Telemedicine Enhanced Asthma Management Through the Emergency Department (TEAM-ED)

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.

Study Overview

• Status: Completed
• Conditions: Asthma
• Intervention / Treatment: Other: TEAM-ED; Other: Enhanced Usual Care

• Study Type: Interventional
• Enrollment (Actual): 384
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • New York
    • Rochester, New York, United States, 14642
      • University of Rochester

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 3 years to 12 years (Child)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Prior physician diagnosis of asthma
• current emergency visit for an acute asthma exacerbation, requiring nebulized albuterol therapy
• Persistent or poor control of asthma, defined by NHLBI guidelines

Exclusion Criteria:

• Inability to speak and understand either English or Spanish
• No access to a phone for follow-up surveys
• Participation in another asthma study at the time of enrollment, or a sibling participating in this or another study Other significant medical conditions that could interfere with assessment of asthma-related measures
• children in foster care or other situations in which consent cannot be obtained from a legal guardian

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: TEAM-ED Intervention Group; Facilitation of preventive asthma management through telemedicine assessment and follow-ups in addition to guideline-based provider prompting	Other: TEAM-ED; Facilitation of preventive asthma management through telemedicine assessment and follow-ups in addition to guideline-based provider prompting
Active Comparator: Enhanced Usual Care; Report of symptoms to primary care physician	Other: Enhanced Usual Care; Report of symptoms to primary care physician

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Symptom-Free Days in the Prior 2 Weeks	Number of days without symptoms in the prior 2 weeks	At the 3-month follow-up assessment
Number of Symptom-Free Days in the Prior 2 Weeks	Number of days without symptoms in the prior 2 weeks	At the 6-month follow-up assessment
Number of Symptom-Free Days in the Prior 2 Weeks	Number of days without symptoms in the prior 2 weeks	At the 9-month follow-up assessment
Number of Symptom-Free Days in the Prior 2 Weeks	Number of days without symptoms in the prior 2 weeks	At the 12-month follow-up assessment

Collaborators and Investigators

• Sponsor: University of Rochester
• Investigators: Principal Investigator: JIll Halterman, MD, MPH, University of Rochester

Publications and helpful links

General Publications

• Halterman JS, Fagnano M, Tremblay P, Butz A, Perry TT, Wang H. Effect of the Telemedicine Enhanced Asthma Management Through the Emergency Department (TEAM-ED) Program on Asthma Morbidity: A Randomized Controlled Trial. J Pediatr. 2024 Mar;266:113867. doi: 10.1016/j.jpeds.2023.113867. Epub 2023 Dec 6.

Study record dates

Study Major Dates

• Study Start (Actual): December 15, 2016
• Primary Completion (Actual): July 12, 2022
• Study Completion (Actual): July 12, 2022

Study Registration Dates

• First Submitted: March 11, 2016
• First Submitted That Met QC Criteria: April 22, 2016
• First Posted (Estimated): April 26, 2016

Study Record Updates

• Last Update Posted (Estimated): September 5, 2025
• Last Update Submitted That Met QC Criteria: September 3, 2025
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Immune System Diseases; Respiratory Tract Diseases; Lung Diseases; Bronchial Diseases; Lung Diseases, Obstructive; Respiratory Hypersensitivity; Hypersensitivity, Immediate; Hypersensitivity; Asthma
• Other Study ID Numbers: 60286