title: Virtual Teach-To-Goal™ Adaptive Learning of Inhaler Technique for Inpatients with Asthma or COPD.
abstract: BACKGROUND
  Asthma and chronic obstructive pulmonary disease (COPD) result in more than 1 million hospitalizations annually. Most hospitalized patients misuse respiratory inhalers. This misuse can be corrected with in-person education; however, this strategy is resource intensive and skills wane quickly after discharge.
  
  
  OBJECTIVE
  The objective of this study was to develop and pilot a virtual teach-to-goal™ (V-TTG™) inhaler skill training module, using innovative adaptive learning technology.
  
  
  METHODS
  Eligible adults with asthma or COPD completed a V-TTG™ metered-dose inhaler session with tailored rounds of narrated demonstration and self-assessments. The primary outcome was the proportion of participants with inhaler misuse post- versus pre-V-TTG™; secondary analyses tested mastery, self-efficacy, and perceived versus actual inhaler skills. Analyses were tested with McNemar's χ2test (P < .05).
  
  
  RESULTS
  Among 90 enrolled participants, the majority were African American (94%), female (62%), and had asthma (68%), with a mean age of 48 years. Among those completing both pre- and post-V-TTG™ (n = 83), misuse was significantly lower post- versus pre-V-TTG™ (24% vs 83%, P < .001). Mastery and confidence both improved significantly (46% vs 7%, P < 0.001; 83% vs 67%, P < .001) post- versus pre-V-TTG™. After V-TTG™, there was greater congruence between perceived versus actual inhaler skills (P < .01). No differences were seen in subgroup analyses for age, health literacy level, or diagnosis.
  
  
  CONCLUSIONS
  This study is the first to demonstrate the efficacy of adaptive V-TTG™ learning to teach the inhaler technique. V-TTG™ improved most participants' technique to an acceptable level, reached mastery for half, and also increased self-efficacy and actualized skill. V-TTG™ has potential to improve health care across care transitions.
authors.affiliation: Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Ill. Electronic address: vpress@medicine.bsd.uchicago.edu.
authors.forename: Valerie G
authors.initials: VG
authors.lastname: Press
authors.affiliation: Pritzker School of Medicine, University of Chicago, Chicago, Ill.
authors.forename: Colleen A
authors.initials: CA
authors.lastname: Kelly
authors.affiliation: Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Ill.
authors.forename: John J
authors.initials: JJ
authors.lastname: Kim
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Ill.
authors.forename: Steven R
authors.initials: SR
authors.lastname: White
authors.affiliation: Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Ill.
authors.forename: David O
authors.initials: DO
authors.lastname: Meltzer
authors.affiliation: Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Ill.
authors.forename: Vineet M
authors.initials: VM
authors.lastname: Arora
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D001249:Asthma / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D036501:Metered Dose Inhalers / Q000706:statistics & numerical data*; D008875:Middle Aged; D010353:Patient Education as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012646:Self Administration; D014743:Videotape Recording
keywords: Adaptive learning; Asthma; Care transitions; Chronic obstructive pulmonary disease; Health care; Inhalation devices; Patient education; Pulmonary disease; Technology; Video module education; Virtual education