Telemedicine Enhanced Asthma Management Through the Emergency Department

NCT02752165 | Completed Results

• 1 other identifier: 60286
• Study Type: interventional
• Target: 384
• Locations: 1 country
• Sites: 1

Brief 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.

Conditions

Asthma

Outcome Measures

Primary Outcomes (4)

• Number of Symptom-Free Days in the Prior 2 Weeks

  Number of days without symptoms in the prior 2 weeks

  At the 3-month follow-up assessment

• Number of Symptom-Free Days in the Prior 2 Weeks

  Number of days without symptoms in the prior 2 weeks

  At the 6-month follow-up assessment

• Number of Symptom-Free Days in the Prior 2 Weeks

  Number of days without symptoms in the prior 2 weeks

  At the 9-month follow-up assessment

• Number of Symptom-Free Days in the Prior 2 Weeks

  Number of days without symptoms in the prior 2 weeks

  At the 12-month follow-up assessment

Study Arms (2)

TEAM-ED Intervention Group

EXPERIMENTAL

Facilitation of preventive asthma management through telemedicine assessment and follow-ups in addition to guideline-based provider prompting

Other: TEAM-ED

Enhanced Usual Care

ACTIVE COMPARATOR

Report of symptoms to primary care physician

Other: Enhanced Usual Care

Interventions

TEAM-ED OTHER

Facilitation of preventive asthma management through telemedicine assessment and follow-ups in addition to guideline-based provider prompting

TEAM-ED Intervention Group

Enhanced Usual Care OTHER

Report of symptoms to primary care physician

Enhanced Usual Care

Eligibility Criteria

• Age: 3 Years - 12 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Prior physician diagnosis of asthma
• current emergency visit for an acute asthma exacerbation, requiring nebulized albuterol therapy
• Persistent or poor control of asthma, defined by NHLBI guidelines

You may not qualify if:

• Inability to speak and understand either English or Spanish
• No access to a phone for follow-up surveys
• Participation in another asthma study at the time of enrollment, or a sibling participating in this or another study Other significant medical conditions that could interfere with assessment of asthma-related measures
• children in foster care or other situations in which consent cannot be obtained from a legal guardian

Sponsors & Collaborators

• University of Rochester: lead

Study Sites (1)

University of Rochester

Rochester, New York, 14642, United States

Location

Related Publications (1)

• Halterman JS, Fagnano M, Tremblay P, Butz A, Perry TT, Wang H. Effect of the Telemedicine Enhanced Asthma Management Through the Emergency Department (TEAM-ED) Program on Asthma Morbidity: A Randomized Controlled Trial. J Pediatr. 2024 Mar;266:113867. doi: 10.1016/j.jpeds.2023.113867. Epub 2023 Dec 6.

  PMID: 38065280 DERIVED

MeSH Terms

Conditions

Asthma

Condition Hierarchy (Ancestors)

Bronchial Diseases; Respiratory Tract Diseases; Lung Diseases, Obstructive; Lung Diseases; Respiratory Hypersensitivity; Hypersensitivity, Immediate; Hypersensitivity; Immune System Diseases

Results Point of Contact

• Title: Jill Halterman
• Organization: University of Rochester

jill_halterman@urmc.rochester.edu

5852755798

Study Officials

• JIll Halterman, MD, MPH

  University of Rochester

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: March 11, 2016
• First Posted: April 26, 2016
• Study Start: December 15, 2016
• Primary Completion: July 12, 2022
• Study Completion: July 12, 2022
• Last Updated: September 5, 2025
• Results First Posted: February 12, 2024

Record last verified: 2025-09

Locations

US (1)