Pediatric Asthma Alert Intervention for Minority Children With Asthma
Condition: Asthma
MeSH terms: Asthma
Study type: Interventional
Phase: Phase 2

Summary: 
      Young inner-city children with asthma have the highest emergency department (ED) visit rates.
      Relying on the emergency department for asthma care can be a dangerous sign of poorly
      controlled asthma. This research will focus on whether having a specialized asthma nurse join
      the family at a child's doctor visit after an ED visit for asthma to make sure the child and
      parent keep the follow-up appointment and have the nurse remind the child's doctor to
      prescribe preventive asthma medicines and an asthma action plan for home (PAAL intervention)
      will result in young children with asthma having fewer days with wheezing and cough.

      The investigators hypothesize that:

        1. Significantly more children receiving the PAAL intervention will attend greater than 2
           non-urgent visits and greater than 6 refills for the child's anti-inflammatory
           medications over 12 months when compared to children in the control or standard asthma
           education group.

        2. Children in the PAAL intervention group will experience less morbidity and caregivers
           will experience increased quality of life compared to children in the control of
           standard asthma education group.
    

Detailed description: 
      Asthma is the number one cause of pediatric emergency department (ED) visits in young
      children and results in a significant economic impact on society and use of health resources.
      Reliance on the ED for asthma care is not only costly but it is also a dangerous index of
      poorly controlled asthma. Recent updated national asthma guidelines recommend daily inhaled
      corticosteroids (ICS) as the cornerstone of treatment for patients with persistent asthma.
      When properly used ICS prevent exacerbations, ED visits and hospitalizations and maintain
      asthma control. However, > 50% of inner city minority children with asthma do not receive or
      use recommended anti-inflammatory preventive medications. In fact, many children encounter
      repeated ED visits with no provision of appropriate preventive medications or other
      components of guideline-based preventive care because of inconsistent follow-up with their
      primary care provider (PCP). The overall goal of this study is to evaluate whether a
      standardized caregiver and physician prompting intervention, Pediatric Asthma Alert Leader
      (PAAL), can improve guideline-based preventive asthma care including increased
      anti-inflammatory use and preventive PCP visits in children with frequent ED visits. This
      study builds on the experience with our parent-child-PCP communication intervention
      ("Improving Asthma Communication in Minority Families", ACE) in which we found that teaching
      parent and child asthma communication skills resulted in increased anti-inflammatory
      medication use at 6 months for children with persistent asthma. However, the beneficial
      effects of this intervention were seen primarily when caregivers and children were reminded
      by the nurse interventionist to relay specific health information to the PCP. Furthermore,
      the intervention was not associated with decreased ED visits or appropriate PCP follow-up to
      sustain preventive care. The proposed PAAL intervention has the potential to substantially
      improve care for children at highest risk for asthma morbidity and we propose to establish
      (1) whether the positive effects of the ACE study can be replicated in a specific group of
      high-risk children with repeat ED visits; 2) whether the effects of the intervention can be
      enhanced by incorporating consistent clinician prompting to assure the provision of each
      component of guideline-based asthma care (ICS use, asthma action plan, and sustaining regular
      follow-up care to monitor asthma control); and 3)whether families not achieving optimal care
      will respond to a more intensive tiered intervention. We propose a caregiver and clinician
      prompting/feedback intervention using a pediatric asthma alert leader (PAAL) nurse to 1)
      organize and relay critical, individualized child health information from the ED and home
      setting to the PCP in a feedback letter, 2) ensure child and caregiver attendance at the
      follow-up visit with the PCP and 3) empower the family and prompt the PCP for guideline-based
      treatment decisions at the PCP visit. We hypothesize that the PAAL intervention will improve
      preventive care and reduce morbidity and health care costs for high-risk children with asthma
      compared to a Standard Asthma Education (SAE) control group.
    

Intervention name(s): Pediatric Asthma Alert (PAAL); Standard asthma education
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Asthma nurse conducts 2 home visits and accompanies the child to primary care provider visit after ED visits; Standard asthma education during 2 home visits.
Other intervention name(s): Pediatric Asthma Alert Leader (Nurse); Asthma Education
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: asthma; feedback; anti-inflammatory; ED visits