the patient experience, provides decision support for provider and patients, and ~90% agreed (with ~10% neutral), that Coach McLungs℠ helps fill gaps in asthma care and is better than other education materials to improve asthma education and treatment planning. Analysis of key informant interviews and other provider/patient facing surveys are currently in progress.

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