334 - Geographic Influence on Remote Patient Monitoring Engagement in Asthma

Publication Number: 2323.334

Akhila Boda, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Courtney Sump, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Eleanor Young, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Asthma is one of the most common chronic diseases of childhood and a leading cause of preventable hospitalization. Notable racial and geographic inequities exist, such that children who identify as Black and live in structurally disadvantaged neighborhoods experience disproportionately higher rates of hospitalization. Remote Patient Monitoring (RPM), a digital health intervention designed to extend care into the home after hospital discharge offers promise to bridge access gaps after hospital discharge. Yet, despite the existing evidence, engagement with digital health tools remains a major challenge.

Objective: Evaluate the association between neighborhood-level social deprivation, measured by the Social Deprivation Index (SDI), and successful remote patient monitoring (RPM) program completion.

Design/Methods: This retrospective cohort study analyzed pediatric patients >3 years old who were enrolled in an Asthma RPM program at a large freestanding children's hospital following an asthma-related hospitalization between 05/19/2023 to 03/31/2025.

Patient reported demographic data was abstracted from the electronic health record. SDI, a composite area-level measure of social disadvantage (poverty, education, employment, housing, single-parent households, crowded housing), was geocoded using patient home addresses at the census tract level to map neighborhood deprivation.

Patient engagement data was obtained from the RPM platform, including rates of successful patient level program completion and inactivity. RPM engagement outcomes were defined as "graduation" or "early discharge" and met graduation criteria if they had an Asthma Control Test score of >19 and had ≥2 months of consistent RPM data submission. Discharge was defined as ≥2 weeks of inactivity and unsuccessful contact from the care team.

Covariates included age and sex. A logistic regression was performed to understand how SDI relates to odds of successful graduation.

Results: 213 children were included in the cohort (mean age 9.9 ± 4.5) with 27% who successfully graduated from the program. The median program duration was 35 days (IQR 19.6-59.3). Higher neighborhood social deprivation was associated with lower odds of completing the Asthma RPM program (p < 0.05). Each incremental increase of 0.1 in SDI corresponded with a 20% reduced likelihood of successful graduation.

Conclusion(s): These early findings highlight the impact that geographic and social factors can have on patients and caregivers' ability to engage in an Asthma RPM program. Future steps include analyzing acute care utilization after being discharged from the program.

Characteristics of Patient Cohort
Demographics and clinical characteristics of the cohort enrolled in the Asthma RPM program.

Geographic Distribution of Patient Cohort
Geographical distribution of patient population. Cities were omitted to avoid identification of the institution.

Density Plot of Social Deprivation Index by Graduation Status
Density plot representing the Social Deprivation Index (SDI) by Graduation Status. The pink represents individuals who were discharged from the program while the blue represents those who graduated from the program. The vertical dashed lines represent the mean SDI for each group. Living in a more deprived neighborhood is associated with lower odds of successful graduation from RPM with every 0.1 unit increase in social deprivation index showing an odds of successful RPM graduation (vs discharge) decrease by about 20% (p < 0.05).