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.

中文翻译：

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自我监控应用程序对小儿哮喘病差异的影响

目标

我们先前报告说，在11家门诊儿科诊所实施了哮喘儿童自我监控工具电子哮喘追踪器（e-AT）之后，结果有所改善。这项研究评估了跨种族/族裔亚组的e-AT依从性和影响。

学习规划

2014年1月至2015年12月使用前瞻性队列研究对2-17岁持续性哮喘患儿进行的前瞻性队列研究的二级数据分析，使用1年。生存分析用于比较种族/族裔亚组之间e-AT使用依从性和广义估计方程模型，以比较e-AT启动前后的结果。

结果

分析了来自318名基线测量儿童的数据：76.4％的白人，11.3％的西班牙裔，7.8％的“其他”和4.4％的未知种族/族裔亚组。白人的平均e-AT依从率为82％（95％CI：79–84％，参考），西班牙裔平均为73％（64–81％，p = 0.025），78％（69–86％，p = 0.373） ）的其他少数族裔。与白人相比，西班牙裔美国人的Cox比例辍学风险比例为2.14（1.31-3.77，p = 0.001），其他少数族裔则为0.95（0.60-1.50，p = 0.834）。与白人相比，基线时存在差异，西班牙裔患者的QOL较低（74.9 vs 80.6； p = 0.025）和哮喘控制（18.4 vs 19.7； p = 0.027）。e-AT启动后，QOL（87.2 vs 90.5; p = 0.159）和哮喘控制（23.1 vs 22.4; p = 0.063）的差异在3个月时消失，一直持续到研究结束。基线之间也存在差距，与白人相比，“其他”少数民族的QOL较低（74.6 vs. 80.6; p = 0.042）和哮喘控制（18.2 vs. 19.7，p = 0.024），而QOL在3个月时消失了（92.7 vs. 90.5，p = 0.432）和哮喘控制（22.7 vs 22.4； p = 0.518），一直持续到研究结束。亚组分析的能力不足以检测口服类固醇使用或ED /医院入院的差异。

结论

我们的研究表明，少数族裔人群哮喘控制和生活质量得到改善，实施e-AT后消除了视差。未来有足够能力的研究将探讨对口服类固醇和ED /医院使用差异的影响。