Publications by authors named "Valerie G Press"

93 Publications

Hospital-Initiated Care Bundle, Posthospitalization Care, and Outcomes in Adults with Asthma Exacerbation.

J Allergy Clin Immunol Pract 2021 Jul 12. Epub 2021 Jul 12.

Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.

Background: Hospitalization for asthma exacerbation is an opportune setting for initiating preventive efforts. However, hospital-initiated preventive asthma care remains underdeveloped and its effectiveness is uncertain.

Objective: To examine the effectiveness of a hospital-initiated asthma care bundle on posthospitalization asthma care and clinical outcomes.

Methods: Prospective multicenter study of adults (18-54 years) hospitalized for asthma exacerbation in 2017 to 2019. During the hospitalization, we implemented an asthma-care bundle (inpatient laboratory testing, asthma education, and discharge care), and prospectively measured chronic asthma care (eg, immunoglobulin E testing, specialist care) and asthma exacerbation (ie, systemic corticosteroid use, emergency department [ED] visit, hospitalizations) outcomes. By applying a self-controlled case series method, we examined within-person changes in these outcomes before (2-year period) and after (1-year period) the bundle implementation.

Results: Of 103 adults hospitalized for asthma exacerbation, the median age was 40 years and 72% were female. Compared with the preimplementation period, the postimplementation period had improved posthospitalized asthma care, including serum specific immunoglobulin E testing (rate ratio [RR] 2.18; 95% confidence interval [95% CI] 0.99-4.84; P = .051) and evaluation by asthma specialist (RR 2.66; 95% CI 1.77-4.04; P < .001). Likewise, after care bundle implementation, patients had significantly lower annual rates of systemic corticosteroid use (4.2 vs 2.9 per person-year; RR 0.70; 95% CI 0.61-0.80; P < .001), ED visits (3.2 vs 2.7 per person-year; RR 0.83; 95% CI 0.72-0.95; P = .008), and hospitalizations (2.1 vs 1.8 per person-year; RR 0.82; 95% CI 0.69-0.97; P = .02). Stratified analyses by sex, race/ethnicity, and health insurance yielded consistent results.

Conclusions: After hospital-initiated care bundle implementation, patients had improved posthospitalization care and reduced rates of asthma exacerbation.
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http://dx.doi.org/10.1016/j.jaip.2021.06.044DOI Listing
July 2021

The National Institutes of Health Should Extend the Systems-Level Approach to Include Extramural Research.

Acad Med 2021 Jul;96(7):934

Associate professor, Departments of Medicine and Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, Illinois.

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http://dx.doi.org/10.1097/ACM.0000000000004086DOI Listing
July 2021

Weak Handgrip at Index Admission for Acute Exacerbation of COPD Predicts All-Cause 30-Day Readmission.

Front Med (Lausanne) 2021 7;8:611989. Epub 2021 Apr 7.

Department of Medicine, University of Chicago, Chicago, IL, United States.

Identifying patients hospitalized for acute exacerbations of COPD (AECOPD) who are at high risk for readmission is challenging. Traditional markers of disease severity such as pulmonary function have limited utility in predicting readmission. Handgrip strength, a component of the physical frailty phenotype, may be a simple tool to help predict readmission. To investigate if handgrip strength, a component of the physical frailty phenotype and surrogate for weakness, is a predictive biomarker of COPD readmission. This was a prospective, observational study of patients admitted to the inpatient general medicine unit at the University of Chicago Medicine, US. This study evaluated age, sex, ethnicity, degree of obstructive lung disease by spirometry (FEV percent predicted), and physical frailty phenotype (components include handgrip strength and walk speed). The primary outcome was all-cause hospital readmission within 30 days of discharge. Of 381 eligible patients with AECOPD, 70 participants agreed to consent to participate in this study. Twelve participants (17%) were readmitted within 30 days of discharge. Weak grip at index hospitalization, defined as grip strength lower than previously established cut-points for sex and body mass index (BMI), was predictive of readmission (OR 11.2, 95% CI 1.3, 93.2, = 0.03). Degree of airway obstruction (FEV percent predicted) did not predict readmission (OR 1.0, 95% CI 0.95, 1.1, = 0.7). No non-frail patients were readmitted. At a single academic center weak grip strength was associated with increased 30-day readmission. Future studies should investigate whether geriatric measures can help risk-stratify patients for likelihood of readmission after admission for AECOPD.
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http://dx.doi.org/10.3389/fmed.2021.611989DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8058414PMC
April 2021

Strategies for Improving Inhalation Technique in Children: A Narrative Review.

Patient Prefer Adherence 2021 29;15:665-675. Epub 2021 Mar 29.

University of Chicago, Departments of Medicine and Pediatrics, Chicago, IL, USA.

Inhaled medicines are commonly utilized by children for various respiratory conditions and must be used effectively for the medication to reach the airways. Poor inhaler technique contributes to poorly controlled asthma with significant associated morbidity. Given the significant consequences of improper inhaler use in children, the goal of this review is to comprehensively describe existing and potential solutions to improve inhaler technique. Because children move through various settings, including clinical practices, schools, pharmacies, and homes, in their daily routine, there is great opportunity to teach and reinforce proper inhaler technique across settings. Within each setting, in-person and technology-based interventions have shown promise to improve technique. These solutions need to be more broadly adopted to deliver tailored education with support for provider training, team-based care, communication structures, and reimbursement. Such solutions hold the potential to improve inhaler use among children, with potential for decreasing morbidity and costs.
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http://dx.doi.org/10.2147/PPA.S267053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8018416PMC
March 2021

Representation of Women on National Institutes of Health Study Sections.

JAMA Netw Open 2021 02 1;4(2):e2037346. Epub 2021 Feb 1.

Section of General Internal Medicine, Department of Medicine, The University of Chicago, Chicago, Illinois.

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http://dx.doi.org/10.1001/jamanetworkopen.2020.37346DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885038PMC
February 2021

Is "Research Literacy" Needed to Increase Diversity Among Participants in Research Studies?

Authors:
Valerie G Press

Mayo Clin Proc 2021 02;96(2):280-281

Departments of Medicine and Pediatrics, University of Chicago, Chicago, IL. Electronic address:

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http://dx.doi.org/10.1016/j.mayocp.2020.12.011DOI Listing
February 2021

National Survey of Wellness Programs in U.S. and Canadian Medical Schools.

Acad Med 2021 05;96(5):728-735

W.W. Lee is associate professor of medicine and associate dean, Professional Development and Engagement, University of Chicago Pritzker School of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0002-7694-1304.

Purpose: To describe the prevalence and scope of wellness programs at U.S. and Canadian medical schools.

Method: In July 2019, the authors surveyed 159 U.S. and Canadian medical schools regarding the prevalence, structure, and scope of their wellness programs. They inquired about the scope of programming, mental health initiatives, and evaluation strategies.

Results: Of the 159 schools, 104 responded (65%). Ninety schools (93%, 90/97) had a formal wellness program, and across 75 schools, the mean full-time equivalent (FTE) support for leadership was 0.77 (standard deviation [SD] 0.76). The wellness budget did not correlate with school type or size (respectively, P = .24 and P = .88). Most schools reported adequate preventative programming (62%, 53/85), reactive programming (86%, 73/85), and cultural programming (52%, 44/85), but most reported too little focus on structural programming (56%, 48/85). The most commonly reported barrier was lack of financial support (52%, 45/86), followed by lack of administrative support (35%, 30/86). Most schools (65%, 55/84) reported in-house mental health professionals with dedicated time to see medical students; across 43 schools, overall mean FTE for mental health professions was 1.62 (SD 1.41) and mean FTE per student enrolled was 0.0024 (SD 0.0019). Most schools (62%, 52/84) evaluated their wellness programs; they used the Association of American Medical Colleges Graduation Questionnaire (83%, 43/52) and/or annual student surveys (62%, 32/52). The most commonly reported barrier to evaluation was lack of time (54%, 45/84), followed by lack of administrative support (43%, 36/84).

Conclusions: Wellness programs are widely established at U.S. and Canadian medical schools, and most focus on preventative and reactive programming, as opposed to structural programming. Rigorous evaluation of the effectiveness of programs on student well-being is needed to inform resource allocation and program development. Schools should ensure adequate financial and administrative support to promote students' well-being and success.
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http://dx.doi.org/10.1097/ACM.0000000000003953DOI Listing
May 2021

#SheForShe: Increasing Nominations Significantly Increased Institutional Awards for Deserving Academic Women.

J Gen Intern Med 2021 Jan 26. Epub 2021 Jan 26.

Department of Medicine, University of Chicago, Chicago, USA.

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http://dx.doi.org/10.1007/s11606-020-06446-1DOI Listing
January 2021

Association between inhaler technique and confidence among hospitalized children with asthma.

Respir Med 2020 Nov - Dec;174:106191. Epub 2020 Oct 9.

University of Chicago Departments of Medicine and Pediatrics, 5841 S Maryland Ave, Chicago, IL, 60637, USA. Electronic address:

Objective: Proper use of respiratory inhalers is crucial to asthma self-management and associated with improved outcomes. Previous studies conducted in outpatient and community settings show parents and children are overconfident in children's ability to use inhalers properly, which may lead healthcare providers to not teach or review inhaler technique. This study examined whether children and parents' confidence were associated with proper inhaler technique among children hospitalized with asthma.

Methods: Children between 5 and 10 years old hospitalized with asthma at an urban academic medical center demonstrated inhaler technique using metered dose inhalers and spacers. Technique was scored based on a validated 12-step scale. Confidence was measured using three items assessing 1. Knowledge to use inhaler, 2. Skills to use inhaler, and 3. Ability to independently use inhaler. These items were five-point scales and analyzed as binary variables. Independent t-tests were used to measure associations between confidence and number of steps performed correctly.

Results: None of the confidence items, when asked to parents or children (n = 70), were associated with the number of steps performed correctly. Further, while the majority of children and parents (59-70%) were confident based on each item, the mean number of steps correctly completed was 6.4 out of 12.

Conclusions: Children and parents' confidence in children's knowledge, skills, and ability to independently use an inhaler were all poor proxies for proper inhaler technique. Inpatient healthcare professionals should objectively evaluate technique and teach proper inhaler use to all children with asthma to optimize outcomes.
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http://dx.doi.org/10.1016/j.rmed.2020.106191DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8063506PMC
June 2021

Measuring eHealth Literacy in Urban Hospitalized Patients: Implications for the Post-COVID World.

J Gen Intern Med 2021 01 19;36(1):251-253. Epub 2020 Oct 19.

General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA.

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http://dx.doi.org/10.1007/s11606-020-06309-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571520PMC
January 2021

Preventing COPD Readmissions Under the Hospital Readmissions Reduction Program: How Far Have We Come?

Chest 2021 Mar 14;159(3):996-1006. Epub 2020 Oct 14.

Division of Pulmonary, Critical Care, and Sleep Medicine, VA Puget Sound Health Care System.

The Hospital Readmissions Reduction Program (HRRP) was developed and implemented by the Centers for Medicare & Medicaid Services to curb the rate of 30-day hospital readmissions for certain common, high-impact conditions. In October 2014, COPD became a target condition for which hospitals were penalized for excess readmissions. The appropriateness, utility, and potential unintended consequences of the metric have been a topic of debate since it was first enacted. Nevertheless, there is evidence that hospital policies broadly implemented in response to the HRRP may have been responsible for reducing the rate of readmissions following COPD hospitalizations even before it was added as a target condition. Since the addition of the COPD condition to the HRRP, several predictive models have been developed to predict COPD survival and readmissions, with the intention of identifying modifiable risk factors. A number of interventions have also been studied, with mixed results. Bundled care interventions using the electronic health record and patient education interventions for inhaler education have been shown to reduce readmissions, whereas pulmonary rehabilitation, follow-up visits, and self-management programs have not been consistently shown to do the same. Through this program, COPD has become recognized as a public health priority. However, 5 years after COPD became a target condition for HRRP, there continues to be no single intervention that reliably prevents readmissions in this patient population. Further research is needed to understand the long-term effects of the policy, the role of competing risks in measuring quality, the optimal postdischarge care for patients with COPD, and the integrated use of predictive modeling and advanced technologies to prevent COPD readmissions.
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http://dx.doi.org/10.1016/j.chest.2020.10.008DOI Listing
March 2021

Mask Use with Spacers/Valved Holding Chambers and Metered Dose Inhalers among Children with Asthma.

Ann Am Thorac Soc 2021 01;18(1):17-22

Department of Medicine and.

Inhaler misuse is highly prevalent and associated with high morbidity and costs. For metered dose inhalers, proper use can be supported with devices such as spacers/valved holding chambers (VHCs) and masks to effectively deliver inhaled medication to the lungs. However, guidelines are vague about which children with asthma should use spacers/VHCs with masks to deliver medication from metered dose inhalers as well as when they should transition to spacers/VHCs with mouthpieces. In this paper, we provide a focused review of the evidence for mask use, highlighting unclear and conflicting information in guidelines and studies. We synthesize the differences in recommendations and practice. Based on these findings, we call for future research to determine the appropriate age and necessary skills for transitioning children from using metered dose inhalers with spacers/VHCs and masks to using spacers/VHCs and mouthpieces. Guidelines about mask use should be standardized to help ensure optimal medical delivery for patients, provide consistent inhaler prescriptions and education across settings, and support team-based care to help lower pediatric asthma morbidity and costs.
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http://dx.doi.org/10.1513/AnnalsATS.202005-522CMEDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7780969PMC
January 2021

The Productivity Requirements of Implementing a Medical Scribe Program.

Ann Intern Med 2021 01 6;174(1):1-7. Epub 2020 Oct 6.

Pritzker School of Medicine, University of Chicago, Chicago, Illinois (T.J.M., W.W.L., V.G.P., N.L.).

Background: Economic analyses of medical scribes have been limited to individual, specialty-specific clinics.

Objective: To determine the number of additional patient visits various specialties would need to recover the costs of implementing scribes in their practice at 1 year.

Design: Modeling study based on 2015 data from the Centers for Medicare & Medicaid Services (CMS) and National Ambulatory Medical Care Survey. Scribe costs were based on literature review and a third-party contractor model. Revenue was calculated from direct visit billing, CPT (Current Procedural Terminology) billing, and data from the National Ambulatory Medical Care Survey.

Data Sources: 2015 data from CMS and the National Ambulatory Medical Care Survey.

Target Population: Health care providers.

Time Horizon: 1 year.

Perspective: Office-based clinic.

Outcome Measures: The number of additional patient visits a physician must have to recover the costs of a scribe program at 1 year.

Results Of Base-case Analysis: An average of 1.34 additional new patient visits per day (295 per year) were required to recover scribe costs (range, 0.89 [cardiology] to 1.80 [orthopedic surgery] new patient visits per day). For returning patients, an average of 2.15 additional visits per day (472 per year) were required (range, 1.65 [cardiology] to 2.78 [orthopedic surgery] returning visits per day). The addition of 2 new patient (or 3 returning) visits per day was profitable for all specialties.

Results Of Sensitivity Analysis: Results were not sensitive to most inputs, with the exception of hourly scribe cost and inclusion of CPT revenue.

Limitation: Use of Medicare data and failure to account for indirect costs, downstream revenue, or changes in documentation quality.

Conclusion: For all specialties, modest increases in productivity due to scribes may allow physicians to see more patients and offset scribe costs, making scribe programs revenue-neutral.

Primary Funding Source: University of Chicago Medicine's Center for Healthcare Delivery Science and Innovation and the Bucksbaum Institute.
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http://dx.doi.org/10.7326/M20-0428DOI Listing
January 2021

Evaluating the Need to Address Digital Literacy Among Hospitalized Patients: Cross-Sectional Observational Study.

J Med Internet Res 2020 06 4;22(6):e17519. Epub 2020 Jun 4.

Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, United States.

Background: Technology is a potentially powerful tool to assist patients with transitions of care during and after hospitalization. Patients with low health literacy who are predisposed to poor health outcomes are particularly poised to benefit from such interventions. However, this population may lack the ability to effectively engage with technology. Although prior research studied the role of health literacy in technology access/use among outpatients, hospitalized patient populations have not been investigated in this context. Further, with the rapid uptake of technology, access may no longer be pertinent, and differences in technological capabilities may drive the current digital divide. Thus, characterizing the digital literacy of hospitalized patients across health literacy levels is paramount.

Objective: We sought to determine the relationship between health literacy level and technological access, use, and capability among hospitalized patients.

Methods: Adult inpatients completed a technology survey that asked about technology access/use and online capabilities as part of an ongoing quality of care study. Participants' health literacy level was assessed utilizing the 3-question Brief Health Literacy Screen. Descriptive statistics, bivariate chi-squared analyses, and multivariate logistic regression analyses (adjusting for age, race, gender, and education level) were performed. Using Bonferroni correction for the 18 tests, the threshold P value for significance was <.003.

Results: Among 502 enrolled participants, the mean age was 51 years, 71.3% (358/502) were African American, half (265/502, 52.8%) were female, and half (253/502, 50.4%) had at least some college education. Over one-third (191/502, 38.0%) of participants had low health literacy. The majority of participants owned devices (owned a smartphone: 116/173, 67.1% low health literacy versus 235/300, 78.3% adequate health literacy, P=.007) and had used the Internet previously (143/189, 75.7% low health literacy versus 281/309, 90.9% adequate health literacy, P<.001). Participants with low health literacy were more likely to report needing help performing online tasks (133/189, 70.4% low health literacy versus 135/303, 44.6% adequate health literacy, P<.001). In the multivariate analysis, when adjusting for age, race, gender, and education level, we found that low health literacy was not significantly associated with a lower likelihood of owning smartphones (OR: 0.8, 95% CI 0.5-1.4; P=.52) or using the internet ever (OR: 0.5, 95% CI 0.2-0.9; P=.02). However, low health literacy remained significantly associated with a higher likelihood of needing help performing any online task (OR: 2.2, 95% CI 1.3-3.6; P=.002).

Conclusions: The majority of participants with low health literacy had access to technological devices and had used the internet previously, but they were unable to perform online tasks without assistance. The barriers patients face in using online health information and other health information technology may be more related to online capabilities rather than to technology access. When designing and implementing technological tools for hospitalized patients, it is important to ensure that patients across digital literacy levels can both understand and use them.
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http://dx.doi.org/10.2196/17519DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303835PMC
June 2020

Concerns About Coronavirus Disease-Related Collateral Damage for Patients With COPD.

Chest 2020 09 28;158(3):866-868. Epub 2020 May 28.

Intermountain Healthcare and the Division of Pulmonary Medicine, University of Utah School of Medicine, Murray, UT.

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http://dx.doi.org/10.1016/j.chest.2020.05.549DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837125PMC
September 2020

The Hospital Readmissions Reduction Program and COPD: More Answers, More Questions.

J Hosp Med 2020 04 11;15(4):252-253. Epub 2020 Feb 11.

Department of Medicine, MedStar Georgetown University Hospital, Washington, DC.

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http://dx.doi.org/10.12788/jhm.3362DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7153487PMC
April 2020

Laboratory-based Intermountain Validated Exacerbation (LIVE) Score stability in patients with chronic obstructive pulmonary disease.

BMJ Open Respir Res 2020 02;7(1)

Medicine, University of Chicago, Chicago, Illinois, USA.

Background: The Laboratory-based Intermountain Validated Exacerbation (LIVE) Score is associated with mortality and chronic obstructive pulmonary disease (COPD) exacerbation risk across multiple health systems. However, whether the LIVE Score and its associated risk is a stable patient characteristic is unknown.

Methods: We validated the LIVE Score in a fourth health system. Then we determined the LIVE Score stability in a retrospective cohort of 98 766 patients with COPD in four health systems where it was previously validated. We assessed whether LIVE Scores changed or remained the same over time. Stability was defined as a majority of surviving patients having the same LIVE Score 4 years later.

Results: The LIVE Score separated patients into three LIVE Score risk groups of low, medium, and high mortality and LIVE Score stability. Mortality ranged from 6.2% for low-risk LIVE to 45.8% for high-risk LIVE (p<0.001). We found that low-risk LIVE groups were stable and high-risk LIVE groups were unstable. Low-risk LIVE group patients remained low risk, but few high-risk LIVE group patients remained high risk (79.0% high vs 48.1% medium vs 8.8% low, p<0.001 for all pairwise comparisons).

Conclusion: The LIVE Score identifies three major clinically actionable cohorts: a stable low-risk LIVE group, an unstable high-risk LIVE group with high mortality rates, and a medium-risk LIVE group. These observations further our understanding of how existing data used to calculate the LIVE Score may target interventions across risk cohorts of patients with COPD in a health system.
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http://dx.doi.org/10.1136/bmjresp-2019-000450DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047500PMC
February 2020

Effectiveness of Virtual vs In-Person Inhaler Education for Hospitalized Patients With Obstructive Lung Disease: A Randomized Clinical Trial.

JAMA Netw Open 2020 01 3;3(1):e1918205. Epub 2020 Jan 3.

Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois.

Importance: Many patients who are hospitalized cannot use inhalers correctly, yet education for their use is often not provided. To address the need for an effective intervention feasible for wide-scale implementation, a virtual teach-to-goal intervention was developed to provide tailored patient-directed education using adaptive learning technology.

Objective: To assess whether the virtual teach-to-goal intervention is noninferior to an in-person teach-to-goal intervention for improving inhaler technique.

Design, Setting, And Participants: An equivalence and noninferiority randomized clinical trial took place from January 13, 2016, through September 20, 2017, with analyses conducted between October 25, 2017, and September 23, 2019. Adult inpatients with asthma or chronic obstructive pulmonary disease (COPD) admitted to general inpatient wards were eligible. Enrolled participants were randomized to virtual (n = 61) or in-person (n = 60) educational interventions. Investigators and research assistants were masked to interventions. Initial enrollment, study assessments, and delivery of the educational intervention occurred in the hospital; participants returned at 30 days for a follow-up research visit.

Interventions: Virtual education was a module delivered via handheld tablet with self-assessment questions before demonstration, narrated video demonstration of the correct technique, and self-assessment questions after demonstration; up to 3 rounds were repeated as needed. In-person education participants received iterative rounds of inhaler technique assessment and education by trained staff.

Main Outcomes And Measures: Noninferiority testing of whether virtual vs in-person education achieved an equal percentage with correct inhaler technique after education (>9 of 12 steps correct) against an a priori noninferiority limit of -10%; logistic regression models were used to adjust for differences in baseline technique and health literacy.

Results: Among 118 participants (59 in each group), most were black (114 [97%]) and female (76 [64%]), with a mean (SD) age of 54.5 (13.0) years. Correct technique increased similarly before vs after education in virtual (67%; range, 2%-69%) and in-person (66%; range, 17% to 83%) groups, although the difference after intervention exceeded the noninferiority limit (-14%; 95% CI lower bound, -26%). When adjusting for baseline inhaler technique, the difference was equivalent to the noninferiority limit (-10%; 95% CI lower bound, -22%).

Conclusions And Relevance: The findings suggest that patient-directed virtual education similarly improved the percentage of participants with correct technique compared with in-person education. Future work should confirm whether virtual teach-to-goal education is noninferior to in-person education and whether it is associated with long-term skills retention, medication adherence, and improved health outcomes.

Trial Registration: ClinicalTrials.gov identifier: NCT02611531.
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http://dx.doi.org/10.1001/jamanetworkopen.2019.18205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6991242PMC
January 2020

High-Deductible Health Plans Make the Chronically Ill Pay More for Less.

Ann Am Thorac Soc 2020 01;17(1):30-31

Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona.

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http://dx.doi.org/10.1513/AnnalsATS.201910-808EDDOI Listing
January 2020

A Mixed-methods Study Examining Inhaler Carry and Use among Children at School.

J Asthma 2020 10 16;57(10):1071-1082. Epub 2019 Jul 16.

Department of Medicine and Pediatrics, University of Chicago Medicine, Chicago, IL, USA.

Asthma self-management depends partly on access to inhalers; for children, this includes independent inhaler carry and use at school ("self-carry"). Although laws and policies support self-carry, little is known about practices within schools. This study aimed to identify factors associated with inhaler self-carry among children and examine barriers and facilitators to self-carry. This mixed-methods observational study included child-parent dyads and nurses from four Chicago schools. Children and parents answered questions about asthma care and morbidity, confidence in self-carry skills, and facilitators and barriers to self-carry. Nurses reported asthma documentation on file and their confidence in children's self-carry skills. Analysis utilized logistic regression. Thematic analysis was performed for open-ended questions. Of 65 children enrolled (mean = 10.66 years), 45 (69.2%) reported having quick-relief medication at school, primarily inhalers, and 35 (53.8%) reported self-carry. Inhaler self-carry was associated with controller medication use and parent confidence in child's self-carry skills. Children and parents identified several facilitators to self-carry: child's asthma knowledge, inhaler characteristics, and need for easy inhaler access. Barriers included child's limited understanding of asthma and inhalers, perception that inhaler is not needed, and limited inhaler access. Children also emphasized social relationships as facilitators and barriers, while parents described children's responsibility as a facilitator and inconsistent policy implementation as a barrier. Efforts to improve inhaler self-carry at school should focus on educating children about asthma and inhaler use, creating supportive environments for self-carry among peers and teachers, and fostering consistent implementation and communication about asthma policy among schools and families.
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http://dx.doi.org/10.1080/02770903.2019.1640729DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6962574PMC
October 2020

Do no harm: Natural language processing of social media supports safety of aseptic allergen immunotherapy procedures.

J Allergy Clin Immunol 2019 07 17;144(1):38-40. Epub 2019 May 17.

Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Allergy and Center for Dissemination and Implementation Science, University of Illinois at Chicago, Chicago, Ill.

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http://dx.doi.org/10.1016/j.jaci.2019.04.022DOI Listing
July 2019

Does inhaler technique align with confidence among African-American children and their parents?

Ann Allergy Asthma Immunol 2019 07 30;123(1):100-101. Epub 2019 Apr 30.

Department of Medicine, University of Chicago Medicine, Chicago, Illinois; Department of Pediatrics, University of Chicago Medicine, Chicago, Illinois.

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http://dx.doi.org/10.1016/j.anai.2019.04.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599723PMC
July 2019

Critical Errors in Inhaler Technique among Children Hospitalized with Asthma.

J Hosp Med 2019 06 8;14(6):361-365. Epub 2019 Apr 8.

University of Chicago, Chicago, Illinois.

Past studies have not evaluated inhaler use in hospitalized children with asthma. The objectives of this study were to evaluate inhaler technique in hospitalized pediatric patients with asthma and identify risk factors for improper use. We conducted a prospective cross-sectional study in a tertiary children's hospital for children 2-16 years of age admitted for an asthma exacerbation, and inhaler technique demonstrations were analyzed. Of 113 participants enrolled, 55% had uncontrolled asthma, and 42% missed a critical step in inhaler technique. More patients missed a critical step when they used a spacer with mouthpiece instead of a spacer with mask (75% [51%-90%] vs 36% [27%-46%]) and were older (7.8 [6.7-8.9] vs 5.8 [5.1-6.5] years). Patients using the spacer with mouthpiece remained significantly more likely to miss a critical step when adjusting for other clinical covariates (odds ratio 6.95 [1.71-28.23], P = .007). Hospital-based education may provide teachable moments to address poor proficiency, especially for older children using a mouthpiece.
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http://dx.doi.org/10.12788/jhm.3195DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6625439PMC
June 2019

The Search for Culturally Tailored Inhaled Corticosteroid Adherence Interventions Continues: A Dearth of Effective Strategies for African Americans with Asthma.

J Allergy Clin Immunol Pract 2019 04;7(4):1194-1196

Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colo.

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http://dx.doi.org/10.1016/j.jaip.2018.11.033DOI Listing
April 2019

Harmonized outcome measures for use in asthma patient registries and clinical practice.

J Allergy Clin Immunol 2019 09 9;144(3):671-681.e1. Epub 2019 Mar 9.

Division of Pulmonary, Allergy, and Critical Care Medicine, NorthShore University HealthSystem, Chicago, Ill.

Background: Asthma, a common chronic airway disorder, affects an estimated 25 million persons in the United States and 330 million persons worldwide. Although many asthma patient registries exist, the ability to link and compare data across registries is hindered by a lack of harmonization in the outcome measures collected by each registry.

Objectives: The purpose of this project was to develop a minimum set of patient- and provider-relevant standardized outcome measures that could be collected in asthma patient registries and clinical practice.

Methods: Asthma registries were identified through multiple sources and invited to join the workgroup and submit outcome measures. Additional measures were identified through literature searches and reviews of quality measures and consensus statements. Outcome measures were categorized by using the Agency for Healthcare Research and Quality's supported Outcome Measures Framework. A minimum set of broadly relevant measures was identified. Measure definitions were harmonized through in-person and virtual meetings.

Results: Forty-six outcome measures, including those identified from 13 registries, were curated and harmonized into a minimum set of 21 measures in the Outcome Measures Framework categories of survival, clinical response, events of interest, patient-reported outcomes, resource utilization, and experience of care. The harmonized definitions build on existing consensus statements and are appropriate for adult and pediatric patients.

Conclusions: The harmonized measures represent a minimum set of outcomes that are relevant in asthma research and clinical practice. Routine and consistent collection of these measures in registries and other systems would support creation of a national research infrastructure to efficiently address new questions and improve patient management and outcomes.
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http://dx.doi.org/10.1016/j.jaci.2019.02.025DOI Listing
September 2019

A feasibility study of a patient-centered educational strategy for rampant inhaler misuse among minority children with asthma.

J Allergy Clin Immunol Pract 2019 Jul - Aug;7(6):2028-2030. Epub 2019 Jan 31.

Department of Medicine, University of Chicago Medicine, Chicago, Ill; Department of Pediatrics, University of Chicago Medicine, Chicago, Ill.

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http://dx.doi.org/10.1016/j.jaip.2019.01.044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8126342PMC
September 2020
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