189 - Telehealth Education for Asthma Connecting Hospital and Home (TEACHH): A Pilot Randomized Trial

Poster Number: 189
Publication Number: 189.550

Background: Children hospitalized for asthma are at heightened risk of future asthma-related acute care visits. Barriers to asthma education are prevalent across care settings. New approaches are needed to ensure educational support for both child and caregiver throughout the hospital-to-home transition.

Objective: To determine the feasibility of implementing an intervention of health literacy-informed, telemedicine-enhanced asthma education and support for hospitalized children and caregivers; and assess caregiver perspectives on the intervention.

Design/Methods: We conducted a pilot randomized trial of the TEACHH intervention, enrolling a convenience sample of children (5-13 yrs) hospitalized with persistent asthma and randomizing them to TEACHH or Standard Care (SC). Children and caregivers in TEACHH received health literacy-informed teaching prior to discharge, including pictorial materials (e.g. scripted flipchart, pictorial action plan), color-coded medication labels, and medication demonstration. Two Zoom follow-up sessions were completed within 1-mo of discharge, using a digital version of the toolkit, formatted for viewing on a smartphone. We assessed feasibility by tracking visit completion, and measured preliminary outcomes using medical record data (acute healthcare use) and blinded surveys of caregivers 2-, 4-, and 6-mos after discharge (i.e., symptoms, quality of life). We interviewed caregivers about TEACHH after the intervention; SC caregivers were interviewed after 6-mo follow-up, at which time the toolkit was reviewed. Interviews were coded inductively.

Results: We enrolled a convenience sample of 26 children (participant characteristics, Table 1) and completed qualitative interviews with 14 caregivers (9 TEACHH, 5 SC). All inpatient sessions were completed, as were 77% of virtual visits (visit 1: 85%; visit 2: 69%). In this pilot sample, both groups experienced improved symptoms and quality of life over time (Table 2), with four ED/hospital visits for asthma in TEACHH and two in SC. Caregivers praised the approach to teaching, especially the inclusion of child engagement, visual tools, and color-coded information (Table 3). They described child-specific benefits and building routine after discharge; perceived benefits to asthma-related communication; and suggested that other families would benefit from similar teaching at the time of initial diagnosis.

Conclusion(s): A novel program of patient-centered asthma education was feasible in both hospital and home settings and well received by caregivers. A larger study is needed to assess the impact of TEACHH on morbidity outcomes in childhood asthma.