Telehealth-Enhanced Asthma Care for Home after the Emergency Room (TEACH-ER)

急诊室后的远程医疗增强哮喘家庭护理 (TEACH-ER)

• 批准号: 10716458
• 负责人: Sean Michael Frey
• 金额: $ 69.71万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-15 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10716458
• 关键词: Absenteeism; Accident and Emergency department; Acute; Address; Adherence; Admission activity; Age; Anti-Inflammatory Agents; Asthma; Black race; Caregivers; Caring; Child; Child Care; Child Support; Childhood; Chronic Disease; Clinical; Color; Computerized Medical Record; Control Groups; Data; Dedications; Diagnosis; Disparity; Drug Prescriptions; Education; Educational process of instructing; Effectiveness; Elements; Emergency Situation; Emergency department visit; Enrollment; Flare; Future; Guidelines; Health; Health Promotion; Health education; Healthcare Systems; Home; Home visitation; Hospitalization; Hospitalized Child; Hospitals; Inpatients; Interruption; Intervention; Label; Link; Low income; Modeling; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Outcome; Outpatients; Participant; Patients; Pharmaceutical Preparations; Population; Practice Management; Prevention; Preventive; Preventive care; Preventive therapy; Preventive treatment; Primary Care; Process; Program Effectiveness; Provider; Psychological reinforcement; Public Health; Quality of life; Recommendation; Regimen; Risk; Risk Factors; Schools; Self Management; Severities; Shapes; Symptoms; Techniques; Technology; Telemedicine; Telephone; Testing; Time; Visit; Work; acute care; care systems; clinical outcome assessment; compliance behavior; cost; disparity reduction; effectiveness evaluation; enhanced care; experience; flexibility; follow up assessment; follow-up; functional outcomes; health care service; health literacy; hospital care; implementation facilitators; implementation intervention; improved; innovation; intervention program; marginalized population; medication compliance; novel; patient home care; patient oriented; pediatric emergency; pilot test; primary care provider; programs; randomized trial; reduce symptoms; response; telehealth; tool; treatment optimization; treatment planning; virtual; virtual visit

Asthma is one of the most prevalent chronic diseases of childhood, and a leading cause of pediatric emergency department (ED) visits in the US. Guideline-based asthma management, including treatment with daily preventive medications, can reduce severe asthma flare-ups requiring acute healthcare services. Unfortunately, many children in the ED with asthma are not adequately treated with preventive medications. Children from low income and historically marginalized populations are disproportionately likely to be diagnosed with asthma and require emergency asthma care, yet least likely to be prescribed preventive medication. Poor rates of primary care follow-up after ED discharge result in missed opportunities to optimize treatment and home management and reduce preventable morbidity. Our prior work has demonstrated that a school-based telemedicine intervention for children 3-12 years can facilitate follow-up assessments by primary care providers after ED discharge, and lead to increased prescriptions for preventive medications. Despite access to appropriate treatment, however, the intervention did not lead to improved adherence or reduce symptoms and repeat ED visits. Reducing morbidity for children with asthma in the ED will require a comprehensive guideline-based approach that combines primary care follow-up and treatment with preventive medications, with patient-centered education to support home management and adherence. To enhance home management, we also successfully piloted an intervention of hospital-to-home educational support for children (5-13 years) admitted with asthma that features pictorial materials, health literacy techniques, and a pair of in-home telehealth visits for educational reinforcement after discharge. In response to NOT-OD-21-100: Improving Patient Adherence to Treatment and Prevention Regimens to Promote Health (PA-20-183), we now propose a 2-group randomized trial to test the TEACH-ER (Telehealth-Enhanced Asthma Care for Home after the Emergency Room) intervention vs an enhanced care (EC) control group. The TEACH-ER intervention combines and expands upon our prior work, and includes: 1) brief initial teaching in the ED; 2) in-home telehealth follow-up visit with primary care providers, with a prompted recommendation for guideline-based preventive treatment and home delivery of prescriptions with a pictorial action plan; 3) two additional in-home telehealth visits to deliver health literacy-informed asthma education and home management support. We will enroll 430 children (ages 3-12 yrs) from the two dedicated pediatric EDs in our region. We will assess the effectiveness of the program in reducing morbidity (e.g. repeat ED visits or hospitalizations for asthma, symptom severity, quality of life), improving adherence, and improving preventive asthma care. Participants will complete telephone follow-up assessments 3, 6, 9, and 12 months after enrollment; we will also collective objective data on acute care use from the electronic medical record and prescription fill data. At the study’s completion, the effectiveness of this novel system of care will be better defined as a sustainable means to improve preventive care and reduce morbidity for children with asthma.

哮喘是最普遍的儿童慢性疾病之一，也是小儿紧急事业的主要原因 部门（ed）在美国访问。基于指南的哮喘管理，包括每日治疗 预防药物可以减少需要急性医疗服务的严重哮喘爆发。很遗憾， 急诊室中的许多患有哮喘的儿童没有得到预防性药物的充分治疗。来自低点的孩子 收入和历史上边缘化的人口不成比例地被诊断为哮喘和 需要紧急哮喘护理，但最不可能开处方预防药物。初级率很差 ED出院后的护理随访导致错过优化治疗和家庭管理的机会 并减少可预防的发病率。我们先前的工作表明，基于学校的远程医疗 3-12岁的儿童干预可以促进在ED之后的初级保健提供者的随访评估 出院，并导致预防药物的处方增加。尽管可以访问适当的 但是，治疗方法并未导致依从性改善或减轻症状并重复 访问。减少ED中哮喘儿童的发病率将需要全面的基于指南 将初级保健随访和治疗与预防药物结合的方法与以患者为中心 教育以支持家庭管理和依从性。为了增强家庭管理，我们也成功地 试点哮喘的儿童（5-13岁）的医院对家庭教育支持 其中包括图形材料，健康素养技术和一对内部远程医疗访问教育 出院后的加固。响应于NOT-OD-21-100：改善患者对治疗的依从性和 预防方案促进健康（PA-20-183），我们现在提出一项2组随机试验，以测试 师范（急诊室之后的远程医疗增强哮喘护理家庭的哮喘护理）干预措施与 增强护理（EC）对照组。教学干预组合并扩展了我们先前的工作， 并包括：1）ED中的简短初始教学； 2）家庭远程医疗后续访问初级保健提供者， 提出促进基于指南的预防治疗和处方交付的建议 制定绘画行动计划； 3）另外两次额外的家庭远程医疗访问，以提供健康扫盲的哮喘 教育和家庭管理支持。我们将从两个专用的儿童中注册430名儿童（3-12岁） 我们地区的儿科ED。我们将评估该计划在降低发病率方面的有效性（例如重复 ED访问或住院治疗哮喘，症状严重程度，生活质量），改善依从性和改善 预防性哮喘护理。参与者将完成电话随访评估3、6、9和12个月 注册;我们还将从电子病历和 处方填充数据。在研究完成时，这种新颖的护理系统的有效性将更好 被定义为改善预防保健并减少哮喘儿童发病率的可持续方法。