自我监测应用对儿科哮喘差异的影响。

Impact of a self-monitoring application on pediatric asthma disparities.

机构信息

University of Utah, Salt Lake City, UT, United States.

出版信息

Int J Med Inform. 2020 Dec;144:104294. doi: 10.1016/j.ijmedinf.2020.104294. Epub 2020 Oct 5.

DOI:10.1016/j.ijmedinf.2020.104294

PMID:33080504

Abstract

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.

摘要

目的

我们之前报道过，在 11 家门诊儿科诊所实施电子哮喘追踪器（e-AT），一种针对哮喘儿童的自我监测工具，可改善预后。本研究评估了 e-AT 在不同种族/民族亚组中的依从性和影响。

研究设计

这是一项对 2014 年 1 月至 2015 年 12 月期间使用 e-AT 进行为期 1 年的 2-17 岁持续性哮喘儿童的前瞻性队列研究的二次数据分析。采用生存分析比较 e-AT 使用依从性，采用广义估计方程模型比较种族/民族亚组在 e-AT 启动前后的结局。

结果

对 318 名基线测量患儿的数据进行了分析：76.4%为白人，11.3%为西班牙裔，7.8%为“其他”，4.4%为未知种族/民族亚组。白人组 e-AT 依从率为 82%（95%CI：79-84%，参考），西班牙裔组为 73%（64-81%，p=0.025），其他少数民族组为 78%（69-86%，p=0.373）。与白人相比，西班牙裔组研究辍学风险的 Cox 比例风险比为 2.14（1.31-3.77，p=0.001），其他少数民族组为 0.95（0.60-1.50，p=0.834）。在基线时存在差异，西班牙裔儿童的 QOL（74.9 比 80.6；p=0.025）和哮喘控制（18.4 比 19.7；p=0.027）低于白人。在 e-AT 启动后，3 个月时 QOL（87.2 比 90.5；p=0.159）和哮喘控制（23.1 比 22.4；p=0.063）的差异消失，并持续到研究结束。在基线时，“其他”少数民族儿童的 QOL（74.6 比 80.6；p=0.042）和哮喘控制（18.2 比 19.7，p=0.024）也低于白人，3 个月时 QOL（92.7 比 90.5，p=0.432）和哮喘控制（22.7 比 22.4；p=0.518）的差异消失，并持续到研究结束。亚组分析的效力不足以检测口服类固醇使用或 ED/住院的差异。