This is a prospective, randomized controlled trial designed to test and compare the effectiveness of emergency department (ED)-based, time- limited interventions to increase follow-up to primary care provider (PCP) after an emergency visit for asthma. A cohort of parents of low income, urban children with asthma, 2-12 years of age, will be recruited at the time of a visit at the St. Louis Children's Hospital (SLCH) ED for asthma exacerbation. All subjects will receive usual care (UC), consisting of asthma education and advice concerning follow-up with PCP (Asthma 1-2-3 Plan). The intervention will be the combination of case management, 2 telephone contacts to the parents at 48 hr and 5 days after the enrolling ED visit to facilitate follow-up asthma care visit, and a monetary incentive, $15 given to the parent for completion of a follow-up visit within 2 weeks of the ED visit (CM+MI). After informed consent, subjects will be randomly assigned to either UC or CM+MI, stratified by physician practice. A child will be entered into the study only once. The primary outcome will the time interval to return to PCP specifically for routine care of asthma (includes planning for exacerbations) after an emergency visit for acute asthma. We have chosen categories of time, 1-7d, 8-14d, 15-28d, 29d-6m, greater than 6m (no visit in the time of study). Secondary outcomes will be a) the proportion of children who obtain subsequent regular care for asthma from PCP for the 6 months of study, b) number doctor visits and hospitalizations for acute asthma for the 6 months of study, c) quality of life of parents at the end of the 6 months of study, d) asthma severity through symptoms and medication use at the end of the 6 months of study, e) psychometric properties of the Pros and Cons/Barriers associated with regular care and which Cons/Barriers are overcome by CM+MI, and f) the net cost of asthma-related care. Primary outcome will be determined by chart audit, as will the number of subsequent regular care visits and visits for acute asthma and hospitalizations. Data for determination of parent quality of life, asthma severity, and Pros and cons/Barriers will be obtained during phone interviews. Duration of the project is 4 years, with planned enrollment of 520 subjects (260 per group) to provide 90 percent power at the 5 percent significance level to detect a doubling of the proportion of patients returning for a follow-up visit within 14 days. The intent to treat model will be used, as primary outcome can be obtained after consent even if not contact cannot be made at 2 week and 6 month phone calls.
| Fisher, Edwin B; Strunk, Robert C; Highstein, Gabrielle R et al. (2009) A randomized controlled evaluation of the effect of community health workers on hospitalization for asthma: the asthma coach. Arch Pediatr Adolesc Med 163:225-32 |
