Improving Asthma Referrals Following Emergency Department Evaluation

NCT05072808 | Completed

• 1 other identifier: IRB-19-09-1259
• Study Type: interventional
• Target: 76
• Locations: 1 country
• Sites: 1

Brief 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.

Conditions

Asthma in Children

Keywords

Asthma; Emergency Department; Children; Referral; Pediatric Asthma Control and Communication Instrument for the Emergency Department; PACCI-ED

Outcome Measures

Primary Outcomes (1)

• Proportion of referrals

  Proportion of referrals for outpatient asthma care placed in the electronic medical record.

  Eight months

Secondary Outcomes (3)

• Proportion of subspecialty referrals

  Eight months

• Patient and provider characteristics

  Eight months

• Completed outpatient clinic visits following a referral

  30 days following the ED visit

Study Arms (2)

Intervention Group

ACTIVE COMPARATOR

ED Providers randomized to the Intervention Group will be able to view the results of the parent-completed questionnaire, the Pediatric Asthma Control and Communication Instrument for the Emergency Department (PACCI-ED), and outpatient referral recommendations aligned with asthma severity.

Other: View PACCI-ED and referral recommendations

Control Group

NO INTERVENTION

ED providers randomized to the Control Group will neither receive the results of the parent-completed PACCI-ED or specific recommendations for outpatient referrals. Patients randomized to the control group will receive usual care.

Interventions

View PACCI-ED and referral recommendations OTHER

Results of parent completed PACCI-ED and referral recommendations

Intervention Group

Eligibility Criteria

• Age: 5 Years - 11 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Presenting to Children's Hospital of Michigan (CHM), Detroit, Emergency Department (ED) for an acute asthma exacerbation
• History of asthma as reported by parents

You may not qualify if:

• Transfer from outside ED for a higher level of care
• Admitted to the hospital following pediatric ED evaluation
• Significant co-morbidity (pulmonary, cardiac, or other systemic disease)
• Hemodynamic instability
• Non-English speaking
• Previously enrolled in this study
• Patients without their primary caregiver at ED presentation
• Not under the care of CHM ED provider who has consented to be a part of the study

Sponsors & Collaborators

• Wayne State University: lead

Study Sites (1)

Children's Hospital of Michigan

Detroit, Michigan, 48201, United States

Location

Related Publications (5)

• Akinbami LJ, Moorman JE, Simon AE, Schoendorf KC. Trends in racial disparities for asthma outcomes among children 0 to 17 years, 2001-2010. J Allergy Clin Immunol. 2014 Sep;134(3):547-553.e5. doi: 10.1016/j.jaci.2014.05.037. Epub 2014 Aug 1.

  PMID: 25091437 BACKGROUND

• Rachelefsky GS, Kennedy S, Stone A. Enhancing the role of the emergency department in the identification and management of childhood asthma. Pediatrics. 2006 Apr;117(4 Pt 2):S57-62. doi: 10.1542/peds.2005-2000b. No abstract available.

  PMID: 16777838 BACKGROUND

• Goldberg EM, Laskowski-Kos U, Wu D, Gutierrez J, Bilderback A, Okelo SO, Garro A. The Pediatric Asthma Control and Communication Instrument for the Emergency Department (PACCI-ED) improves physician assessment of asthma morbidity in pediatric emergency department patients. J Asthma. 2014 Mar;51(2):200-8. doi: 10.3109/02770903.2013.859267. Epub 2013 Dec 4.

  PMID: 24219842 BACKGROUND

• Wu DJ, Hipolito E, Bilderback A, Okelo SO, Garro A. Predicting future emergency department visits and hospitalizations for asthma using the Pediatric Asthma Control and Communication Instrument - Emergency Department version (PACCI-ED). J Asthma. 2016;53(4):387-91. doi: 10.3109/02770903.2015.1115520. Epub 2016 Jan 22.

  PMID: 26667853 BACKGROUND

• Pade KH, Agnihotri NT, Vangala S, Thompson LR, Wang VJ, Okelo SO. Asthma specialist care preferences among parents of children receiving emergency department care for asthma. J Asthma. 2020 Feb;57(2):188-195. doi: 10.1080/02770903.2019.1565768. Epub 2019 Jan 21.

  PMID: 30663904 BACKGROUND

MeSH Terms

Conditions

Asthma; Emergencies

Condition Hierarchy (Ancestors)

Bronchial Diseases; Respiratory Tract Diseases; Lung Diseases, Obstructive; Lung Diseases; Respiratory Hypersensitivity; Hypersensitivity, Immediate; Hypersensitivity; Immune System Diseases; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Amy M DeLaroche, MBBS

  Detroit Medical Center

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: CARE PROVIDER
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: September 22, 2021
• First Posted: October 11, 2021
• Study Start: November 15, 2021
• Primary Completion: April 30, 2023
• Study Completion: April 30, 2023
• Last Updated: December 8, 2023

Record last verified: 2023-12

Locations

US (1)