Telehealth for Childhood Asthma

(TEACH-ER Trial)

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: University of Rochester

Must be taking: Daily controller

Disqualifiers: Cystic fibrosis, Congenital heart disease, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 8

430 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores a new method for caring for children with asthma after an emergency room visit. The study compares two approaches: one group receives enhanced standard care (Enhanced Care, EC), while the other receives additional support through telehealth visits and specialized education on managing asthma at home (Telehealth-Enhanced Asthma Care for Home After the Emergency Room, TEACH-ER). The researchers aim to determine if telehealth can reduce the need for further emergency visits, improve asthma symptoms, and enhance the quality of life for children. Children aged 3 to 12 who recently visited the emergency room for asthma and live in Monroe County, NY, may be suitable candidates. As an unphased trial, this study provides a unique opportunity to contribute to innovative asthma care strategies that could improve children's health and well-being.

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications. It seems likely that participants will continue their current asthma medications, as the study focuses on enhancing asthma care.

What prior data suggests that this telehealth approach is safe for childhood asthma care?

Research has shown that telehealth for children with asthma is generally safe and effective. Studies have found that telemedicine helps children adhere to their treatment plans and improves their quality of life while reducing unexpected emergency room visits.

No serious side effects have been reported in studies on telehealth for asthma care. Regular online check-ins enable children to manage their asthma better. This method educates families about asthma and ensures correct medication use, with no major safety issues identified.

In summary, telehealth for asthma management appears to be a safe choice for children, aiding in asthma control without introducing new risks. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Telehealth-Enhanced Asthma Care for Home After the Emergency Room (TEACH-ER) because it offers a new way to manage childhood asthma using telehealth technology right after an emergency room visit. Unlike traditional asthma care, which typically involves in-person follow-ups and standard medication management, TEACH-ER integrates virtual check-ins and personalized care plans, making it easier for families to manage asthma symptoms at home. This approach not only aims to reduce the need for repeat hospital visits but also empowers parents and children with real-time support and guidance from healthcare professionals. By leveraging technology, TEACH-ER could significantly improve asthma management and overall quality of life for children with asthma.

What evidence suggests that this trial's treatments could be effective for childhood asthma?

Research shows that telehealth can improve asthma management after an emergency room visit. In this trial, participants in the Telehealth-Enhanced Asthma Care for Home After the Emergency Room (TEACH-ER) arm will receive a new model of patient-centered asthma management. Studies on similar telehealth programs have found that children experienced better asthma control and missed fewer school days. For instance, children using telehealth had an average of 1.32 more symptom-free days and were less likely to need another emergency visit. This evidence suggests that telehealth can help maintain asthma control and reduce hospital visits. Meanwhile, participants in the Enhanced Care (EC) Comparison Group will receive standard emergency department care for asthma exacerbations, enhanced through a report of recent symptoms sent to PCPs and systematic feedback on asthma management. ^{1 2 4 6 7}

Are You a Good Fit for This Trial?

This trial is for children aged 3-12 with persistent asthma or poor control, living in Monroe County, NY. They must have had an emergency visit for acute asthma and be on a daily controller medication as per NHLBI guidelines. Excluded are those who can't understand English or Spanish, lack phone access, are in foster care without guardian consent, or have other significant medical conditions.

Inclusion Criteria

Child and caregiver live in Monroe County, NY

My child is between 3 and 12 years old.

I have asthma that requires daily medication.

Exclusion Criteria

I do not have major health issues like cystic fibrosis or serious heart disease that could affect asthma assessments.

No access to a working phone for follow-up surveys

Children in foster care or other situations in which consent cannot be obtained from a legal guardian

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Initial Education and Discharge

Brief, pictorial, and health literacy-informed asthma education in the ED, with color- and shape-coded labels provided for home asthma medications

1 day

1 visit (in-person)

Telehealth Follow-up

Virtual primary care follow-up within 1 week of discharge using in-home telemedicine, featuring provider prompts for guideline-based preventive therapy and home delivery of prescribed medications with pictorial action plans

1 week

1 visit (virtual)

Continued Virtual Visits

Two additional in-home virtual visits to reinforce teaching, review treatment plans, label medications, and support effective management practices

2 weeks

2 visits (virtual)

Follow-up

Participants are monitored for safety and effectiveness after treatment through blinded follow-up telephone surveys at 3, 6, 9, and 12 months after discharge

12 months

4 visits (telephone)

What Are the Treatments Tested in This Trial?

Interventions

• Enhanced Care (EC)
• Telehealth-Enhanced Asthma Care for Home After the Emergency Room (TEACH-ER)

Trial Overview The study compares TEACH-ER—a telehealth program including education in the ER, virtual follow-ups with home medication delivery—and Enhanced Care (EC). It aims to see if TEACH-ER reduces further emergency visits/hospitalizations over a year and improves symptoms, adherence to medication, quality of life and guideline-based care.

How Is the Trial Designed?

Group I: Telehealth-Enhanced Asthma Care for Home After the Emergency Room Experimental Treatment 1 Intervention

New model of patient-centered asthma management.

Group II: Enhanced Care (EC) Comparison Group Active Control 1 Intervention

Standard emergency department care for asthma exacerbations, enhanced through a report of recent symptoms sent to PCPs, and systematic feedback on asthma management/care at intervals that parallel the TEACH-ER group's telemedicine assessments.

Who Is Running the Clinical Trial?

University of Rochester

Lead Sponsor

Trials

883

Recruited

555,000+

National Heart, Lung, and Blood Institute (NHLBI)

Collaborator

Trials

3,987

Recruited

47,860,000+

Published Research Related to This Trial

The study involved 10 pediatric patients with persistent asthma who used an Internet-based telehealth system to monitor their medication adherence and asthma control, showing significant improvement in inhaler technique scores during the second study period.

Caregivers reported improved quality of life for patients in the virtual education group, and the telehealth system effectively reduced emergency department visits and hospital admissions, indicating its efficacy and acceptance among users.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An Internet-based store-and-forward video home telehealth system for improving asthma outcomes in children. Chan, DS., Callahan, CW., Sheets, SJ., et al.[2019]

Telemedicine in school settings for asthma education showed positive or neutral effects on quality of life and self-management behaviors for children, with no reported negative effects from the interventions.

Clinical outcomes related to asthma management, such as airway inflammation and medication use, had mixed results, indicating that while some improvements were noted, further validation of these telemedicine methods is needed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Telemedical Asthma Education and Health Care Outcomes for School-Age Children: A Systematic Review. Culmer, N., Smith, T., Stager, C., et al.[2021]

A tailored self-management intervention delivered in the pediatric emergency department significantly increased caregivers' confidence in managing their child's asthma 14 days after the intervention.

The intervention group had more well-asthma visits and fewer urgent care or emergency department visits at 9 months, particularly among children with intermittent asthma, indicating potential long-term benefits of the program.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Delivering tailored asthma family education in a pediatric emergency department setting: a pilot study. Sockrider, MM., Abramson, S., Brooks, E., et al.[2019]

A telemedicine system for monitoring asthma at home significantly reduced emergency room visits and improved daily living activities for patients at high risk of hospitalization over a six-month period.

Patients using the telemedicine system successfully measured and transmitted their peak expiratory flow (PEF) values, leading to noticeable improvements in their PEF, indicating effective asthma management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Tele-medicine system for high-risk asthmatic patients]. Kokubu, F., Suzuki, H., Sano, Y., et al.[2006]

An educational program aimed at reducing emergency room visits for asthma in 253 children did not succeed in its goal, as both the experimental and control groups still had significant ER visits in the year following the intervention.

Specifically, the experimental group had 55 ER visits from 24 patients, while the control group had 39 visits from 18 patients, indicating that the educational approach did not effectively lower emergency care usage.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of a patient education program on emergency room use for inner-city children with asthma. Shields, MC., Griffin, KW., McNabb, WL.[2022]

A self-management program for asthmatic children, involving 26 participants aged 2 to 14, led to significantly fewer hospitalizations and emergency room visits, demonstrating its efficacy in managing asthma.

The educational intervention resulted in tenfold less school absenteeism and improved understanding and compliance with asthma management, indicating that effective education can enhance treatment outcomes for children with asthma.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Teaching self-management skills to asthmatic children and their parents in an ambulatory care setting. Fireman, P., Friday, GA., Gira, C., et al.[2018]

The telemedicine-based program (TEAM-ED) significantly improved follow-up visits and preventive care actions for children with asthma after an emergency department visit, with 91% of participants attending at least one telemedicine visit.

While TEAM-ED showed better follow-up and preventive medication use, it did not lead to overall improvements in asthma morbidity or medication adherence, highlighting the need for ongoing management support.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of the Telemedicine Enhanced Asthma Management through the Emergency Department (TEAM-ED) Program on Asthma Morbidity: A Randomized Controlled Trial. Halterman, JS., Fagnano, M., Tremblay, P., et al.[2023]

The interactive computer-assisted asthma education program (PEMT) was well-received by children in the emergency department, with 81% finding it very easy to use and 75% expressing a willingness to use it again.

After participating in the PEMT program, children showed a significant 13% improvement in their knowledge about asthma management, indicating its effectiveness as an educational tool in acute care settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A pilot study to evaluate self initiated computer patient education in children with acute asthma in pediatric emergency department. Joshi, A., Lichenstein, R., Rafei, K., et al.[2007]

In a study of 107 children with asthma visiting emergency departments, 38% of the visits were deemed potentially avoidable due to inadequate prehospital treatment, highlighting a significant gap in self-management practices.

The presence of a Written Asthma Action Plan (WAAP) did not independently reduce the likelihood of avoidable visits, suggesting that additional strategies, such as improving asthma education and developing electronic self-management tools, are needed to enhance care and reduce emergency visits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Avoidable Emergency Visits for Acute Asthma in Children: Prevalence and Risk Factors. Beydon, N., Cochez, M., Mahut, B., et al.[2022]

A follow-up clinic for asthma patients in the emergency department significantly reduced the number of unscheduled visits for asthma care, with an average of 1.39 visits in the intervention group compared to 2.34 in the control group, indicating improved management of asthma.

Patients who attended the follow-up clinic showed better compliance with inhaled corticosteroid use and reported improved quality of life, with more patients experiencing no limitations in daily activities and functional quality of life after 6 months.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improved asthma outcomes in a high-morbidity pediatric population: results of an emergency department-based randomized clinical trial. Teach, SJ., Crain, EF., Quint, DM., et al.[2022]

In a study of 140 children aged 2-16 with asthma, interactive education during hospitalization led to significantly fewer hospitalizations (10.1% vs 22.5%) compared to didactic education at 6 months, indicating its potential effectiveness in reducing severe asthma episodes.

While there were no differences in emergency department visits between the two education methods, the interactive group showed improved inhaler technique and better patient-reported asthma symptoms and quality of life at 12 months, suggesting that interactive education may enhance long-term asthma management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Interactive Inpatient Asthma Education: A Randomized Controlled Trial. Samady, W., Rodriguez, VA., Gupta, R., et al.[2022]

A bedside asthma education program was implemented for high-risk children at a children's hospital, involving 45 minutes of individualized education and a follow-up call, aimed at reducing repeat emergency department visits and hospitalizations.

Despite the intervention, there was no significant improvement in repeat emergency department utilization or hospitalizations among the 698 children who received the education compared to a matched control group over a 12-month period.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A matched-cohort evaluation of a bedside asthma intervention for patients hospitalized at a large urban children's hospital. Davis, AM., Benson, M., Cooney, D., et al.[2021]

Citations

1. reporter.nih.gov reporter.nih.gov/project-details/10930101

Telehealth-Enhanced Asthma Care for Home after the ... 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 ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT03414177

NCT03414177 | Telehealth Enhanced Asthma Management The overarching hypothesis is that utilization of TM for asthma follow-up will result in improved clinical outcomes such as Asthma Control Test (ACT) scores, ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10922928/

Effect of the Telemedicine Enhanced Asthma Management ... TEAM-ED significantly improved follow-up and preventive care after an ED visit for asthma. We also saw improved SFDs with pre-pandemic data.

4. jpeds.com jpeds.com/article/S0022-3476(25)00413-5/abstract

Effect of the Telemedicine Enhanced Asthma Management ... We found that children in TEAM-UP vs eUC had more SFDs (mean difference: 1.32; 95% CI 0.58–2.05) and were less likely to miss school (OR: 0.70; ...

5. sciencedirect.com sciencedirect.com/science/article/abs/pii/S002234762300731X

Effect of the Telemedicine Enhanced Asthma Management ... This intervention was designed to decrease asthma morbidity by improving the delivery of preventive asthma care after an emergency visit for asthma.

6. withpower.com withpower.com/trial/phase-asthma-6-2023-41339

Telehealth for Childhood Asthma (TEACH-ER Trial) The investigators propose a randomized controlled trial of Telehealth-Enhanced Asthma Care for Home After the Emergency Room (TEACH-ER) vs. enhanced care (EC).

7. explorationpub.com explorationpub.com/Journals/eaa/Article/100981

A telemedicine care protocol for pediatric and adolescent ... Telemedicine significantly enhances asthma management, improving treatment adherence, quality of life, and patient education while reducing unplanned visits.