Use of Text Messages to Improve Care For Children Following an ED Visit for Asthma

Use of Text Messages to Improve Care For Children Following an ED Visit for Asthma

BACKGROUND Asthma is a prevalent and troublesome pediatric condition. In 2013, Emergency Department (ED) providers treated over 3,500 cases of asthma-related complaints at Children's Hospitals and Clinics of Minnesota. Pediatric ED visits for asthma exceeds billions of dollars annually when including direct cost and lost productivity. Many of these visits and resultant costs are avoidable. Patients with well-controlled asthma do not typically exhibit these patterns, while patients with poorly controlled asthma show patterns of increased utilization of healthcare resources and lower quality of life. Evidence suggests that a text message reminder and educational program might positively influence pediatric asthma care practices.

RESEARCH QUESTION Does a targeted ED based text message intervention program improve outpatient follow-up and routine preventive care in pediatric asthma patients?

METHODS Study subjects will be block randomized based on age and insurance group. The experimental group will receive text messages with guidance towards follow-up care with their PCP and the importance of the flu vaccine for children with asthma. The control group will receive a series of educational self-care and health based text messages unrelated to asthma or the flu vaccine. Some self-report of behaviors will be captured via text message response.

ANALYSIS Primary outcomes for the educational versus targeted text message groups will be compared use Chi-square tests. Additional adjustments may be applied for missing data or if, despite randomization, there is substantial imbalance between group in key covariates (eg race/ethnicity, insurance type or asthma severity.)

Inclusion Criteria:

• Caregivers of patients aged 4 - 17 years (inclusive) will be eligible for study participation if they meet the following criteria:

  1. Presentation to the ED with a chief complaint related to an asthma exacerbation such as shortness of breath, respiratory distress, wheezing, etc…
  2. Receive an albuterol treatment in the ED
  3. Previous history of asthma as represented in the medical record or by parental report
  4. Have a cell phone that is able to receive text messages
  5. Able to communicate and provide consent in English or Spanish

Exclusion Criteria:

• Caregivers of patients will be excluded from this study for the following reasons:

  1. First episode of wheezing

  2. Admitted to the hospital

  3. Co-morbid respiratory disease:

     1. Cystic fibrosis
     2. Bronchiectasis
     3. Pulmonary hypertension
     4. Other chronic lung disease

  4. Current cancer diagnosis

  5. Previous cardiovascular surgery

  6. Inflammatory bowel disease

  7. Sickle Cell disease