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Zhou G, Thompson LR, Barry F, Flores-Vazquez J, Holifield C, Ravandi B, Chang TP, Halterman JS, Szilagyi PG, Okelo SO. Parent Perceptions of a Validated Asthma Questionnaire in the Emergency Department. Acad Pediatr 2024; 24:124-131. [PMID: 31785379 DOI: 10.1016/j.acap.2019.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/19/2019] [Accepted: 11/22/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE While a number asthma questionnaires have been validated, most have not been used in an emergency department (ED) setting, nor evaluated patient feedback or clinical benefit. We sought to evaluate parent feedback on an asthma questionnaire used in an ED setting. METHODS We recruited parents of children 2-17 years old presenting to a tertiary pediatric ED for asthma care. Parents first completed then rated the Pediatric Asthma Control and Communication Instrument (PACCI-ED). RESULTS One hundred seventy-four parents (84%) completed surveys. Approximately two-thirds were Latinx, and 82% completed high school. Ninety-three percent of children had uncontrolled asthma. Parents endorsed the PACCI-ED: as easy to answer (94%); useful in understanding their child's asthma (83%); used the right words to describe their child's condition (95%); and would help the ED physician (93%) and primary care provider (PCP) (89%) better understand their child's asthma. Eleven percent reported that the PACCI-ED interfered with ED care. Parents with lower health literacy were more likely to agree the PACCI-ED asked more complete questions about their child's asthma than the ED physician (64% vs 45%, P = .02). Parents of children with uncontrolled asthma were more likely to agree that the PACCI-ED should become part of regular ED care (88% vs 62%, P = .02). Parents were more likely to agree that the PACCI-ED would help their PCP understand their child's asthma if they had a lower income (92% vs 50%, P < .001), less education (100% vs 88%, P = .004), were Latinx (94% vs 83%, P = .006), or were not using controller medication (93% vs 83%, P = .03). CONCLUSIONS Parents endorse an asthma questionnaire as valuable during an ED encounter. Because it is endorsed to be valuable to parents, this questionnaire could be used to facilitate patient-centered asthma care.
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Affiliation(s)
- Geena Zhou
- USCF School of Medicine (G Zhou), San Francisco, Calif
| | - Lindsey R Thompson
- Department of Pediatrics (LR Thompson, F Barry, J Flores-Vazquez, C Holifield, PG Szilagyi, SO Okelo), UCLA David Geffen School of Medicine, Los Angeles, Calif
| | - Frances Barry
- Department of Pediatrics (LR Thompson, F Barry, J Flores-Vazquez, C Holifield, PG Szilagyi, SO Okelo), UCLA David Geffen School of Medicine, Los Angeles, Calif
| | - Jessica Flores-Vazquez
- Department of Pediatrics (LR Thompson, F Barry, J Flores-Vazquez, C Holifield, PG Szilagyi, SO Okelo), UCLA David Geffen School of Medicine, Los Angeles, Calif
| | - Chloe Holifield
- Department of Pediatrics (LR Thompson, F Barry, J Flores-Vazquez, C Holifield, PG Szilagyi, SO Okelo), UCLA David Geffen School of Medicine, Los Angeles, Calif
| | - Bahareh Ravandi
- Children's Hospital Los Angeles (B Ravandi, TP Chang), Los Angeles, Calif
| | - Todd P Chang
- Children's Hospital Los Angeles (B Ravandi, TP Chang), Los Angeles, Calif
| | | | - Peter G Szilagyi
- Department of Pediatrics (LR Thompson, F Barry, J Flores-Vazquez, C Holifield, PG Szilagyi, SO Okelo), UCLA David Geffen School of Medicine, Los Angeles, Calif
| | - Sande O Okelo
- Department of Pediatrics (LR Thompson, F Barry, J Flores-Vazquez, C Holifield, PG Szilagyi, SO Okelo), UCLA David Geffen School of Medicine, Los Angeles, Calif.
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Cotter J, Schmiege S, Moss A, Ambroggio L. How to Interact With Interactions: What Clinicians Should Know About Statistical Interactions. Hosp Pediatr 2023; 13:e319-e323. [PMID: 37732385 DOI: 10.1542/hpeds.2023-007259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Affiliation(s)
| | - Sarah Schmiege
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Angela Moss
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado, Aurora, Colorado
| | - Lilliam Ambroggio
- Sections of Hospital Medicine and
- Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
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Okelo SO. Racial Inequities in Asthma Care. Semin Respir Crit Care Med 2022; 43:684-708. [DOI: 10.1055/s-0042-1756492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractRacial inequities in asthma care are evolving as a recognized factor in long-standing inequities in asthma outcomes (e.g., hospitalization and mortality). Little research has been conducted regarding the presence or absence of racial inequities among patients seen in asthma specialist settings, this is an important area of future research given that asthma specialist care is recommended for patients experiencing the poor asthma outcomes disproportionately experienced by Black and Hispanic patients. This study provides a systematic review of racial asthma care inequities in asthma epidemiology, clinical assessment, medication prescription, and asthma specialist referral practices.
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Affiliation(s)
- Sande O. Okelo
- Division of Pediatric Pulmonology and Sleep Medicine, The David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
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Williamson SF, Grayling MJ, Mander AP, Noor NM, Savage JS, Yap C, Wason JMS. Subgroup analyses in randomized controlled trials frequently categorized continuous subgroup information. J Clin Epidemiol 2022; 150:72-79. [PMID: 35788399 DOI: 10.1016/j.jclinepi.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/15/2022] [Accepted: 06/28/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate how subgroup analyses of published Randomized Controlled Trials (RCTs) are performed when subgroups are created from continuous variables. METHODS We carried out a review of RCTs published in 2016-2021 that included subgroup analyses. Information was extracted on whether any of the subgroups were based on continuous variables and, if so, how they were analyzed. RESULTS Out of 428 reviewed papers, 258 (60.4%) reported RCTs with a subgroup analysis. Of these, 178/258 (69%) had at least one subgroup formed from a continuous variable and 14/258 (5.4%) were unclear. The vast majority (169/178, 94.9%) dichotomized the continuous variable and treated the subgroup as categorical. The most common way of dichotomizing was using a pre-specified cutpoint (129/169, 76.3%), followed by a data-driven cutpoint (26/169, 15.4%), such as the median. CONCLUSION It is common for subgroup analyses to use continuous variables to define subgroups. The vast majority dichotomize the continuous variable and, consequently, may lose substantial amounts of statistical information (equivalent to reducing the sample size by at least a third). More advanced methods that can improve efficiency, through optimally choosing cutpoints or directly using the continuous information, are rarely used.
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Affiliation(s)
- S Faye Williamson
- Biostatistics Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Michael J Grayling
- Biostatistics Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Nurulamin M Noor
- Medical Research Council Clinical Trials Unit at University College London (MRC CTU at UCL), London, UK
| | - Joshua S Savage
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Christina Yap
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - James M S Wason
- Biostatistics Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
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