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159 Evaluation of coach Mclungs5 M implementation, a shared decision-making intervention in the emergency department
  1. Thomas Ludden1,
  2. Kelly Reeves1,
  3. Stacy Reynolds2,
  4. Lindsay Shade1,
  5. Lyn Nuse1,
  6. Cheryl Courtlandt1,
  7. Andrea Desantis1,
  8. Diane Derkowski1,
  9. Denise Derkowski1,
  10. Jeremy Thomas1,
  11. Melanie Hogg2,
  12. Melissa Calvert1,
  13. Beth Burton1,
  14. Saul Amezquita1,
  15. Caroline Cox3,
  16. Lindsay Deneault1,
  17. Hazel Tapp1
  1. 1Department of Family Medicine, Atrium Health, Charlotte, USA
  2. 2Department of Emergency Medicine, Atrium Health, Charlotte, USA
  3. 3Wellstar Health System, Marietta, GA USA

Abstract

Introduction Significant disparities in asthma outcomes occur by gender, race, ethnicity, and socioeconomic status. Patients with the worst outcomes often lack continuity primary care and receive care at emergency departments during exacerbations. lmproved asthma outcomes are associated with effective communication between patients and providers, such as using shared decision-making. Coach Mcl ungs8 M, a health information technology solution designed for primary care, engages patients, caregivers, and providers in shared decision-making about asthma. This Patient-Centered Outcomes Research lnstitute (PCORI) funded study evaluates the implementation of Coach Mcl ungs8 M in an emergency care setting.

Methods This asthma intervention took place in an urban pediatric emergency department in Charlotte, North Carolina, USA, that serves a low-income, high-minority community. Patients aged 7–17 were evaluated for shared decision-making, self-efficacy, satisfaction, and knowledge. 6-month pre/post evaluation of emergency department utilization, hospitalization, steroid prescriptions, and primary care provider (PCP) utilization took place.

Results 60 patients with Asthma utilized Coach Mcl ungs8 M (83% African-American, 15% Caucasian, 57% male, with an average age of 10.4 +/- 2.6). Results showed a high level of shared decision-making (CollaboRATE average score 8.57 +/- 1.3). Self-efficacy and satisfaction were high, (’knowing what to discuss with the doctor’ 84%, ’feelingthat Coach Mcl ungs8M was helpful’ 89%). ln terms of knowledge, 92% reported understanding asthma. 6-month pre/post evaluation, although not statistically significant, showed ED utilization, hospitalization, and steroid prescriptions decreased 30% to 25% ([95%]CI -0.18 to 0.08, p=0.44), 5% to 2% ([95%]CI -0.03 to 0.10, p=0.32), and 35% to 28% ([95%]CI -0.08 to 0.22, p=0.37), respectively, and PCP utilization increased from 25% to 33% ([95%]CI -0.07 to 0.24, p=0.28).

Conclusions lmplementation of a shared decision-making intervention, originally designed for primary care, was feasible and effective in the emergency department. Additionally, increased utilization of Coach Mcl ungs8 Mtrended towards improved asthma outcomes for populations with known disparities.

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