Use of Text Messages to Improve Care For Children Following an ED Visit for Asthma

BACKGROUND Asthma is a prevalent and troublesome pediatric condition. In 2013, Emergency Department (ED) providers treated over 3,500 cases of asthma-related complaints at Children's Hospitals and Clinics of Minnesota. Pediatric ED visits for asthma exceeds billions of dollars annually when including direct cost and lost productivity. Many of these visits and resultant costs are avoidable. Patients with well-controlled asthma do not typically exhibit these patterns, while patients with poorly controlled asthma show patterns of increased utilization of healthcare resources and lower quality of life. Evidence suggests that a text message reminder and educational program might positively influence pediatric asthma care practices.

RESEARCH QUESTION Does a targeted ED based text message intervention program improve outpatient follow-up and routine preventive care in pediatric asthma patients?

METHODS Study subjects will be block randomized based on age and insurance group. The experimental group will receive text messages with guidance towards follow-up care with their PCP and the importance of the flu vaccine for children with asthma. The control group will receive a series of educational self-care and health based text messages unrelated to asthma or the flu vaccine. Some self-report of behaviors will be captured via text message response.

ANALYSIS Primary outcomes for the educational versus targeted text message groups will be compared use Chi-square tests. Additional adjustments may be applied for missing data or if, despite randomization, there is substantial imbalance between group in key covariates (eg race/ethnicity, insurance type or asthma severity.)

Study Overview

• Status: Unknown
• Conditions: Asthma
• Intervention / Treatment: Behavioral: General text messages; Behavioral: Targeted text messages

• Study Type: Interventional
• Enrollment (Anticipated): 195
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Minnesota
    • Minneapolis, Minnesota, United States, 55404
      • Recruiting
      • Children's Hospitals and Clinics of Minnesota - Emergency Department
      • Contact: Anupam B Kharbanda, MD
    • Saint Paul, Minnesota, United States
      • Recruiting
      • Children's Minnesota
      • Contact: Anupam Kharbanda, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 4 years to 17 years (Child)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Caregivers of patients aged 4 - 17 years (inclusive) will be eligible for study participation if they meet the following criteria:

  1. Presentation to the ED with a chief complaint related to an asthma exacerbation such as shortness of breath, respiratory distress, wheezing, etc…
  2. Receive an albuterol treatment in the ED
  3. Previous history of asthma as represented in the medical record or by parental report
  4. Have a cell phone that is able to receive text messages
  5. Able to communicate and provide consent in English or Spanish

Exclusion Criteria:

• Caregivers of patients will be excluded from this study for the following reasons:

  1. First episode of wheezing
  2. Admitted to the hospital

  3. Co-morbid respiratory disease:

     1. Cystic fibrosis
     2. Bronchiectasis
     3. Pulmonary hypertension
     4. Other chronic lung disease
  4. Current cancer diagnosis
  5. Previous cardiovascular surgery
  6. Inflammatory bowel disease
  7. Sickle Cell disease

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Control; Subjects receive general, health-related text messages applicable for children with asthma.	Behavioral: General text messages; Subjects received text messages generalized to children with asthma
Experimental: Test group; Subjects receive specific, targeted text messages for post-emergency department discharge asthma care.	Behavioral: Targeted text messages; Subjects received text messages specific to post ED asthma follow-up

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Follow-up care with primary care provider	Assessed via text and follow-up call if no response to text message	1 week after emergency department discharge

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Influenza vaccine	Assessed via text and follow-up call if no response to text message	30 days after emergency department discharge
Return visit to the emergency department	Assessed via text and follow-up call if no response to text message; Our health record also checked for return visits	30 days after the inaugural emergency department visit

Collaborators and Investigators

• Sponsor: Children's Hospitals and Clinics of Minnesota
• Collaborators: HealthPartners Institute

Study record dates

Study Major Dates

• Study Start: October 1, 2014
• Primary Completion (Anticipated): December 1, 2018
• Study Completion (Anticipated): December 1, 2018

Study Registration Dates

• First Submitted: May 1, 2015
• First Submitted That Met QC Criteria: May 1, 2015
• First Posted (Estimate): May 6, 2015

Study Record Updates

• Last Update Posted (Actual): November 22, 2017
• Last Update Submitted That Met QC Criteria: November 20, 2017
• Last Verified: November 1, 2017

More Information

Terms related to this study

• Keywords: Emergency Medicine; Pediatrics; Text messaging
• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Immune System Diseases; Lung Diseases; Hypersensitivity, Immediate; Bronchial Diseases; Lung Diseases, Obstructive; Respiratory Hypersensitivity; Hypersensitivity; Asthma
• Other Study ID Numbers: 1409-082