Family-centered integration of social and medical care to optimize health outcomes among all children with asthma - Asthma disproportionately impacts under-resourced, Black, and Hispanic youth who experience higher asthma morbidity. These disparities are partially explained by social adversity experienced at multiple levels (child, family, community). Yet, these critical associations between social adversity and pediatric asthma are not fully incorporated into strategies to address morbidity among children which may exacerbate existing disparities, meaning such at-risk children experience decreased quality of life, higher school absenteeism, and decreased educational and employment achievement in late childhood and adulthood. In this proposal, Dr. Tyris’ objective is to advance the existing knowledge on social adversity and asthma morbidity with diverse methodologies that seek to better integrate social care (activities mitigating health-related adverse social factors) into medical care for children. She will pursue this overall objective through the following specific aims: Aim 1: Predict risk of hospitalization among DC children with asthma using multi-level social adversity indicators. A population-based machine learning model using the DC Pediatric Asthma Registry (n= >19,000) and social adversity, clinical, and demographic data will be developed to predict risk of asthma-related hospitalization and to identify which variables are most predictive of children at highest risk for hospitalization. Aim 2: Characterize caregiver perspectives of mechanisms to address modifiable family-level variables that impact child asthma morbidity. A community advisory board will be established to conduct longitudinal focus groups and engage with caregivers of children frequently hospitalized for asthma to refine family-level approaches to address social adversity and enhance recruitment and retention issues for a pilot RCT. Aim 3: Determine feasibility and acceptability of an integrated social care intervention of individualized assistance and adjustment strategies among caregivers of children with asthma. Dr. Tyris will conduct a pilot randomized controlled trial to determine if using addressing social adversity in routine asthma care with assistance (helping resolve social adversity) and adjustment (modifying health care to overcome social barriers) will be acceptable to caregivers and feasible to implement. The outlined career development plan, including the proposed aims, will enable Dr. Tyris to gain advanced training and knowledge in four key areas: machine learning methods for risk prediction, stakeholder-engaged intervention design, clinical trial design and execution, and integrated social and medical care interventions. She will leverage the expertise of Dr. Tyris’ mentors (Drs. Teach and Parikh) and advisors (Drs. Trujillo Rivera, Hinds, and Gottlieb) and the robust, supportive research environment at Children’s National Hospital and George Washington University. Successful completion of this career development and research proposal will facilitate Dr. Tyris’ overarching career goal to become an independent and federally funded investigator who creates, implements, evaluates, and effectively translates stakeholder-engaged solutions designed to mitigate social adversity, reduce health disparities, and improve care and outcomes for children with asthma.
