Improving Asthma Referrals Following Emergency Department Evaluation
Condition: Asthma in Children
MeSH terms: Asthma; Emergencies
Study type: Interventional

Summary: 
      Asthma is the most common chronic condition among children and many children seek emergency
      department (ED) care. A key aspect of ED asthma management at the time of discharge is
      appropriate outpatient referral. Part of the challenge for ED providers is determining which
      patients require intensive outpatient support as ED providers often do not have the time or
      familiarity with the asthma guidelines to appropriately stratify asthma severity. Thus, the
      aim of this study is to determine whether the proportion of children referred to outpatient
      asthma care can be improved by incorporating a previously validated tool [the Pediatric
      Asthma Control and Communication Instrument for the Emergency Department (PACCI- ED)] into ED
      clinical care.
    

Detailed description: 
      Emergency department (ED) physicians play an important role in the management of pediatric
      asthma through acute intervention, family education, and appropriate referral to outpatient
      resources. However, time constraints in the ED limit physicians' ability to appropriately
      stratify both asthma severity and outpatient referrals. The Pediatric Asthma Control and
      Communication Instrument for the Emergency Department (PACCI-ED) improves ED providers
      assessment of asthma control and disease burden. We hypothesize that implementation of the
      PACCI-ED at the point of care may help to facilitate appropriate referrals to outpatient
      asthma care.

      ED providers will be randomized to the control or intervention group. Providers in the
      intervention group will receive the results of the parent-completed PACCI-ED accompanied by a
      one page summary of referral recommendations aligned with asthma guidelines and based upon
      asthma severity. Providers in the control group will not receive this information and will
      provide 'usual care'. All providers will complete a brief demographic questionnaire.
      School-aged children with a history of asthma presenting to the ED for an asthma exacerbation
      and discharged home who consent to participate will be assigned to the control or the
      intervention group based upon the ED provider caring for the patient during their ED
      encounter. Parents will complete a brief demographic questionnaire, the PACCI-ED, and answer
      two short qualitative audio-recorded questions about barriers to asthma care during their ED
      visit. Following the ED visit, additional data will be abstracted from the electronic medical
      record including outpatient referrals placed at the time of ED discharge and follow-up with
      the referrals within a one-month time-frame.
    

Intervention name(s): View PACCI-ED and referral recommendations
Intervention type(s): Other
Intervention description(s): Results of parent completed PACCI-ED and referral recommendations
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Care Provider)
Primary purpose: Health Services Research
Keywords: Asthma; Emergency Department; Children; Referral; Pediatric Asthma Control and Communication Instrument for the Emergency Department; PACCI-ED