Asthma Express: Bridging the Emergency to Primary Care in Underserved Children
Condition: Asthma
MeSH terms: Asthma; Emergencies
Study type: Interventional

Summary: 
      Asthma is the number one cause of pediatric emergency department (ED) visits in young
      minority children and is responsible for high healthcare costs. The ED is often the point of
      contact for many inner city children and many families view the ED as the child's primary
      source of asthma care. This study plans to test a new model of asthma care, Asthma Express
      (AEx), that includes a follow-up asthma visit in the ED for an asthma "check-up" , asthma
      education, a prescription for preventive asthma medications, an appointment for the child to
      see their pediatric provider and a home visit to assist families with environmental control
      methods to prevent asthma symptoms.
    

Detailed description: 
      Asthma, the leading chronic disorder in childhood, is the number one cause of pediatric
      emergency department (ED) visits in young children and is responsible for a substantial
      impact on healthcare costs. The ED is often the point of contact for low-income children and
      many families view the ED as their primary source of asthma care. Poor and minority children
      have the highest asthma morbidity, are the least likely to receive adequate preventive
      therapy or specialty care and more frequently exposed to environmental triggers than non-poor
      children. However, prior studies, including our pilot, indicate that children with frequent
      asthma ED visits will attend a one-time ED-based follow-up clinic for an asthma "check-up"
      and education. The goal of this randomized controlled trial is to test the efficacy of a
      multifaceted, ED + primary care provider (PCP) and home-based intervention, Asthma Express
      (AEx), for children with > 2 asthma ED visits or 1 hospitalization/year that provides
      tailored guideline based asthma care. Allergy and cotinine biomarkers, collected during the
      ED visit, are used to target the home environmental control component of the intervention.
      The AEx intervention (n=132) will be compared to an attention control (CON) group (n=132) for
      the specific aims: (1) to reduce asthma morbidity (increase symptom free days and nights) and
      decrease ED visits and hospitalizations and increase asthma control and caregiver quality of
      life, (2) to improve the use of appropriate preventive anti-inflammatory medication based on
      child pharmacy refill records and (3) to compare the economic cost and effects of this
      intervention. Children aged 3-12 years with > 2 asthma ED visits or 1 hospitalization within
      the past 12 months and a current ED visit for asthma will be recruited from the Johns Hopkins
      Pediatric-ED and followed for 12 months. Symptom frequency, health care utilization,
      caregiver quality of life and cotinine measures will be collected at baseline, 6 and 12
      months and pharmacy data collected at baseline and 12 months. Data analysis includes initial
      cross tabulations of health outcomes by group (AEx vs. CON) and multivariate generalized
      linear regression models to study the effects of the AEx treatment on mean symptom free
      days/nights, repeat ED visits, hospitalizations and caregiver quality of life scores and
      anti-inflammatory medication refills. Mean total costs of ED, PCP visits, hospital days and
      medication costs will be compared between groups (AEx and CON) for the economic analysis. The
      AEx model is designed to be accessible, guideline-based, easily replicated and incorporated
      into ED care. If successful, this study will fill critical gaps in the ED transition to
      preventive care asthma interventional research.
    

Intervention name(s): Asthma Express Intervention; Standard Asthma Education Control Group
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Asthma Express clinic visit for asthma education + nurse home visit; Asthma Express home nurse visits for asthma education
Other intervention name(s): Asthma Express; Attention Control
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Health Services Research
Keywords: Pediatric; Emergency department visit