Use of Text Messages to Improve Care For Children Following an ED Visit for Asthma

Study Overview
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Brief Summary
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BACKGROUND Asthma is a prevalent and troublesome pediatric condition. In 2013, Emergency Department (ED) providers treated over 3,500 cases of asthma-related complaints at Children's Hospitals and Clinics of Minnesota. Pediatric ED visits for asthma exceeds billions of dollars annually when including direct cost and lost productivity. Many of these visits and resultant costs are avoidable. Patients with well-controlled asthma do not typically exhibit these patterns, while patients with poorly controlled asthma show patterns of increased utilization of healthcare resources and lower quality of life. Evidence suggests that a text message reminder and educational program might positively influence pediatric asthma care practices. RESEARCH QUESTION Does a targeted ED based text message intervention program improve outpatient follow-up and routine preventive care in pediatric asthma patients? METHODS Study subjects will be block randomized based on age and insurance group. The experimental group will receive text messages with guidance towards follow-up care with their PCP and the importance of the flu vaccine for children with asthma. The control group will receive a series of educational self-care and health based text messages unrelated to asthma or the flu vaccine. Some self-report of behaviors will be captured via text message response. ANALYSIS Primary outcomes for the educational versus targeted text message groups will be compared use Chi-square tests. Additional adjustments may be applied for missing data or if, despite randomization, there is substantial imbalance between group in key covariates (eg race/ethnicity, insurance type or asthma severity.)

Official Title
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Use of Text Messages to Improve Care For Children Following an ED Visit for Asthma

Conditions
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Asthma

Intervention / Treatment
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* Behavioral: Targeted text messages
* Behavioral: General text messages


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Caregivers of patients aged 4 - 17 years (inclusive) will be eligible for study participation if they meet the following criteria: Presentation to the ED with a chief complaint related to an asthma exacerbation such as shortness of breath, respiratory distress, wheezing, etc… Receive an albuterol treatment in the ED Previous history of asthma as represented in the medical record or by parental report Have a cell phone that is able to receive text messages Able to communicate and provide consent in English or Spanish Exclusion Criteria: Caregivers of patients will be excluded from this study for the following reasons: First episode of wheezing Admitted to the hospital Co-morbid respiratory disease: Cystic fibrosis Bronchiectasis Pulmonary hypertension Other chronic lung disease Current cancer diagnosis Previous cardiovascular surgery Inflammatory bowel disease Sickle Cell disease

Ages Eligible for Study
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Minimum Age: 4 Years
Maximum Age: 17 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Control<br>Subjects receive general, health-related text messages applicable for children with asthma. | Behavioral: General text messages<br>* Subjects received text messages generalized to children with asthma<br>|
| Experimental: Test group<br>Subjects receive specific, targeted text messages for post-emergency department discharge asthma care. | Behavioral: Targeted text messages<br>* Subjects received text messages specific to post ED asthma follow-up<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Follow-up care with primary care provider | Assessed via text and follow-up call if no response to text message | 1 week after emergency department discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Influenza vaccine | Assessed via text and follow-up call if no response to text message | 30 days after emergency department discharge | 
| Return visit to the emergency department | Assessed via text and follow-up call if no response to text message; Our health record also checked for return visits | 30 days after the inaugural emergency department visit | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Pediatrics, Emergency Medicine, Text messaging