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.

哮喘是儿童期最常见的慢性疾病之一，也是儿科急诊的主要原因 在美国进行基于指南的哮喘管理，包括每日治疗。 预防性药物可以减少需要紧急医疗服务的严重哮喘发作。 急诊科的许多患有哮喘的儿童没有得到充分的预防性药物治疗。 收入和历史人口被诊断出患有哮喘的可能性不成比例 需要紧急哮喘护理，但最不可能接受初级预防药物治疗。 急诊科出院后的护理随访导致错失优化治疗和家庭管理的机会 并减少可预防的发病率。我们之前的工作表明，以学校为基础的远程医疗是可行的。 对 3-12 岁儿童的干预可以促进初级保健提供者在 ED 后进行后续评估 出院，并导致预防性药物处方的增加，尽管可以获得适当的药物。 然而，干预措施并没有提高依从性或减轻症状和重复急诊科 减少急诊室哮喘儿童的发病率需要基于全面的指南。 将初级保健随访和治疗与预防性药物相结合的方法，以患者为中心 支持家庭管理和遵守的教育 为了加强家庭管理，我们还成功地做到了这一点。 对因哮喘入院的儿童（5-13岁）试行从医院到家庭的教育支持干预措施 其中包括图片材料、健康素养技巧以及两次家庭远程医疗访问以进行教育 出院后的强化响应 NOT-OD-21-100：提高患者对治疗的依从性 促进健康的预防方案 (PA-20-183)，我们现在提出一项 2 组随机试验来测试 TEACH-ER（急诊室后远程保健增强型哮喘家庭护理）干预与 加强护理 (EC) 对照组。 TEACH-ER 干预结合并扩展了我们之前的工作， 包括：1) 在急诊室进行简短的初步教学；2) 与初级保健提供者进行家庭远程医疗随访， 提供基于指南的预防性治疗和家庭提示处方交付的建议 附有图示行动计划；3) 两次额外的家庭远程医疗就诊，以提供哮喘健康知识 我们将从两个专门学校招收 430 名儿童（3-12 岁）。 我们将评估该计划在降低发病率方面的有效性（例如重复）。 因哮喘、症状严重程度、生活质量而去急诊室或住院，提高依从性，并改善 参与者将在 3、6、9 和 12 个月后完成电话随访评估。 我们还将从电子病历中收集有关急症护理使用的客观数据； 研究完成后，这种新型护理系统的有效性将会更好。 被定义为改善哮喘儿童预防保健和降低发病率的可持续手段。