Family Learning on Asthma Topics
Family Learning on Asthma Topics
1. Hypothesis: The Family Learning on Asthma Topics (F.L.O.A.T) in the form of a a group
 teaching environment for family education stemming from standardized education materials
 on asthma, created and taught by nationally certified asthma educators will promote
 optimal asthma knowledge, management and quality of life among the individuals with
 asthma and their caregivers.

 2. Aim 1: To determine if the availability of educational services outside of regular
 clinic hours or admission status could improve asthma outcomes and decrease unnecessary
 medical utilization.

 3. Aim 2: By providing small-group learning environments for families, the investigators
 aim to encourage families to learn from each other's experiences and to decrease stigma
 around the disease.
I. Hypotheses and Specific Aims:

 1. Hypothesis: The Family Learning on Asthma Topics (F.L.O.A.T) in the form of a a group
 teaching environment for family education stemming from standardized education materials
 on asthma, created and taught by nationally certified asthma educators will promote
 optimal asthma knowledge, management and quality of life among the individuals with
 asthma and their caregivers.

 2. Aim 1: To determine if the availability of educational services outside of regular
 clinic hours or admission status could improve asthma outcomes and decrease unnecessary
 medical utilization.

 3. Aim 2: By providing small-group learning environments for families, the investigators
 aim to encourage families to learn from each other's experiences and to decrease stigma
 around the disease.

 II. Background and Significance:

 Despite recent improvements in treatment and the ongoing research in better understanding of
 the disease, emergency room visits and hospitalization rates for asthma remain high. The
 Centers for Disease Control and Prevention surveillance data reports that at a national
 level, health care use for emergency department services for asthma was 1.6 million in 2013,
 and that of 439,435 hospital admissions for asthma 136,669 or 31% are for children below the
 age of 18 years of age. The annual cost of asthma on the U.S. economy equates to more than
 $80 billion in medical expenses, including days missed from school, work and even death.
 Nurmagambetov, et.al. in their study state that the "combined costs of medical care,
 mortality, and absenteeism render the total cost of asthma a substantial and serious economic
 burden on society. These findings highlight the critical need to support and further
 strengthen asthma control strategies through increased provision of guideline-based care,
 improvements in self-management, and reduction of environmental asthma triggers to reduce ER
 visits, hospitalizations, absenteeism, and mortality".

 Bäuerle et al. used a prospective single-center controlled trial to show that by providing
 motivating and patient-oriented didactics on asthma, there is a statistically significant
 increase in asthma health outcomes and that asthma control can be improved by education
 measures. Although it is a key component of all international asthma guidelines, education in
 self-management is still insufficiently available in primary care settings. In the ambulatory
 setting, there are some families that require more extensive education and time is limited in
 a usual care appointment to address all their specific asthma needs.

 Providing patient education by an experienced asthma educator is an important step in
 supporting patients and families as they are diagnosed with asthma and as they adapt to life
 with a chronic condition. Educating families about the nature of the disease, triggers,
 identification of early signs and symptoms, principles of treatment, and asthma management
 can reduce children's use of acute care services. According to Srof et al., asthma management
 education programs should be connected to the chronic illness management within the fabric of
 the family system. The paradigm of group education supports engagement, promoting
 communication among all participants including facilitator to enhance a social construct for
 validating personal experiences, empowering caregivers, and solving asthma management
 problems.

 III. Preliminary Studies/Progress Report: none

 IV. Research Methods

 A. Outcome Measure(s):

 Decrease emergency room visits, hospitalizations, and systemic steroid use for each child 12
 months after completing the three, group classroom educational sessions.

 1. Description of Population to be Enrolled:

 The investigators will enroll legal guardians and or primary caregiver (18 years and
 older) of children 4-17 years of age along with those children/adolescents who have a
 diagnosis of asthma, and have documented poor control as evidenced by requiring two or
 more systemic steroids, one or more hospitalizations and/or two or more ED visits due to
 asthma in the 12 months prior to the asthma clinic or hospital visit. Patients and
 caregivers will be English or Spanish speaking.

 2. Study Design and Research Methods:

 Patients and caregivers will be recruited from the Pulmonary outpatient clinic and
 inpatient services at Children's Hospital Colorado. Patients will also be referred to
 the Family Learning on Asthma Topic (F.L.O.A.T) program by health care providers
 participating in these clinics/inpatient service. Children will be: 1) 4-17 years age,
 2) have poor evidence of asthma control based on > 2 systemic steroid courses; > 2
 Emergency Room visits; and >1 hospitalization for asthma exacerbation in the preceding
 12 months. The investigators anticipate to enroll 75 patients and enrollment to begin in
 the Spring 2019 through the Spring 2020.

 Family Learning on Asthma Topics classes will aim to emphasize, encourage, and support
 teaching methods that include standardized instructions. There will be three topics
 lasting approximately 45 minutes: General Asthma Knowledge; Asthma Triggers,
 Medications, and Self-Management. These topics were chosen based on the EPR-3 guideline
 recommendations to ensure the continuity of messaging. Each class size will be
 approximately 8 persons and will be taught by a Certified Asthma Educator (AE-C) and
 will be held in the Family Learning Center at the Children's Hospital Colorado. Classes
 will be taught in both English and Spanish. An in person Spanish asthma educator will be
 available to help teach the classes.

 The materials used for each class were created by the CHCO Health Literacy Team in
 collaboration with Asthma Educator Certified members of the Breathing Institute to
 ensure that evidence-based information will be communicated effectively to patients and
 families. Instead of a lecture style course, each class will facilitate interactive
 learning for patients and families to help them prepare for real life problem-solving
 and to promote self-awareness regarding medication use.

 Patient and families enrolled will be notified of the class schedule and receive
 reminders 1 week and the day before each of their classes either through email, phone
 call and or text messaging.

 There will be a general asthma knowledge questionnaire consisting of 12 questions and
 the standardized Asthma Control Test (ACT) that consists of 7 standardized questions,
 one for children 4 - 11 years of age and one for children 12 years and older, that
 participants will fill out at the start of their first class. After each class, there
 will be 4 questions to be answered regarding their understanding of that class. Handouts
 and visuals will be available in English and Spanish pertaining to information about
 that class. Other class materials will include a folder to keep their handouts in and
 paper and pencils for note taking. Peak flow meters and their Asthma Action Plans will
 also be provided. At the completion of the class series there will be a satisfaction
 survey, participants will fill out anonymously.

 Twelve months following the completion of the class series, the investigators will be
 conducting a chart review gathering data on frequency of emergency room visits,
 hospitalizations and systemic steroid use for asthma exacerbations along with any
 routine follow up visits for asthma.

 3. Description, Risks and Justification of Procedures and Data Collection Tools:

 Data collected will be through pre and post class questionnaires, Asthma Control Test (ACT),
 validated Inhaler Technique Assessment Tool (iDAT), and demographic information filled out by
 the families and noted in their EMR (EPIC). Information about participant's asthma care
 utilization and systemic steroid use will be obtained through EMR/EPIC chart review, 12
 months prior to enrollment and 12 months post last completed class. All information will be
 entered in to a secure REDCap data base and paper copies will be kept in the locked research
 cabinet of study personnel.

 E. Potential Scientific Problems: The investigators do not anticipate any scientific problems

 F. Data Analysis Plan:

 Inclusion requirements will be defined through the electronic medical record based on
 inclusion requirements by either the outpatient pulmonary team or inpatient asthma education
 team.

 After enrollment the following information will be placed into RedCap (HIPPA compliant
 database) from the EMR: Childs name, DOB, Race, Ethnicity, Cell phone number, Email, Zip
 Code, Sex, Preferred language (caregiver), Pulmonary or Allergy specialist seen within the
 previous year, Payer, Hospital visits (ED and hospital visits) 12 months prior to consent.

 Right after enrollment a pre-knowledge base survey of 12 questions and asthma control survey
 of 7 questions will be sent via RedCap to caregivers defined phone and email. The data will
 be collected electronically and stored in RedCap.

 Throughout the 4-month study period, every week an administrative support person will pull
 the child's name, caregivers name, designated contact phone number, and email from RedCap
 databased to send a text, email, and phone call reminders of upcoming classes and asking the
 caregiver to reply electronically if they are planning on attending. The administrative
 assistant will review the reply's and notify the educators of the number of class attendees
 and their names.

 Upon completing each of the three classes the instructor will ask for the administrative
 assistant to send a post knowledge bases survey of 4 questions out of RedCap to the primary
 caregiver. The electronic responses will be electronically entered into RedCap.

 Upon completion of the 3 classes and/or 4months the administrative assistant will send a
 post-knowledge survey consisting of 12 questions, an asthma control test survey of 7
 questions, and a satisfaction survey to the primary caregiver. The electronic responses will
 be entered into RedCap.

 Each quarter the overview of pre-knowledge base survey results, post-knowledge survey results
 and satisfaction survey will be reviewed by the team members to evaluate if any changes need
 to be made to the education curriculum.

 Child specific data will be reviewed 12 months after completion of the classes and/or study.

 G. Summarize Knowledge to be Gained:

 By conducting this group focused asthma education series for high risk asthmatics and their
 care givers, the investigators anticipate improved knowledge along with retention of
 knowledge gained through these classes thereby reducing exacerbations, and need for acute
 care interventions. Group centered learning will enhance opportunities to learn from others
 who may have similar experiences and will generate discussion and new skills and ideas.
Inclusion Criteria:

 -  Legal guardians and or primary caregiver (18 years and older) of children 4-17 years
 of age

 -  Children/adolescents who have a diagnosis of asthma, and have documented poor control
 as evidenced by requiring two or more systemic steroids, one or more hospitalizations
 and/or two or more ED visits due to asthma in the 12 months prior to the asthma clinic
 or hospital visit.

 -  Patients and caregivers will be English or Spanish speaking.

 Exclusion Criteria:

 -  children < 4 yrs of age

 -  children with multiple chronic lung diseases

 -  Children and families whose primary language is other than English or Spanish