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

To study the efficacy of a telemedicine-based program in reducing asthma morbidity in children who present to the emergency department (ED) for an asthma exacerbation by increasing access to primary care follow-up.This study included 373 children ages 3–12 years old with a physician diagnosis of persistent or poorly-controlled asthma. Patients were screened from 2 emergency departments in Rochester, New York between 2016 and 2021. Of patients, 60% were male, 54% identified as African American or Black, 32% were Hispanic, and the mean age was 6.4 years. Other demographic characteristics were similar between the 2 groups.Screening and enrollment was done before ED discharge. Eligible patients were randomized to either the Telemedicine Enhanced Asthma Management through the Emergency Department (TEAM-ED) or enhanced usual care (eUC) groups. Caregivers were provided with an asthma symptom diary. Guideline-based care recommendations were sent to primary care physician in both groups following ED discharge and at scheduled intervals throughout the study. Telemedicine follow ups for the TEAM-ED group were conducted at 1 week, 4 to 6 weeks, and 8 to 12 weeks following discharge from the ED either at either the child’s school or home. The children in the eUC group followed up with their PCP at the same time intervals. The primary endpoint was the mean number of symptom-free days (SFDs) over 2 weeks collected via telephone surveys at 3, 6, and 9 months and through a home follow-up visit at 12 months.Symptoms for both TEAM-ED and eUC groups improved over time. There was no significant difference in SFDs between groups. There were greater statistically significant SFDs for children in the TEAM-ED group when followed further out from intervention, as well as when looking at pre-pandemic data. Among patients without smoke exposure in the home, acute care visits were lower in the TEAM-ED group. The TEAM-ED group’s caregivers reported more follow up visits and preventive care actions than the eUC group. There was wide satisfaction with the program by both providers and caregivers.Children in both the TEAM-ED and eUC groups had similar rates of reported symptom-free days, but there were improvements over time in SFDs in children in the TEAM-ED group. Overall, there was no difference between groups.Many patients presenting to the ED for asthma exacerbations do not seek follow-up with their PCP after discharge. Previous studies have shown that various interventions to increase follow-up and compliance do not decrease ED visits. Similar to other studies, however, this study demonstrated reduced acute care visits in patients not exposed to smoke in the home. Caregiver satisfaction and symptom improvement were demonstrated in both groups, emphasizing the importance of a close caregiver-provider relationship. Increasing access to care via telemedicine increases opportunities to discuss important interventions such as smoking cessation at more regular intervals. Additional studies are needed to identify the most effective interventions to decrease asthma morbidity.