Chicago II:
Evaluative research to identify resources and barriers of implementing evidence-based pediatric asthma care.
Client:
CHICAGO Collaboration II
Industry:
healthcare;
Team:
Research with Bryan Spence and Jenni Schneiderman; Design with Hongxuan Ge
Expertise:
in-person key informant interviews, user-centered interviews and observations, re-aim framework analysis and synthesis, communication design; storytelling;
Feb 2016 - June 2016.
CHALLENGE
24%
African American children in Chicago who have asthma, roughly 1 in 4.
9x
visits to the ED by African American children as compared to white children in Chicago
Chicago is the epicenter for asthma in the US.
African American children living in Chicago are 8 times more likely to die from an asthma attack than their white counterparts. In the predominantly Hispanic Chicago neighborhood of Humboldt Park, 41% of children suffer from asthma. These populations have limited access to healthcare and often end up in the Emergency Room (ER) for asthma attacks.
Many evidence-based care strategies have demonstrated the ability to improve asthma control, but uncertainty remains about how best to implement, integrate, and sustain these strategies in settings where children live, learn, play, and receive medical care.
How can we keep kids with asthma from returning to the ER?
RESEARCH APPROACHES
Carried out seven key informant interviews, three site tours and one user-centered interview. (30+ interviews for the whole team) Each in-person key informant interview lasted for 1 hour and talked about six interventions in a structured way. We also asked the interviewee to rank the interventions at the end of the interview.
We conducted research with five different stakeholder groups: ER physicians, ER nurses, ER nurse administrators, primary care physicians and caregivers of children with asthma. We made observations at primary care clinics, asthma specialists’ clinics and one medical call center and at all 6 participating ERs. During our interviews, we employed incentive techniques to better understand both the patient journey and the clinicians’ processes.
The "Asthma Room"
We created six intervention boards for the interview. They are Community Health Workers, Asthma Discharge Plan(CAPE), School Based Health Center, Fight Asthma Now, Propeller Health. By showing them and letting interviewee react with each intervention, we were able to easily explain concepts to the interviewee and got better results from the interviews.
INSIGHTS & LEARNINGS
"I keep all my documents to prove to my boss my absence was because I took my kid to the ER."
—Caregiver
“Fast acting or rescue medication? Honestly? I never knew what the controller medicine was to what’s a rescue medicine.”
—caregiver
“They have no idea what happened in the ED, and they don’t have their paperwork with
them. You’re trying to assess are they recovering from their acute exacerbation and also how can
I best help this family in moving forward, avoid another emergency room visit, and keep their asthma under control. That could take an hour.”
“Parents don’t want to sit here and listen to this stuff when their ride is waiting outside and they’ve already been here
for four to six hours, and they’re tired and hungry and miserable
and their kid’s screaming.”
—ED staff
Solution
“Up to 92% of asthmatic patients incorrectly use inhalers.”
- Researchers at the University of Texas, Galveston
“I didn’t know bleach was a trigger! I use bleach all the time.” - Caregiver
“They have no idea what happened in the ED, and they don’t have their paperwork with
them. You’re trying to assess are they recovering from their acute exacerbation and also how can
I best help this family in moving forward, avoid another emergency room visit, and keep their asthma under control. That could take an hour.”
“And we also help build a relationship with a physician. So if they don’t have a physician we get them a physician. If they do have a physician we send letters and asthma action plans.” _CHW
“It’s one thing to educate caregivers. But in the end, it’s the child who knows when he can’t breathe” - ED Nurse
