Effect of the Telemedicine Enhanced Asthma Management Through the Emergency Department (TEAM-ED) Program on Asthma Morbidity: A Randomized Controlled Trial

Abstract

Objective: To test the effectiveness of a telemedicine-based program in reducing asthma morbidity among children who present to the emergency department (ED) for asthma, by facilitating primary care follow-up and promoting delivery of guideline-based care.

Study design: We included children (3-12 years of age) with persistent asthma who presented to the ED for asthma, who were then randomly assigned to Telemedicine Enhanced Asthma Management through the Emergency Department (TEAM-ED) or enhanced usual care. TEAM-ED included (1) school-based telemedicine follow-ups, completed by a primary care provider, (2) point-of-care prompting to promote guideline-based care, and 3) an opportunity for 2 additional telemedicine follow-ups. The primary outcome was the mean number of symptom-free days (SFDs) over 2 weeks at 3, 6, 9, and 12 months.

Results: We included 373 children from 2016 through 2021 (participation rate 68%; 54% Black, 32% Hispanic, 77% public insurance; mean age, 6.4 years). Demographic characteristics and asthma severity were similar between groups at baseline. Most (91%) TEAM-ED children had ≥1 telemedicine visit and 41% completed 3 visits. At 3 months, caregivers of children in TEAM-ED reported more follow-up visits (66% vs 48%; aOR, 2.07; 95% CI, 1.28-3.33), preventive asthma medication actions (90% vs 79%; aOR, 3.28; 95% CI, 1.56-6.89), and use of a preventive medication (82% vs 69%; aOR, 2.716; 95% CI, 1.45-5.08), compared with enhanced usual care. There was no difference between groups in medication adherence or asthma morbidity. When only prepandemic data were included, there was greater improvement in SFDs over time for children in TEAM-ED vs enhanced usual care.

Conclusions: TEAM-ED significantly improved follow-up and preventive care after an ED visit for asthma. We also saw improved SFDs with prepandemic data. The lack of overall improvement in morbidity and adherence indicates the need for additional ongoing management support.

Trial registration: NCT02752165.

Keywords: asthma; child; emergency department; prevention; telemedicine.

Figure 1:

Consort Diagram

Figure 2:

Symptom-Free Days over 2-weeks: Data Collected Prior to the COVID-19 Pandemic Figure 2 shows symptom-free days over time for children in the TEAM-ED group and children in the eUC group, including only data collected prior to the COVID-19 pandemic. After adjusting for covariates, significant improvement in SFDs were seen between 3-months to 9-months, and 3-months to 12-months within the TEAM-ED group (p=.007 and p=.040, respectively). There was also a significant interaction effect between intervention and time (p=0.040), with the improvement in SFD over time greater for the TEAM-ED vs. eUC group.

Figure 3:

Unanticipated Acute Visits for Asthma Reported at Follow-up Figure 3 shows the percent of children with ≥1 unanticipated acute visits for asthma by group reported at each follow-up time point. The number of acute visits were higher for children in the eUC group compared to children in the TEAM-ED group at the 3-month and 12-month time points; however, these findings were not statistically different.