Telehealth Education for Asthma Connecting Hospital and Home (TEACHH)

哮喘是儿童期最常见的慢性疾病，也是儿科急症护理的主要原因 ACU（美国）住院是晚期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艾德就诊。基于指南的护理，包括教育 和日常控制治疗，可以减少ACU和防止高达80%的哮喘再入院。然而，在这方面， 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 药物治疗，最有可能住院和重新入院。一旦住院， 医院到家庭过渡期间的教育支持错过了促进家庭的机会 高风险儿童及其家庭的管理。改善依从性和临床结局， 住院儿童需要跨环境的教育，使患者和护理人员有意义地参与， 最好使用为低识字率人口设计的材料， 药物治疗还需要在出院后提供便利的后续支持。本研究的目的是 评估技术强化教育的可行性、可接受性和初步效果 为照顾者和因哮喘住院的儿童提供干预。 我们提出了一个试点随机对照试验，60名儿童（5-11岁）因哮喘住院，在戈利萨诺儿童医院， 纽约州罗切斯特的医院。基线评估后，受试者将被随机分配至：1）远程医疗 哮喘教育连接医院和家庭（TEACHH）干预，包括住院 使用图画材料、家庭药物的颜色/形状标签（绿色）对儿童/护理人员进行教育 星星=控制器，黄色/红色圆圈=救援），以及一对家庭，基于智能手机的远程医疗访问后， 出院以加强有效的家居管理;或，2）标准护理条件， 标准住院教育和常规门诊随访。TEACHH中的患者也将接受所有SC 措施所有护理人员将在术后2、4和6个月完成设盲电话随访评估。 出院;将在基线和6个月时询问儿童药物问题。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在改善关键临床结局方面的初步疗效， 包括7天、30天和6个月时的哮喘相关ACU（根据电子健康记录文件） 每次随访时的无腹泻天数（由护理人员报告）;并评估次要临床和 功能结局，包括哮喘相关的生活质量、因哮喘而缺课或工作、照顾者 和儿童用药知识，以及报告的依从性。这项工作的结果将建立一个强有力的 基金会的全面试验，并指导未来的努力，提供基于指南的哮喘护理服务不足 儿童和家庭面临最大的可预防疾病风险。

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.