Improving care transitions for pediatric asthma patients

The following is an interview published in the FierceHealthIT eBook "Technology to Enable Care Transitions." Download the eBook here to read more.

Ivor Horn, M.D., an emergency medical physician at Children's National Medical Center in Washington, D.C., has her sights set on creating truly patient-centered technology with mobile solutions. She and fellow physicians at Children's are focusing on at-risk children and adolescents with asthma--and the stress and confusion that caring for those children that can cause parents.

Horn and her colleagues received a grant from the Patient-Centered Outcomes Research Institute to research how mobile technology can be used to reach poor and at-risk populations, in part to manage care transitions and communication between physicians and patients.

"That is the key to really making a difference so that it's not mHealth, just a novelty for an elite group, but that it's something for everybody," Horn said.

A successful pilot program of a text messaging intervention called Text2Breathe, a texting intervention program that sends care information to parents of children, conducted this year at Children's proved the effectiveness of mobile technology to improve care transitions. Thanks to the program, fewer kids landed in the emergency room for asthma attacks and parents were better equipped to care for their children, Horn reports.

Below are some of the highlights from Horn's interview with FierceHealthIT about the Text2Breathe program--as well as future mobile initiatives.

FierceHealthIT: Why was treating asthma and the stress of treating and caring for asthma your first focus for a mobile intervention to aid care transitions?

Ivor Horn: In our hospital, we have an asthma clinic in the emergency department--we've had it for ten years. Kids were cycling in and out of the ED for asthma, so we took that opportunity to say, "This is a teachable moment for families, and they already identify asthma care with the emergency department."

Steven Teach, M.D., medical director of the department, who started the asthma clinic in the ED, found that the family would come back a week after the first ED visit, but they were not always following up with a primary care physician.

So at the time of the emergency department health communication intervention, families felt empowered, and liked it, but it was only for a short period of time. So we extended it with Text2Breathe.

FHIT: How does the Text2Breathe messaging system work--and how did it help improve care transitions?

IH: Our goal was to extend the effectiveness of the intervention and provide families with intervention at the time they needed it.

Some of the people participating in the pilot have smart phones, but mainly, they just have basic cell phones—and most don't have a data plan. The messages are based on National Heart, Lung, and Blood Institute asthma care guidelines, which are based on health communications, evidence and theory. It's an algorithm that provides educational texts to the parents. Some texts pose questions, some include reminders or general information, and some blasts include basic asthma care guidelines, such as how to deal with an asthma attack.

Families really liked it. We realized that families had other stressors impacting their ability to provide for their children. I'm a believer in the use of mobile, we know minority populations are early adopters of technology. They're more likely to use their mobile phone and it's how they access the Internet.

FHIT: How will this pilot help long-term?

IH: This is what we're starting with--getting input for urban, inner-city families--asking "How do we make this work for you and your family?" We're going out and doing interviews with families and asking them what things they think technology can do to help them.

We want to do something that's not what we think is the best thing for families, but what families need and want.

Mobile is another tool in our toolbox to engage and interact with our patients in a way we haven't before, because of a limited time in the clinic. Convergence of technology with expectations of Meaningful Use provides us with a great way to bring them together.

FHIT: How will mHealth change care as we know it, especially for patients with asthma and other chronic conditions?

IH: We have to ask how we can incorporate mHealth into people's workflow. We're very fortunate in pediatrics because we have all these digital natives; we can use things like gamifaction to teach kids about their asthma at a very early age. We can train them on how to do that in a way that is seamless, that is part of the provider's workflow.

Diabetes, obesity and asthma give us the opportunity to create a model that can be used for other chronic conditions.I think the key thing is the tool.

Just as we're integrating cell phones into our everyday lives, we're going to continue to incorporate mHealth into our healthcare and health. It's not a matter of if, but when and how.

To read this and other similar articles--download the free FierceHealthIT eBook, "Technology to Enable Care Transitions." 

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