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.

哮喘是最普遍的儿童慢性疾病，也是小儿急性护理的主要原因 美国利用率（ACU）。住院是后来ACU的主要危险因素：40％的患者将是 在出院后6个月内，已读或去急诊室进行哮喘。基于指南的护理，包括教育 每天的控制器疗法可以减少ACU并防止多达80％的哮喘再入院。然而， 来自低收入和种族/族裔少数民族的儿童接收或使用控制者最不可能 药物，最有可能住院和重新入院。一旦住院，全身障碍 医院到家过渡期间的教育支持创造了错过的机会来促进房屋 高危儿童及其家人的管理。改善的依从性和临床结果 住院儿童需要跨越有意义地吸引患者和看护人的环境的教育， 理想情况下，使用专为低识字群体设计的材料并实现可靠的视觉识别。 药物。还需要促进出院后获得后续支持。这项研究的目的是 评估技术增强教育的可行性，可接受性和初步效率 干预因哮喘而住院的护理人员和儿童。 我们提出了一个飞行员RCT，在Golisano Children's，有60名儿童（5-11岁）住院的儿童（5-11岁） 纽约州罗切斯特的医院。基线评估后，受试者将被随机分配给：1）远程医疗 哮喘连接医院和家庭（Teachh）干预的教育，包括住院 使用图形材料，家庭药物的颜色/形状标签（绿色）的儿童/照顾者教育 星=控制器，黄色/红色圆圈=救援），以及一对基于智能手机的远程医疗访问 释放以加强有效的家庭管理；或，2）标准护理（SC）条件，其特征 标准的住院教育和常规门诊后续行动。 Teachh的患者也将获得所有SC 措施。所有护理人员将在2、4和6个月完成盲目的电话随访评估 释放;将在基线和6个月的时间询问儿童的药物问题。我们将描述 通过审查流程测量数据实施教学干预的可行性和可接受性 在整个研究中收集；评估Teachh在改善关键临床结果中的初步效率， 在7天，30天和6个月时包括与哮喘相关的ACU（根据电子健康记录文件） 和每次随访的无症状天（护理人员报告）；并评估次要临床和 功能结果包括与哮喘相关的生活质量，由于哮喘，看护人而错过学校或工作 和儿童用药知识，并报告了依从性。这项工作的发现将建立强大的 全面试验的基础，并指导未来的努力，以提供基于指南的哮喘护理给服务不足 儿童和家庭面临可预防发病率的最大风险。