Telehealth Education for Asthma Connecting Hospital and Home (TEACHH)

Uncontrolled asthma continues to be a leading cause of pediatric hospitalization in the United States, especially among children from low-income and racial/ethnic minority populations. A history of prior hospitalization is a key risk factor for subsequent asthma-related hospitalization and emergency care. Guideline-recommended daily controller therapy can reduce the likelihood of severe exacerbations in children with persistent asthma, but nonadherence to this therapy is common. Effective support for home asthma management can increase adherence, promote a successful transition from hospital to home, and reduce future morbidity.

For children who are hospitalized due to asthma, barriers to patient education in both inpatient and outpatient settings result in missed opportunities to address suboptimal asthma treatment in the home. Improvement of adherence and outcomes for these children requires education and self-management support to bolster home-based care. This support will engage patients and caregivers using an appropriate, low-literacy framework, and can be readily implemented in inpatient and home settings. To address these barriers, the researchers will conduct a pilot study of a novel intervention that includes patient-centered asthma education in the hospital and virtual followup visits to support ongoing home-based care.

The specific aims of the research are as follows:

• Determine the feasibility and acceptability of implementing Telehealth Education for Asthma Connecting Hospital and Home (TEACHH) for children with asthma throughout the hospital-to-home transition. 
• Estimate the preliminary efficacy of TEACHH on patient-important outcomes, and provide parameter estimates for a subsequent fullscale trial. 

In a previous study, the researchers demonstrated the feasibility of implementing a health literacy-informed asthma education toolkit for children and caregivers in an ambulatory care setting. For this current research, they will extend the use of this toolkit to inpatient and home telehealth settings, and provide patient-centered support guided by the Model of Medication Self-Management framework.

They will conduct a randomized controlled trial, enrolling 60 children aged 5–11 years over a 9-month period to the TEACHH intervention or a standard care (SC) comparison group. The TEACHH group will receive health literacy-informed asthma education, including color and shape labels for home medications to improve controller identification, in the hospital and at home. This group will also receive two home-based virtual visits to reinforce teaching and self-management support using smartphone-accessible teleconferencing software. Both the intervention and SC groups will watch inpatient teaching videos and have routine followup after discharge. TEACHH is designed to provide an effective educational platform appropriate for all health literacy levels, with initial instruction in the hospital and reinforcement at home, using virtual visits, to circumvent common barriers to self-management support in clinical settings.

By incorporating evidence-based educational strategies with telemedicine-enhanced communication, TEACHH will deliver high-quality self-management support across care settings for underserved children at greatest risk of preventable asthma morbidity. If successful, this model of educational support could be applied broadly to reach children with asthma in various other care settings. It also could be applied to other chronic childhood diseases, such as diabetes and sickle cell anemia, that require well-informed home management to decrease preventable morbidity and improve health.