Implementation and User-Centered Design in Outpatient Care: A Case-Study with Pediatric Asthma and Digital Health

Kristin Kan, MD, MPH, MSc
Ann & Robert H. Lurie Children’s Hospital of Chicago

ABSTRACT:
Of the 5.5 million US children with pediatric asthma, over half have uncontrolled symptoms due in part to poor asthma self-management, leading to high rates of acute unscheduled care and activity limitations. Guideline-based, preventive asthma care is a critical step in reducing uncontrolled symptoms among high-risk asthma populations. An asthma care model using technology-enhanced tools, like digital device monitoring and population health management, is one promising approach to aid patients’ adherence to recommended care. However, implementation of technology-based care in outpatient care settings poses real-world barriers with integration in health delivery systems, changing health provider behaviors, and shifting care out of the clinic into home and community environments. In 2016, the Center for Food Allergy and Asthma Research (NU) partnered with community and hospital-affiliated primary care practices with using digital medication sensors and a mobile app with patients in a randomized trial. Using CFIR, interviews with patients, nurses, and clinicians were conducted post-trial to understand implementation constructs. The findings informed an upcoming feasibility trial, leveraging a population health model and digital asthma app and device. This presentation will reflect on the dynamic context of health system’s use of digital-enhanced healthcare, engagement of health providers and patients in changed expectations with these tools, and redesign that had to be considered for implementing in the outpatient care setting.