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Improving follow-up for children with asthma after an acute Emergency Department visit
Sharon R Smith1, David M Jaffe, Edwin B Fisher
1Washington University School of Medicine, St Louis Children's Hospital, Department of Pediatrics, Division of Emergency Medicine, St. Louis, Missouri, USA. srsmith@ccmckids.org
Insights
Telephone coaching and monetary incentives improved primary care follow-up for urban children with asthma after emergency visits. This intervention reduced asthma symptoms but did not affect long-term care or emergency room visits.
Area of Science:
- Pediatric Asthma Management
- Public Health Interventions
- Healthcare Access
Background:
- Acute asthma exacerbations frequently lead to Emergency Department (ED) visits, particularly among children from low-income urban families.
- Effective follow-up with primary care providers (PCPs) is crucial for managing pediatric asthma and preventing recurrent ED visits.
- Gaps in care coordination often exist for vulnerable populations, necessitating targeted interventions.
Purpose of the Study:
- To assess the effectiveness of a combined telephone asthma coaching and monetary incentive program.
- To improve timely follow-up care with PCPs for children after ED visits for asthma.
- To evaluate the impact on asthma symptom burden and subsequent healthcare utilization.
Main Methods:
- A prospective, randomized controlled trial was conducted with 527 parents of children treated for asthma in the ED.
- Participants were from low-income urban families, with children covered by Medicaid or uninsured.
- The intervention group received telephone asthma coaching and a monetary incentive, compared to a control group.
Main Results:
- The intervention group showed a significantly higher proportion of children with asthma-planning visits within 15 days of the ED visit (35.7% vs. 18.9%, P < .0001).
- A decrease in asthma symptom nights/days was observed at 2 weeks in the intervention group.
- No significant differences were found between groups in subsequent asthma-planning visits or acute care visits from 16 days to 6 months post-intervention.
Conclusions:
- Combined telephone coaching and monetary incentives effectively increase short-term primary care follow-up for urban children with asthma post-ED visit.
- The intervention successfully reduced immediate asthma symptom burden.
- The intervention did not demonstrate sustained improvements in long-term asthma care adherence or reductions in ED visits or hospitalizations.
Objective:
To improve follow-up with primary care providers after acute Emergency Department (ED) asthma visits for children from low-income urban families.
Study Design:
A prospective, randomized, controlled trial evaluated combined telephone asthma coaching and monetary incentive. The primary outcome was asthma-planning visits with primary care providers within 15 days of index ED visits. The subjects were urban parents whose children were treated for asthma in the ED and had Medicaid or no insurance.
Results:
We enrolled 527 parents (264 control and 263 intervention). There was a significant difference ( P < .0001) between the intervention (35.7%) and control (18.9%) groups in the proportion of children who had asthma-planning visits and decreased mean nights/days with asthma symptoms by 4.36 intervention and 3.31 control at 2 weeks. The proportions of children with asthma-planning visits and acute asthma care visits during the 16-day to 6-month period were similar for both groups.
Conclusions:
Telephone coaching and a monetary incentive significantly increased the proportion of low-income urban parents who brought their children for asthma-planning visits, and decreased asthma symptoms shortly after asthma ED visits. The intervention did not increase subsequent asthma-planning visits or decrease ED visits or hospitalizations.
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