student research day - Case Western Reserve University School of ...

Laurence Cook
Assessment of the relationship between knowledge and disease management in patients presenting
to an emergency department with asthma: In search of a common misunderstanding.
Laurence Cook, Dr. Rita Cydulka
MetroHealth Emergency Department - MetroHealth Hospital
Asthma is defined as an airway hyperresponsiveness to stimuli accompanied by edema and inflammation. The selfreported
prevalence of asthma has increased by 74% since 1980 and accounts for approximately 2 million ED visits
annually. Treatment of asthma in the ED can be very expensive and many episodes are preventable. The advancements
in understanding the pathophysiology of asthma and the efficacy of pharmacologic agents has not translated to better
quality of life for patients. This is reflected in the increased number of ED visits since 1992. A patients understanding of
their disease is crucial in the effective self-management of their asthma. The complexity of asthma as an immunological
condition, coupled with its intermittent nature makes it difficult for most patients to fit asthma into a classic chronic
disease framework. An understanding of asthma as an intermittent chronic disease that can be managed through the
identification of asthma triggers can lead to better outcomes for the patient. Poor patient understanding of their disease
process and medication use truncates the effectiveness of self-management as a viable management strategy. An
analysis studying the relationship between a patient’s management of their own asthma and their understanding of their
disease would be effective in determining the correlation between knowledge and the effectiveness of self-management.
This project utilizes a cross sectional approach to evaluate patients who come to the Metro Health ED with selfreported
asthma. Patients who come to the ED and have a self-reported history of asthma have been and continue to be
interviewed regarding their asthma knowledge and maintenance. The interview is conducted regardless of their reason
for their ED visit is because of an asthma related complaint. The interview is designed in such a way to access the
patient’s knowledge of the pathophysiologic of asthma. Patients are asked if they can identify what is unique about their
own asthma and its triggers. Finally, patients are asked if they understand the rational and efficacy of both home and
clinical treatment strategies The questions are a combination of true/false and open response format. The second
component of the interview uses a universal set of questions used by ED visions to access a patient’s management of
their asthma. This gives the interviewer the information needed to access how able the patient is to control their asthma.
The data gathered from these questionnaires will be used in a two-pronged approach to determine the correlation
between knowledge and the effectiveness of self-management. The true/false questions lend themselves to a numerical
score and will be compared to a score of their asthma management determined from the management question set.
These two sets of numbers will be compared to determine correlation between knowledge and management. The free
response questions will give the researchers unique insight to find common components of a patient’s disease schema.
These common components might lend themselves to better or worse management of asthma as a chronic disease. This
vital component of the project could affectively tweeze out common misconceptions to look out for in a clinical setting.
These misconceptions could then be remedied through explanations regarding their asthma.
The questions that this study addresses are ones that encompass the fields of public health and health service
strategies. The questions that the project addresses are
Does better knowledge of your disease correlates with a better management of that disease? Preliminary data from the
questionnaires suggests that having a good foundational knowledgebase of what asthma is as a chronic immune
mediated disease gives the patient a much better chance at adequate management. Those patient’s that view their
disease as something that they cannot control, and a disease they cannot predict, have decreased management skills and
more frequent visits to the emergency department. One of the more interesting developments from the preliminary data
shoes that poorer asthma knowledge correlates with your chief compaint for coming to the emergency department. If
this trend in the data continues, it could mean that better patient education could not only lead to better patient outcome
but also more efficient departmental resource utilization in the emergency department. This increased efficiency would
stem from keeping more asthma patients out of the ED by increasing their ability to manage their own disease.
Another question this project analyzes is: are their common misconception about the pathophysiology of a chronic
condition that lends itself to poor disease management and more ED visits? Preliminary data from the project suggests
that physicians need to do a better job helping their patients discover what their own asthma trigger is. Patients who
could name their own asthma trigger seem to score much better on their management questionnaire. This is an
interesting concept that will be further analyzed as the project continues.
The final question that this project poses looks at the components of a chronic condition that, when understood by the
patient, empowers them to make better self-management decisions. This question will require more data, and more
analysis to adequately answer and understand. This project will dissect and analyze the disease models that patients use
to understand (or misunderstand) their conditions in order to identify areas where improvement would give the patient a
better quality of life.
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