Telehealth Education for Asthma Connecting Hospital and Home (TEACHH)

连接医院和家庭的哮喘远程医疗教育 (TEACHH)

• 批准号: 10370547
• 负责人: Sean Michael Frey
• 金额: $ 4.94万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-03 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10370547
• 关键词: Telehealth; Education; Asthma; Connecting; Hospital

Asthma is the most prevalent chronic disease of childhood and a leading cause of pediatric acute care utilization (ACU) in the US. Hospitalization is a leading risk factor for later ACU: 40% of patients will be readmitted or go to the ED for asthma within 6 months of discharge. Guideline-based care, including education and daily controller therapy, can reduce ACU and prevent up to 80% of asthma readmissions. However, children from low income and racial/ethnic minority populations are the least likely to receive or use controller medication, and the most likely to be hospitalized and readmitted. Once hospitalized, systemic barriers to educational support during the hospital-to-home transition create missed opportunities to promote home management among high-risk children and their families. Improving adherence and clinical outcomes for hospitalized children requires education across settings that meaningfully engages patients and caregivers, ideally using materials designed for low literacy populations and enabling reliable visual identification of key medications. Facilitated access to follow-up support after discharge is also needed. The goal of this study is to evaluate the feasibility, acceptability, and preliminary efficacy of a technology-enhanced educational intervention for caregivers and children who are hospitalized due to asthma. We propose a pilot RCT with 60 children (5-11 yrs) hospitalized with asthma at the Golisano Children’s Hospital in Rochester, NY. After baseline assessment, subjects will be randomized to either: 1) the Telehealth Education for Asthma Connecting Hospital and Home (TEACHH) intervention, which includes inpatient child/caregiver education using pictorial materials, color/shape labels for home medications (green star=controller, yellow/red circles=rescue), and a pair of in-home, smartphone-based telehealth visits after discharge to reinforce effective home management; or, 2) the standard care (SC) condition, which features standard inpatient education and routine outpatient follow-up. Patients in TEACHH will also receive all SC measures. All caregivers will complete blinded telephone follow-up assessments at 2, 4, and 6 months after discharge; children will be asked medication questions at baseline and 6 months. We will describe the feasibility and acceptability of implementing the TEACHH intervention by reviewing process measure data collected throughout the study; assess the preliminary efficacy of TEACHH in improving key clinical outcomes, including asthma-related ACU at 7 days, 30 days, and 6 months (per electronic health record documentation) and symptom-free days at each follow-up (reported by caregivers); and assess secondary clinical and functional outcomes including asthma-related quality of life, missed school or work due to asthma, caregiver and child medication knowledge, and reported adherence. Findings from this work will establish a strong foundation for a full-scale trial, and guide future efforts to deliver guideline-based asthma care to underserved children and families at the greatest risk for preventable morbidity.

哮喘是儿童期最常见的慢性疾病，也是儿科急性护理的主要原因 在美国，住院治疗是后期 ACU 的主要危险因素：40% 的患者将住院。 出院后 6 个月内因哮喘再次入院或前往急诊室，接受基于指南的护理，包括教育。 和日常控制治疗，可以减少 ACU 并预防高达 80% 的哮喘再入院。 来自低收入和少数种族/族裔的儿童最不可能接受或使用控制器 服药，并且最有可能住院并再次入院，出现全身障碍。 从医院到家庭过渡期间的教育支持错失了宣传家庭的机会 提高高危儿童及其家庭的治疗依从性和临床结果。 住院儿童需要跨环境的教育，让患者和护理人员有意义地参与其中， 理想地使用为低识字人群设计的材料，并能够可靠地视觉识别关键 还需要促进出院后获得后续支持。 评估技术增强教育的可行性、可接受性和初步效果 对因哮喘住院的护理人员和儿童进行干预。 我们提议对 Golisano 儿童医院的 60 名因哮喘住院的儿童（5-11 岁）进行试点随机对照试验 纽约州罗彻斯特医院 基线评估后，受试者将被随机分配至：1) 远程医疗。 连接医院和家庭的哮喘教育 (TEACHH) 干预措施，其中包括住院患者 使用图形材料、家庭药物颜色/形状标签（绿色）对儿童/看护者进行教育 星号=控制器，黄色/红色圆圈=救援），以及两次基于智能手机的家庭远程医疗就诊 出院以加强有效的家庭管理；或者，2) 标准护理 (SC) 条件，其特点是 TEACHH 中的患者也将接受标准住院教育和常规门诊随访。 所有护理人员将在 2、4 和 6 个月后完成盲法电话随访评估。 出院后，我们将在基线和 6 个月时询问儿童用药问题。 通过审查过程测量数据实施 TEACHH 干预的可行性和可接受性 在整个研究过程中收集；评估 TEACHH 在改善关键临床结果方面的初步功效， 包括 7 天、30 天和 6 个月时与哮喘相关的 ACU（根据电子健康记录文件） 每次随访时的无症状天数（由护理人员报告）并评估二次临床和 功能结果，包括与哮喘相关的生活质量、因哮喘缺课或缺勤、照顾者 和儿童用药知识以及报告的依从性将建立强有力的基础。 为全面试验奠定基础，并指导未来为服务不足的人群提供基于指南的哮喘护理的努力 儿童和家庭是可预防发病风险最大的群体。