Telehealth Education for Asthma Connecting Hospital and Home (TEACHH)

哮喘是儿童最常见的慢性疾病，也是儿科急救的主要原因。 美国的利用率(ACU)。住院是以后ACU的主要风险因素：40%的患者将 出院后6个月内因哮喘再次入院或到急诊科就诊。以指导方针为基础的护理，包括教育 而每日控制治疗，可以减少ACU，并防止高达80%的哮喘再次住院。然而， 来自低收入和种族/少数民族人口的儿童最不可能接受或使用控制器 药物，以及最有可能住院和再次住院的人。一旦住院，就会出现系统性障碍 医院到家庭过渡期间的教育支持创造了错失的推广家庭的机会 对高危儿童及其家庭的管理。改善依从性和临床结果 住院儿童需要跨环境进行教育，使患者和照顾者有意义地参与进来， 理想情况下，使用专为低识字率人群设计的材料，并实现对关键字的可靠视觉识别 药物。还需要便利地获得出院后的后续支持。这项研究的目标是 评估技术增强教育的可行性、可接受性和初步效果 对因哮喘住院的照顾者和儿童进行干预。 我们建议在Golisano儿童医院对60名哮喘儿童(5-11岁)进行随机对照试验 纽约罗切斯特的一家医院。在基线评估后，受试者将被随机分配到：1)远程健康 医院与家庭相连接的哮喘教育干预(TEACHH)，包括住院患者 使用图画材料、家庭药物的颜色/形状标签(绿色)进行儿童/照顾者教育 星=控制器，黄/红圈=救援)，以及一对家庭内、基于智能手机的远程医疗会诊 出院以加强有效的家庭管理；或2)标准护理(SC)状况，其特点是 标准的住院教育和常规的门诊随访。TEACHH中的患者也将接受所有SC 措施。所有照顾者将在2个月、4个月和6个月后完成盲法电话随访评估 出院；儿童将在基线和6个月时被问及用药问题。我们将描述 通过回顾过程测量数据实施TEACHH干预的可行性和可接受性 在整个研究过程中收集；评估TEACHH在改善关键临床结果方面的初步疗效， 包括7天、30天和6个月的哮喘相关ACU(根据电子健康记录文档) 和无症状天数(由照顾者报告)；并评估二级临床和 功能结果，包括与哮喘相关的生活质量、因哮喘而缺课或缺勤、照顾者 和儿童药物知识，并报告遵守。这项工作的发现将建立一个强有力的 为全面试验奠定基础，并指导未来为服务不足的人提供基于指南的哮喘护理的努力 儿童和家庭患上可预防的疾病的风险最大。

Asthma is the most prevalent chronic disease of childhood and a leading cause of pediatric acute care utilization (ACU) in the US. Hospitalization is a leading risk factor for later ACU: 40% of patients will be readmitted or go to the ED for asthma within 6 months of discharge. Guideline-based care, including education and daily controller therapy, can reduce ACU and prevent up to 80% of asthma readmissions. However, children from low income and racial/ethnic minority populations are the least likely to receive or use controller medication, and the most likely to be hospitalized and readmitted. Once hospitalized, systemic barriers to educational support during the hospital-to-home transition create missed opportunities to promote home management among high-risk children and their families. Improving adherence and clinical outcomes for hospitalized children requires education across settings that meaningfully engages patients and caregivers, ideally using materials designed for low literacy populations and enabling reliable visual identification of key medications. Facilitated access to follow-up support after discharge is also needed. The goal of this study is to evaluate the feasibility, acceptability, and preliminary efficacy of a technology-enhanced educational intervention for caregivers and children who are hospitalized due to asthma. We propose a pilot RCT with 60 children (5-11 yrs) hospitalized with asthma at the Golisano Children’s Hospital in Rochester, NY. After baseline assessment, subjects will be randomized to either: 1) the Telehealth Education for Asthma Connecting Hospital and Home (TEACHH) intervention, which includes inpatient child/caregiver education using pictorial materials, color/shape labels for home medications (green star=controller, yellow/red circles=rescue), and a pair of in-home, smartphone-based telehealth visits after discharge to reinforce effective home management; or, 2) the standard care (SC) condition, which features standard inpatient education and routine outpatient follow-up. Patients in TEACHH will also receive all SC measures. All caregivers will complete blinded telephone follow-up assessments at 2, 4, and 6 months after discharge; children will be asked medication questions at baseline and 6 months. We will describe the feasibility and acceptability of implementing the TEACHH intervention by reviewing process measure data collected throughout the study; assess the preliminary efficacy of TEACHH in improving key clinical outcomes, including asthma-related ACU at 7 days, 30 days, and 6 months (per electronic health record documentation) and symptom-free days at each follow-up (reported by caregivers); and assess secondary clinical and functional outcomes including asthma-related quality of life, missed school or work due to asthma, caregiver and child medication knowledge, and reported adherence. Findings from this work will establish a strong foundation for a full-scale trial, and guide future efforts to deliver guideline-based asthma care to underserved children and families at the greatest risk for preventable morbidity.