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Multicenter Study
. 2016 Jan;5(1):17-30.
doi: 10.2217/cer.15.52. Epub 2015 Dec 21.

Engaging stakeholders to design a comparative effectiveness trial in children with uncontrolled asthma

Kim Erwin  1 , Molly A Martin  2 , Tara Flippin  1 , Sarah Norell  1 , Ariana Shadlyn  1 , Jie Yang  1 , Paula Falco  1 , Jaime Rivera  1 , Stacy Ignoffo  3 , Rajesh Kumar  4 , Helen Margellos-Anast  5 , Michael McDermott  6 , Kate McMahon  7 , Giselle Mosnaim  8 , Sharmilee M Nyenhuis  2 , Valerie G Press  9 , Jessica E Ramsay  5 , Kenneth Soyemi  10 , Trevonne M Thompson  2 , Jerry A Krishnan  2   11
Affiliations
Multicenter Study

Engaging stakeholders to design a comparative effectiveness trial in children with uncontrolled asthma

Kim Erwin et al. J Comp Eff Res. 2016 Jan.

Erratum in

  • Corrigendum.
    [No authors listed] [No authors listed] J Comp Eff Res. 2016 Mar;5(2):228. doi: 10.2217/cer.15.52101. Epub 2016 Feb 8. J Comp Eff Res. 2016. PMID: 26852882 Free PMC article. No abstract available.

Abstract

Aim: To present the methods and outcomes of stakeholder engagement in the development of interventions for children presenting to the emergency department (ED) for uncontrolled asthma.

Methods: We engaged stakeholders (caregivers, physicians, nurses, administrators) from six EDs in a three-phase process to: define design requirements; prototype and refine; and evaluate.

Results: Interviews among 28 stakeholders yielded themes regarding in-home asthma management practices and ED discharge experiences. Quantitative and qualitative evaluation showed strong preference for the new discharge tool over current tools.

Conclusion: Engaging end-users in contextual inquiry resulted in CAPE (CHICAGO Action Plan after ED discharge), a new stakeholder-balanced discharge tool, which is being tested in a multicenter comparative effectiveness trial.

Keywords: asthma; health communication; patient discharge; pediatrics; stakeholder engagement; written action plan.

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Conflict of interest statement

Financial & competing interests disclosure

The study was sponsored by the Patient-Centered Outcomes Research Institute (contract #AS-1307-05420). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Figures

<b>Figure 1.</b>
Figure 1.. We employed a three-phase design process to develop a stakeholder-balanced asthma discharge tool.
Stakeholders included patient caregivers, emergency department clinicians (physicians, nurses, administrators) and ambulatory (outpatient) physicians. A highlight of findings from each stage is also presented. ED: Emergency department.
<b>Figure 2.</b>
Figure 2.. Sample projectives used with stakeholders in Phase I (from left to right): a caregiver-drawn asthma journey map; a physician-annotated prototype discharge tool; three sample discharge tools built by outpatient providers from a toolkit of preprinted sticky notes.
<b>Figure 3.</b>
Figure 3.. In Phase II, an early prototype was refined through iterative stakeholder input to develop a new discharge tool, CAPE (CHICAGO Action Plan after emergency department discharge).
CHICAGO: Coordinated Healthcare Interventions for Childhood Asthma Gaps in Outcome; QR: Quick response.
<b>Figure 4.</b>
Figure 4.. The new discharge tool, or CAPE (CHICAGO Action Plan after emergency discharge), includes several key advances in design to improve communication of medications, symptom recognition and action steps, and trigger recognition and self-management.
CHICAGO: Coordinated Healthcare Interventions for Childhood Asthma Gaps in Outcome; QR: Quick response.
<b>Figure 5.</b>
Figure 5.. Using the Gibson survey, clinicians and caregivers report higher levels of preference for the new discharge tool, CAPE (CHICAGO Action Plan after ED discharge), compared with existing documents.
CHICAGO: Coordinated Healthcare Interventions for Childhood Asthma Gaps in Outcome.
<b>Figure 6.</b>
Figure 6.. The card sorting activity supports findings from the Gibson survey, indicating greater clinician preference for the new discharge tool, CAPE (CHICAGO Action Plan after emergency department discharge).
CHICAGO: Coordinated Healthcare Interventions for Childhood Asthma Gaps in Outcome.
<b>Figure 7.</b>
Figure 7.. The card sorting activity supports findings from the Gibson survey, indicating greater caregiver preference for the new discharge tool.
CHICAGO: Coordinated Healthcare Interventions for Childhood Asthma Gaps in Outcome.
See this image and copyright information in PMC

References

    1. Comparative Effectiveness Research: National Institutes of Health. PCAST Session on Health Reform and CER. 2009. www.whitehouse.gov/files/documents/ostp/PCAST/Nabel%20Presentation.pdf
    1. National Institutes of Health/National Heart, Lung, and Blood Institute. Expert Panel Report 3: guidelines on asthma. www.nhlbi.nih.gov/health-pro/guidelines/current/asthma-guidelines/full-r...
    1. Global Initiative for Asthma (GINA) www.ginasthma.org/
    1. Gupta S, Wan FT, Ducharme FM, Chignell MH, Lougheed MD, Straus SE. Asthma action plans are highly variable and do not conform to best visual design practices. Ann. Allergy Asthma Immunol. 2012;108(4):260–265. - PubMed
    1. Ring N, Jepson R, Hoskins G, et al. Understanding what helps or hinders asthma action plan use: a systematic review and synthesis of the qualitative literature. Patient Educ. Couns. 2011;85(2):e131–e143. - PubMed

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