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

哮喘是儿童最常见的慢性病之一，也是导致儿科急症的主要原因。 在美国的部门(ED)访问。以指南为基础的哮喘管理，包括每日治疗 预防性药物可以减少需要急性医疗服务的严重哮喘发作。不幸的是， 急症室里许多哮喘儿童没有得到足够的预防性药物治疗。来自低地的孩子 收入和历史上被边缘化的人群更有可能被诊断为哮喘和 需要紧急哮喘护理，但最不可能开出预防性药物。初等教育不良率 ED出院后的护理跟踪导致错过优化治疗和家庭管理的机会 并减少可预防的发病率。我们之前的工作表明，以学校为基础的远程医疗 对3-12岁儿童的干预可以促进初级保健提供者在ED后的随访评估 出院，并导致预防性药物处方增加。尽管可以访问适当的 然而，干预治疗并没有改善依从性或减少症状和复发ED 来访。要减少急诊室哮喘儿童的发病率，需要一个基于全面指南的 将初级保健跟踪和治疗与预防性药物相结合，以患者为中心的方法 支持家庭管理和坚持的教育。为了加强家居管理，我们也成功地 对入院的哮喘儿童(5-13岁)进行医院到家庭教育支持干预试点 其中包括图片材料，健康素养技术，以及一对家庭远程健康访问，用于教育 卸货后的加固。应对NOT-OD-21-100：提高患者对治疗的依从性 促进健康的预防方案(PA-20-183)，我们现在建议进行一项两组随机试验，以测试 TEST-ER(急诊室后远程健康增强的家庭哮喘护理)干预与AN 加强护理(EC)对照组。TASH-ER干预结合并扩展了我们之前的工作， 包括：1)在急诊室进行简短的初始教学；2)与初级保健提供者进行家庭远程健康随访， 并提示建议以指南为基础的预防性治疗和处方的上门交付 通过图画行动计划；3)增加两次家庭远程保健访问，以提供健康知识知情的哮喘 教育和家庭管理支持。我们将从两个专门的学校招收430名儿童(3-12岁) 我们地区的儿科急救人员。我们将评估该计划在减少发病率方面的有效性(例如，重复 急诊科就诊或住院治疗哮喘、症状严重程度、生活质量)，提高依从性，并改善 预防性哮喘护理。参与者将在3、6、9和12个月后完成电话跟踪评估 登记；我们还将从电子病历和 处方配给数据。在这项研究完成后，这种新的护理系统的有效性将会更好 被定义为改善预防护理和降低哮喘儿童发病率的可持续手段。

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.