Improving follow-up for children with asthma after an acute Emergency Department visit.
OBJECTIVE
To improve follow-up with primary care providers after acute Emergency Department (ED) asthma visits for children from low-income urban families.


METHODS
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.
Smith
Sharon R
SR
Washington University School of Medicine, St Louis Children's Hospital, Department of Pediatrics, Division of Emergency Medicine, St. Louis, Missouri, USA. srsmith@ccmckids.org
Jaffe
David M
DM
Fisher
Edwin B
EB
Trinkaus
Kathryn M
KM
Highstein
Gabrielle
G
Strunk
Robert C
RC
D001249:Asthma / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D017057:Medically Uninsured; D010290:Parents; D010351:Patient Discharge; D011203:Poverty; D011320:Primary Health Care / Q000379:methods*; D014505:Urban Population