Telemedicine Enhanced Asthma Management Through the Emergency Department
Condition: Asthma
MeSH terms: Asthma; Emergencies
Study type: Interventional

Summary: 
      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. 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. In the investigators' prior work they have found
      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.
      They have also found that telemedicine can link children with persistent asthma to a provider
      for optimal chronic illness management. The 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. The investigators will utilize a 2-group randomized trial to test the TEAM-ED
      intervention. The intervention includes: 1) a telemedicine assessment 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. The investigators will assess the
      effectiveness of the program in reducing respiratory morbidity and improving preventive
      asthma care, with follow-up assessments at 3, 6, 9, and 12 months.
    


Intervention name(s): TEAM-ED; Enhanced Usual Care
Intervention type(s): Other; Other
Intervention description(s): Facilitation of preventive asthma management through telemedicine assessment and follow-ups in addition to guideline-based provider prompting; Report of symptoms to primary care physician
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment