Impact of a self-monitoring application on pediatric asthma disparities

• Published in: International journal of medical informatics (Shannon, Ireland) Vol. 144; p. 104294
• Main Authors: Nkoy, Flory L., Wilkins, Victoria L., Fassl, Bernhard A., Sheng, Xiaoming, Stone, Bryan L.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.12.2020
• Subjects: Adherence; Adolescent; Asthma; Child; Child, Preschool; Disparities; European Continental Ancestry Group; Healthcare Disparities; Hispanic Americans; Humans; Outcomes; Prospective Studies; Quality of Life; Race/ethnicity; Self-monitoring; Adherence; Disparities; Self-monitoring; Race/ethnicity; Outcomes; Asthma
• ISSN: 1386-5056; 1872-8243
• DOI: 10.1016/j.ijmedinf.2020.104294

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. 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. 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. 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.