Death rates for asthma are higher for African American adolescents aged 15-19 years, than for adolescent Whites and younger children. Teens in underserved communities are more likely to use the Emergency Department (ED) for asthma as a primary source of care. This episodic care impedes development of the patient self-regulation skills necessary for asthma control. Strategies for connecting with high risk groups of urban adolescents with uncontrolled asthma remain elusive. Acute care settings, however, represent a promising means of identifying and intervening upon asthma patients with the greatest need. Puff City is a web-based, computer-tailored intervention that targets urban teens. Under R01 HL68971-01 and a Competing Renewal (R01 HL68971-05), Puff City has been rigorously evaluated using randomized trials conducted in Detroit high schools. Results of both trials showed significantly fewer symptom-days (primary outcome) at the 12 month follow-up for treatment teens compared to controls, while preliminary results from the Competing Renewal show a strong intervention effect for treatment students of few resources (symptom days, p=0.008;missed school, p=0.04;and ED visits, p=0.03). The objective of this project is to evaluate the feasibility of conducting a randomized controlled trial to evaluate implementation of Puff City in an urban ED setting. This pilot will target adolescents presenting to an urban ED with acute asthma. Specifically, we will (1) Engage ED staff in the finalization and implementation of a protocol for recruiting 15-19 year old teens with acute asthma into an ED-initiated pilot trial of an online asthma management program and describe resulting recruitment and refusal rates;(2) measure participant compliance with the pilot study protocol including 4 online sessions (teens) and a 6 (teens and caregivers) and 12 month (teens) follow-up survey);(3) determine the Internet accessibility of participating teens and the impact of accessibility on study participation, compliance and retention;and (4) collectively use pilot study results to describe the intervention effect on selected outcomes (ED visits, Asthma Control Questionnaire, functional status, quality of life, behavior change), describe costs, and the potential for detecting a positive intervention effect in a larger trial. Outreach to urban teens with asthma will require innovative and non-traditional strategies. Puff City has excellent dissemination potential and high fidelity. Before conducting a full-scale randomized trial, feasibility must be assessed. If study findings are positive, the resut will be a more efficient, streamlined and cost effective RCT, and by incorporating as many features of comparative effectiveness research and pragmatic study design as possible, we hope to accelerate translation from research to practice.

Public Health Relevance

The objective of this application is to determine the feasibility of conducting a randomized controlled trial to evaluate the effectiveness of an online, Emergency Department- initiated asthma management intervention designed to reduce asthma-related morbidity among urban teenagers aged 15-19 years with uncontrolled asthma. The study will examine issues around recruitment, participant compliance with the study protocol, Internet access, and attrition. (End of Abstract)

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Planning Grant (R34)
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Clinical Trials Review Committee (CLTR)
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Freemer, Michelle M,
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Henry Ford Health System
United States
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Joseph, Christine L M; Lu, Mei; Stokes-Bruzzelli, Stephanie et al. (2016) Initiating an online asthma management program in urban emergency departments: the recruitment experience. Ann Allergy Asthma Immunol 116:43-8