Telemedicine Enhanced Asthma Management through the Emergency Department (TEAM-ED)

通过急诊科远程医疗加强哮喘管理 (TEAM-ED)

• 批准号: 9238604
• 负责人: Jill S Halterman
• 金额: $ 74.83万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-01-01 至 2021-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9238604
• 关键词: Absenteeism; Accident and Emergency department; Acute; Adherence; Age; Asthma; Caring; Child; Child health care; Chronic Disease; Clinical; Communities; Diffusion of Innovation; Education; Effectiveness; Effectiveness of Interventions; Emergency Care; Emergency Situation; Emergency department visit; Enrollment; Exhalation; Goals; Guidelines; Hospitalization; Intervention; Link; Medicaid; Medical; Modeling; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Nitric Oxide; Office Visits; Outcome; Parents; Pharmaceutical Preparations; Population; Preventive; Preventive care; Preventive treatment; Primary Health Care; Program Effectiveness; Provider; Public Health; Quality of life; Regimen; Research Infrastructure; Resources; Schools; Self Management; Severities; Symptoms; System; Technology; Telemedicine; Testing; Time; Urban Health; Visit; Work; airway inflammation; base; care delivery; care systems; cost effective; design; follow up assessment; follow-up; functional outcomes; health care service utilization; health economics; high risk; improved; innovation; minority children; novel; point of care; prevent; primary outcome; programs; public health relevance; racial and ethnic; randomized trial; recidivism; respiratory; successful intervention; telehealth; theories; treatment as usual; treatment response; urban children

 DESCRIPTION (provided by applicant): In the US, children from minority ethnic and racial backgrounds suffer disproportionately from asthma and account for substantially more emergency department (ED) visits and hospitalizations than non-minority children. While NHLBI guidelines recommend daily preventive medications for all children with persistent asthma to prevent morbidity as well as ED visits and hospitalizations, many children who should receive preventive medications are not receiving them. This is in part because children presenting to the ED for an acute asthma exacerbation rarely receive preventive asthma care, due to the ED's focus on acute, episodic care. In order to provide optimal preventive care and prevent ED recidivism, the NHLBI guidelines recommend that children follow-up with a primary care provider (PCP) within 1-4 weeks of the ED visit. The post-ED follow- up visit is an opportunity for the PCP to prescribe effective preventive asthma medications, step-up medication for children who demonstrate poor control, promote adherence, and provide education on asthma self- management and trigger control. However, rates for follow-up after an asthma-related ED visit are extremely low, and preventive care is delivered inconsistently even when children are seen in follow-up, resulting in substantial preventable morbidity. Our prior work has demonstrated that a provider prompting intervention can enhance the delivery of guideline-based preventive asthma treatments at the time of a primary care office visit and ultimately reduce morbidity for high-risk children with asthma. We have also found that telemedicine, a mobile medical system that allows clinicians to provide assessment through remote audiovisual technology; can link children with persistent asthma to a provider for optimal chronic illness management. The overall goal of this project is to use a novel telemedicine-based program to facilitate primary care follow-up and promote the delivery of guideline-based preventive care for high-risk children presenting to the ED for an asthma exacerbation. We propose a 2-group randomized trial to test the TEAM-ED (Telemedicine Enhanced Asthma Management through the Emergency Department) intervention. The intervention includes: 1) a telemedicine assessment initiated by a clinical tele-health assistant (CTA) at the child's school within one week of discharge from the ED and completed by a PCP, 2) `point-of-care' prompting to promote the provision of guideline-based preventive care during the telemedicine visit, and 3) two additional telemedicine-assisted follow-up assessments to assure optimal response to treatment and tailor the care regimen as needed. We plan to enroll 430 children (ages 4-12 years) over four years from two EDs in urban Rochester, NY. We will assess the effectiveness of the program in reducing respiratory morbidity (e.g. symptom severity, quality of life, repeat unscheduled asthma visits) and improving preventive asthma care, with follow-up assessments at 3, 6, 9, and 12 months. 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 high-risk urban children with asthma.

 描述（由申请人提供）：在美国，少数民族和种族背景的儿童患哮喘的比例不成比例，与非少数民族儿童相比，急诊科（艾德）就诊和住院的比例显著增加。虽然NHLBI指南建议所有持续性哮喘儿童每天服用预防性药物，以防止发病以及艾德就诊和住院，但许多应该接受预防性药物治疗的儿童没有接受预防性药物治疗。部分原因是因为艾德对急性哮喘发作的儿童很少进行预防性哮喘治疗，因为艾德的重点是急性发作性治疗。为了提供最佳的预防护理和防止艾德复发，NHLBI指南建议儿童在艾德就诊后1-4周内与初级保健提供者（PCP）进行随访。ED后的随访是一个机会， PCP处方有效的预防性哮喘药物，对控制不佳的儿童加强药物治疗，促进依从性，并提供哮喘自我管理和触发控制的教育。然而，哮喘相关艾德就诊后的随访率极低，即使在随访中看到儿童，预防性护理也不一致，导致大量可预防的发病率。我们之前的工作已经证明，提供者提示干预可以在初级保健办公室就诊时加强基于指南的预防性哮喘治疗的提供，并最终降低哮喘高危儿童的发病率。我们还发现，远程医疗是一种移动的医疗系统，允许临床医生通过远程视听技术提供评估;可以将患有持续性哮喘的儿童与提供者联系起来，以实现最佳的慢性病管理。该项目的总体目标是使用一种新型的基于远程医疗的方案，以促进初级保健随访，并促进提供基于指南的预防性护理的高风险儿童提出的艾德哮喘急性发作。我们提出了一项2组随机试验，以测试TEAM-ED（通过急诊科进行远程医疗增强哮喘管理）干预。干预措施包括：1）在儿童从艾德出院后一周内，由儿童学校的临床远程健康助理（CTA）启动远程医疗评估，并由PCP完成，2）“护理点”提示在远程医疗访问期间促进提供基于指南的预防性护理，和3）两个额外的远程医疗辅助随访评估，以确保对治疗的最佳反应，并根据需要调整护理方案。我们计划在四年内从纽约罗切斯特市区的两个急诊室招募430名儿童（4-12岁）。我们将评估该计划在降低呼吸道疾病发病率（例如症状严重程度、生活质量、重复计划外哮喘访视）和改善预防性哮喘护理方面的有效性，并在3、6、9和12个月进行随访评估。在研究完成后，这种新型护理系统的有效性将被更好地定义为一种可持续的手段，以改善预防护理和降低高风险城市哮喘儿童的发病率。