Telehealth-Enhanced Asthma Care for Home after the Emergency Room (TEACH-ER)

点击翻译按钮获取中文摘要

Asthma is one of the most prevalent chronic diseases of childhood, and a leading cause of pediatric emergency department (ED) visits in the US. Guideline-based asthma management, including treatment with daily preventive medications, can reduce severe asthma flare-ups requiring acute healthcare services. Unfortunately, many children in the ED with asthma are not adequately treated with preventive medications. Children from low income and historically marginalized populations are disproportionately likely to be diagnosed with asthma and require emergency asthma care, yet least likely to be prescribed preventive medication. Poor rates of primary care follow-up after ED discharge result in missed opportunities to optimize treatment and home management and reduce preventable morbidity. Our prior work has demonstrated that a school-based telemedicine intervention for children 3-12 years can facilitate follow-up assessments by primary care providers after ED discharge, and lead to increased prescriptions for preventive medications. Despite access to appropriate treatment, however, the intervention did not lead to improved adherence or reduce symptoms and repeat ED visits. Reducing morbidity for children with asthma in the ED will require a comprehensive guideline-based approach that combines primary care follow-up and treatment with preventive medications, with patient-centered education to support home management and adherence. To enhance home management, we also successfully piloted an intervention of hospital-to-home educational support for children (5-13 years) admitted with asthma that features pictorial materials, health literacy techniques, and a pair of in-home telehealth visits for educational reinforcement after discharge. In response to NOT-OD-21-100: Improving Patient Adherence to Treatment and Prevention Regimens to Promote Health (PA-20-183), we now propose a 2-group randomized trial to test the TEACH-ER (Telehealth-Enhanced Asthma Care for Home after the Emergency Room) intervention vs an enhanced care (EC) control group. The TEACH-ER intervention combines and expands upon our prior work, and includes: 1) brief initial teaching in the ED; 2) in-home telehealth follow-up visit with primary care providers, with a prompted recommendation for guideline-based preventive treatment and home delivery of prescriptions with a pictorial action plan; 3) two additional in-home telehealth visits to deliver health literacy-informed asthma education and home management support. We will enroll 430 children (ages 3-12 yrs) from the two dedicated pediatric EDs in our region. We will assess the effectiveness of the program in reducing morbidity (e.g. repeat ED visits or hospitalizations for asthma, symptom severity, quality of life), improving adherence, and improving preventive asthma care. Participants will complete telephone follow-up assessments 3, 6, 9, and 12 months after enrollment; we will also collective objective data on acute care use from the electronic medical record and prescription fill data. At the study’s completion, the effectiveness of this novel system of care will be better defined as a sustainable means to improve preventive care and reduce morbidity for children with asthma.