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Asthma Care Education in African American Children

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PICOT Question

The PICOT question in this study is as follows: In African American children (P), will proper education on asthma management (I) compared to no education (C) help reduce the disruption of daily lives (O) over a one-year period (T)?

The PICOT question presupposes the use of a control group and an experimental group to check the effect of education on patients. The decision to include the time limit is justified by the need to establish the appropriate duration of an intervention in case it proves to be successful and is recommended for use in the future.

Evidence Synthesis

PubMed Study #1 Study #2 Study #3 Study #4 Study #5 Synthesis
(p) Population Children hospitalized for acute asthma exacerbation Children hospitalized for asthma Children admitted for asthma or bronchodilator-responsive wheezing Children and adolescents with asthma Pediatric patients admitted for asthma Available evidence relates to children and adolescents admitted to hospitals for asthma, asthma exacerbation, and bronchodilator-responsive wheezing
(i) Intervention Educating caregivers with the aim of lowering readmission rates Educating caregivers with the aim of decreasing the levels of readmission Better access to caregivers educational and occupational choices to increase the level of childrens wellbeing and the rates of readmissions Decreasing obesity with the aim of relieving asthma symptoms Educating caregivers and healthcare workers with the aim of lowering readmission rates The interventions are focused on educating caregivers; none of them involves educating children
(c) Comparison Quality of care at hospitals and in home settings Caregivers knowledge before and after the intervention Levels of readmission in African Americans and whites Obesity rates and ethnicity differences The risk of hospitalization with asthma compared to a reference of a cohort of children hospitalized with other diagnoses The majority of studies focus on changes over time and aim at lowering the readmission rates
(o) Outcome Children with access to insurance have the lowest rates of readmissions Greater asthma knowledge
and decreased medication adherence is associated with readmissions		 African American children are twice as likely to be readmitted
as white children		 Reduced injury rates and improved safety outcomes Obese children have worse asthma control Interventions are aimed at achieving both theoretical (knowledge) and practical (lower readmissions) results
(t) Time One year One year One year One month Four years (2004-2008) Their majority of studies are performed within a one-year period

Evaluation Table

Citation Design Sample size:
adequate? 		Major variables: independent/
dependent 		Study findings: strengths and weaknesses Level of evidence Evidence synthesis
1. Auger, K. A., Kahn, R. S., Davis, M. M., Beck, A. F., & Simmons, J. M. (2013). Medical home quality and readmission risk for children hospitalized with asthma exacerbations. Pediatrics, 131(1), 64-70. Mixed methods design was used. Quantitative design was chosen for the study. Qualitative Likert-based,
validated survey was used to collect data from caregivers.		 The sample size is 601 children, and it may be considered as highly sufficient. The children are aged between one and sixteen years old. The dependent variable in the study is the number of readmissions. The independent variable is the decreased number of readmissions. Strengths: the study has a large sample and involves a variety of methods.
Limitations: the type of study design does not eliminate the option of unknown cofounders. Also, scholars are unable to conclude whether childrens medical homes are not changed within the follow-up time. Another limitation is the inclusion of patients from only one hospital.		 Level III The study results show that high rates of readmission are associated with insufficient access to a medical home. The authors conclude that enhanced access to physicians is capable of lowering readmission rates among children with asthma.
2. Auger, K. A., Kahn, R. S., Davis, M. M., Beck, A. F., & Simmons, J. M. (2015). Pediatric asthma readmission: Asthma knowledge is not enough? The Journal of Pediatrics, 166(1), 101-108. A prospective observational cohort study was chosen as a method of research. The sample size is 601 children, and it is rather adequate. Such a sample allows researchers to make valid conclusions and increases the reliability of findings. The dependent variable is the number of readmissions of children with asthma.
The independent variable is the prevention of readmissions as a result of gaining knowledge of the disease.		 Strengths: the duration of the study (one year plus a follow-up), a large sample, the inclusion of African American children in the sample.
Limitations: observational study design. Also, the authors combined two scales of asthma knowledge, which may take away from reliability since no formal psychometric testing was employed. Another limitation is that the adherence measures were grounded in reports of caregivers rather than the electronic measurement. Also, since only one hospital was involved in the study, it cannot represent the national scale.		 Level IV The results indicate that irrespective of asthma knowledge, readmission rates may be high in case of decreased medication adherence. Therefore, it is recommended to focus on medication adherence rather than on asthma education in order to gain reduced rates of readmissions.
3. Beck, A. F., Huang, B., Simmons, J. M., Moncrief, T., Sauers, H. S., Chen, C., & Kahn, R. S. (2014). Role of financial and social hardships in asthma racial disparities. Pediatrics, 133(3), 431-439. The design of the study is a population-based,
prospective observational cohort
at Cincinnati Childrens Hospital
Medical Center.		 The sample size is 771 children. It is quite sufficient. In addition, researchers recorded such data about the participants as hardships, socioeconomic status, and race. The dependent variable is the number of readmissions of children ill with asthma. The independent variable is the decreased number of readmissions based on the improvement of African American childrens social status Strengths: a large sample, the inclusion of African American children in the study, the analysis of several factors influencing the frequency of readmissions.
Limitations: data were only collected on the children staying at Cincinnati Childrens Hospital
Medical Center. Also, the generalizability of the sample was limited. Next, there were crucial differences concerning race and insurance in those who were and were not enrolled.		 Level IV The study suggests evidence of African American children having a high disposition to asthma. The results of the study indicate that more thorough educational measures need to be taken in order to decrease the rates of readmissions.
4. Borrell, L. N., Nguyen, E. A., Roth, L. A., Oh, S. S., Tcheurekdjian, H., Sen, S., & Burchard, E. G. (2013). Childhood obesity and asthma control in the GALA II and SAGE II studies. American Journal of Respiratory and Critical Care Medicine, 187(7), 697-702. The study design is represented by two clinic-based asthma case-control studies: the Genes-environments and Admixture in Latino Americans (GALA
II) Study and the Study of African Americans, Asthma, Genes		 The sample size is adequate: 2,022 children in GALA II and 769 children in SAGE II. The dependent variable is the impact of obesity on the development of asthma. The independent variable is the decreased level of asthma in children who have managed their obesity issues. Strengths: a large sample, the inclusion of African American children in research; the use of two studies.
Limitations: because the study was cross-sectional, it was not possible to create a temporal connection between the exposure and the result. Next, the evaluation of asthma control was performed within a rather short period: one week.		 Level IV The findings suggest that asthma control is lower in boys suffering from obesity and girls belonging to ethnic minority groups.
5. Shaw, M. R., Daratha, K. B., Odom-Maryon, T., & Bindler, R. C. (2013). Pediatric patients with asthma: A high-risk population for subsequent hospitalization. Journal of Asthma, 50(6), 548-554. The design chosen for research is an observational cohort study. The sample size is 81,946 children (during a four-year period), which is adequate. The dependent variable is hospital admissions. The independent variable is the reduction of hospital admissions through developing relevant interventions. Strengths: a large sample and long duration of the study.
Limitations: the absence of researchers ability to record emergency department visits that did not result in admissions. Another limitation was the lack of data on patients ethnicity.		 Level IV The study provides evidence on hospital admission rates for children with asthma as compared to pediatric patients other diseases.

References

Auger, K. A., Kahn, R. S., Davis, M. M., Beck, A. F., & Simmons, J. M. (2013). Medical home quality and readmission risk for children hospitalized with asthma exacerbations. Pediatrics, 131(1), 64-70.

Auger, K. A., Kahn, R. S., Davis, M. M., Beck, A. F., & Simmons, J. M. (2015). Pediatric asthma readmission: Asthma knowledge is not enough? The Journal of Pediatrics, 166(1), 101-108.

Beck, A. F., Huang, B., Simmons, J. M., Moncrief, T., Sauers, H. S., Chen, C., & Kahn, R. S. (2014). Role of financial and social hardships in asthma racial disparities. Pediatrics, 133(3), 431-439.

Borrell, L. N., Nguyen, E. A., Roth, L. A., Oh, S. S., Tcheurekdjian, H., Sen, S., & Burchard, E. G. (2013). Childhood obesity and asthma control in the GALA II and SAGE II studies. American Journal of Respiratory and Critical Care Medicine, 187(7), 697-702.

Shaw, M. R., Daratha, K. B., Odom-Maryon, T., & Bindler, R. C. (2013). Pediatric patients with asthma: A high-risk population for subsequent hospitalization. Journal of Asthma, 50(6), 548-554.

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