Telemedicine Enhanced Asthma Management Through the Emergency Department

NCT ID: NCT02752165

Last Updated: 2025-09-05

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 384 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2016-12-15
• Study Completion Date: 2022-07-12

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

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

TEAM-ED Intervention Group

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

Group Type: EXPERIMENTAL

TEAM-ED

Intervention Type: OTHER

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

Enhanced Usual Care

Report of symptoms to primary care physician

Group Type: ACTIVE_COMPARATOR

Enhanced Usual Care

Intervention Type: OTHER

Report of symptoms to primary care physician

Interventions

TEAM-ED

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

Intervention Type: OTHER

Enhanced Usual Care

Report of symptoms to primary care physician

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• 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

Exclusion Criteria

• 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

• Minimum Eligible Age: 3 Years
• Maximum Eligible Age: 12 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of Rochester

OTHER

Sponsor Role: lead

Responsible Party

Jill Halterman

Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

JIll Halterman, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

University of Rochester

Locations

University of Rochester

Rochester, New York, United States

Countries

United States

References

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.

Reference Type: DERIVED

PMID: 38065280 (View on PubMed)

Provided Documents

Document Type: Study Protocol and Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

60286

Identifier Type: -

Identifier Source: org_study_id