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Use of Remote Electronic Monitoring Improves Asthma Outcomes Through Improved Adherence
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A1164 - Use of Remote Electronic Monitoring Improves Asthma Outcomes Through Improved Adherence
Author Block: J. C. Carl1, D. Isakov2, S. Winners2, T. Lucik1, A. Ferchau1, A. Antara3, C. Becker3, D. Van Sickle3; 1Center for Pediatric Pulmonary Medicine, Cleveland Clinic Childrens, Cleveland, OH, United States, 2Cleveland Clinic Childrens, Cleveland, OH, United States, 3Propeller Health, Madison, WI, United States.
Rationale: Acute asthma exacerbations including ED and hospital admissions reflect poor outcomes, result in increased healthcare expenditures and are associated with controller nonadherence and increased albuterol use. We aimed to determine whether a quality improvement program employing digital health platform could improve pediatric asthma outcomes such as controller medication adherence and decreased albuterol use.
Methods: A 12 month monitoring study of 82 patients ages 4-18 years randomly indentified from Cleveland Clinic subspecialty clinics between November 2016 to present. At enrollment, patients received Propeller Health electronic sensors for controller and albuterol metered inhalers and access to vendor platform guideline based education . Study personnel monitored patient status and its correlation to both controller and rescue medication usage data received digitally. All participants received standard care from primary asthma clinicians. Retrospective electronic medical chart review was conducted for 12 months prior to enrollment to determine baseline clinical status and health resource utilization.
Results: Study enrollment included 82 patients (43 males, 39 females) with comorbidities: allergic rhinitis (66%), atopic dermatitis (29%), and GERD/obesity/food allergy (each 8.5%). Additional baseline characteristics: ≥1 sick office visit (75%), ≥ 1 ED/urgent care visit (58%), ≥ 1 oral steroid course (84%), ≥ 1 hospitalization (36%). Enrollment data included: current action plan (75%), ACT score distribution (poorly (28.5%), not well (33%), well controlled (38.5%)). Sensor data is currently available for about one half of patients through 6 months. Aggregate average controller adherence tracked for 1 week at 1, 2, 3, and 6 month post-enrollment time points demonstrates rates of 58%, 64%, 62% and 55% respectively. Average weekly rescue event rate at these time points demonstrates decreased events from mean baseline (0.597/week) to 0.21 (63%), 0.2 (69%), 0.25 (59%), and (75%) respectively.
Conclusions: This study demonstrated inclusion of digital health platform into standard guidelines-based asthma practice can inform caregivers about controller adherence and to rescue patterns that may indicate exacerbations. Although adherence rates varied over time, patients demonstrated higher rates than several prior studies that reported adherence rates around 22%. Substantial decrease in event rates for rescue albuterol use was sustained through enrollment period to date. Controller medication adherence is important in overall disease control. Many factors affect adherence, and this digital health platform was felt by patients to improve self-awareness and real-time communication with clinicians. Use of the electronic data sensor platform resulted in improvements in several key asthma management measures widely agreed to represent improved quality of care.
Author Block: J. C. Carl1, D. Isakov2, S. Winners2, T. Lucik1, A. Ferchau1, A. Antara3, C. Becker3, D. Van Sickle3; 1Center for Pediatric Pulmonary Medicine, Cleveland Clinic Childrens, Cleveland, OH, United States, 2Cleveland Clinic Childrens, Cleveland, OH, United States, 3Propeller Health, Madison, WI, United States.
Rationale: Acute asthma exacerbations including ED and hospital admissions reflect poor outcomes, result in increased healthcare expenditures and are associated with controller nonadherence and increased albuterol use. We aimed to determine whether a quality improvement program employing digital health platform could improve pediatric asthma outcomes such as controller medication adherence and decreased albuterol use.
Methods: A 12 month monitoring study of 82 patients ages 4-18 years randomly indentified from Cleveland Clinic subspecialty clinics between November 2016 to present. At enrollment, patients received Propeller Health electronic sensors for controller and albuterol metered inhalers and access to vendor platform guideline based education . Study personnel monitored patient status and its correlation to both controller and rescue medication usage data received digitally. All participants received standard care from primary asthma clinicians. Retrospective electronic medical chart review was conducted for 12 months prior to enrollment to determine baseline clinical status and health resource utilization.
Results: Study enrollment included 82 patients (43 males, 39 females) with comorbidities: allergic rhinitis (66%), atopic dermatitis (29%), and GERD/obesity/food allergy (each 8.5%). Additional baseline characteristics: ≥1 sick office visit (75%), ≥ 1 ED/urgent care visit (58%), ≥ 1 oral steroid course (84%), ≥ 1 hospitalization (36%). Enrollment data included: current action plan (75%), ACT score distribution (poorly (28.5%), not well (33%), well controlled (38.5%)). Sensor data is currently available for about one half of patients through 6 months. Aggregate average controller adherence tracked for 1 week at 1, 2, 3, and 6 month post-enrollment time points demonstrates rates of 58%, 64%, 62% and 55% respectively. Average weekly rescue event rate at these time points demonstrates decreased events from mean baseline (0.597/week) to 0.21 (63%), 0.2 (69%), 0.25 (59%), and (75%) respectively.
Conclusions: This study demonstrated inclusion of digital health platform into standard guidelines-based asthma practice can inform caregivers about controller adherence and to rescue patterns that may indicate exacerbations. Although adherence rates varied over time, patients demonstrated higher rates than several prior studies that reported adherence rates around 22%. Substantial decrease in event rates for rescue albuterol use was sustained through enrollment period to date. Controller medication adherence is important in overall disease control. Many factors affect adherence, and this digital health platform was felt by patients to improve self-awareness and real-time communication with clinicians. Use of the electronic data sensor platform resulted in improvements in several key asthma management measures widely agreed to represent improved quality of care.
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