Childhood asthma is a common chronic medical condition associated with substantial symptoms, impairment in quality of life, impact on the family, and economic cost. TLC-Asthma (Telephone-Linked Communications for Asthma) is a computer-based telecommunications system designed by the investigators that monitors, educates and counsels asthmatic children and their parents through regular automated conversations and reports significant findings to the primary providers of care. The TLC technology underpinning TLC-Asthma has been successfully used to monitor, educate and counsel patients with hypertension and improve their blood pressure control and to affect positively patient behavior in medication-taking, diet and exercise. TLC-Asthma will converse with children and their parents in their homes weekly. By questioning them, it will monitor the child's asthma symptoms, quality of life, asthma knowledge and self-care behavior. In response to deficiencies in knowledge and self-care behaviors, TLC-Asthma will educate and counsel the child and parent regarding appropriate self-monitoring, medication use, environmental control and response to exacerbations. The system will store information reported by the users in a database and report the information regularly to the child, parent and the child's primary provider. TLC-Asthma uses computer-controlled speech generation to speak. The child and parents communicate by pressing keys on their touch-tone telephone. In this proposal, we will (1) implement TLC-Asthma conversations and reports, (2) pretest and modify the system, (3) finalize the evaluation methods, and, (4) conduct a randomized controlled clinical trial of 312 children with mild to moderate persistent asthma in a managed care organization in Massachusetts. Subjects will be recruited from five Harvard Pilgrim Health Plan health centers. Eligible subjects will be children ages 5-16 with mild-moderate persistent asthma. Each subject will be randomized to TLC-Asthma or to a minimal asthma intervention control group. Both study groups will receive asthma education on entry into the study and monthly thereafter. Subjects will be followed for one year with assessments at baseline, 4, 8 and 12 months. The goal of the study is to determine whether TLC-Asthma is effective. Clinical outcomes will be changes in the level of respiratory systems, quality of life, and lung function; the social outcome will be the impact of the child's asthma on the family. The health services endpoint will be the utilization of urgent care services, both emergency department use and unscheduled urgent office visits. Lastly, we will assess the attitudes of children, parents, and providers towards the system by using close- ended and open- ended interviews of users, analyzed by both qualitative and quantitative research methods.
