Telemedicine Enhanced Asthma Management Through the Emergency Department

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.