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

Abstract

ObjectiveTo 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 DesignWe included children (3-12 years) with persistent asthma who presented to the ED for asthma, were then randomly assigned to Telemedicine Enhanced Asthma Management through the Emergency Department (TEAM-ED) or enhanced Usual Care (eUC). 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 two 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. ResultsWe 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; 41% completed 3 visits. At 3 months, caregivers of children in TEAM-ED reported more follow-up visits (66%vs.48%, aOR:2.07 [1.28-3.33]), preventive asthma medication actions (90%vs.79%, aOR:3.28 [1.56-6.89]), and use of a preventive medication (82%vs.69%, aOR:2.716 [1.45-5.08]), compared with eUC. There was no difference between groups in medication adherence or asthma morbidity. When only pre-pandemic data were included, there was greater improvement in SFDs over time for children in TEAM-ED versus eUC. ConclusionsTEAM-ED significantly improved follow-up and preventive care after an ED visit for asthma. We also saw improved SFDs with pre-pandemic data. The lack of overall improvement in morbidity and adherence indicates the need for additional ongoing management support.