Asthma is the most prevalent chronic disease of childhood and a leading cause of pediatric acute care utilization (ACU) in the US. Hospitalization is a leading risk factor for later ACU: 40% of patients will be readmitted or go to the ED for asthma within 6 months of discharge. Guideline-based care, including education and daily controller therapy, can reduce ACU and prevent up to 80% of asthma readmissions. However, children from low income and racial/ethnic minority populations are the least likely to receive or use controller medication, and the most likely to be hospitalized and readmitted. Once hospitalized, systemic barriers to educational support during the hospital-to-home transition create missed opportunities to promote home management among high-risk children and their families. Improving adherence and clinical outcomes for hospitalized children requires education across settings that meaningfully engages patients and caregivers, ideally using materials designed for low literacy populations and enabling reliable visual identification of key medications. Facilitated access to follow-up support after discharge is also needed. The goal of this study is to evaluate the feasibility, acceptability, and preliminary efficacy of a technology-enhanced educational intervention for caregivers and children who are hospitalized due to asthma. We propose a pilot RCT with 60 children (5-11 yrs) hospitalized with asthma at the Golisano Children’s Hospital in Rochester, NY. After baseline assessment, subjects will be randomized to either: 1) the Telehealth Education for Asthma Connecting Hospital and Home (TEACHH) intervention, which includes inpatient child/caregiver education using pictorial materials, color/shape labels for home medications (green star=controller, yellow/red circles=rescue), and a pair of in-home, smartphone-based telehealth visits after discharge to reinforce effective home management; or, 2) the standard care (SC) condition, which features standard inpatient education and routine outpatient follow-up. Patients in TEACHH will also receive all SC measures. All caregivers will complete blinded telephone follow-up assessments at 2, 4, and 6 months after discharge; children will be asked medication questions at baseline and 6 months. We will describe the feasibility and acceptability of implementing the TEACHH intervention by reviewing process measure data collected throughout the study; assess the preliminary efficacy of TEACHH in improving key clinical outcomes, including asthma-related ACU at 7 days, 30 days, and 6 months (per electronic health record documentation) and symptom-free days at each follow-up (reported by caregivers); and assess secondary clinical and functional outcomes including asthma-related quality of life, missed school or work due to asthma, caregiver and child medication knowledge, and reported adherence. Findings from this work will establish a strong foundation for a full-scale trial, and guide future efforts to deliver guideline-based asthma care to underserved children and families at the greatest risk for preventable morbidity.

PROJECT NARRATIVE This project is expected to have a profound impact on public health because it proposes an innovative intervention, including active engagement of children and caregivers, patient-centered educational support with medication labeling, and in-home smartphone teleconferencing follow-up to address essential gaps in asthma care for children at the highest risk of poor outcomes. We aim to optimize self-management support for hospitalized children with asthma and their caregivers throughout the hospital-to-home transition period, with a goal of reducing morbidity and future use of costly acute healthcare services. Should this program prove successful in improving home asthma management following discharge, it has the potential to serve as a sustainable model for children with asthma in other care settings, as well as for children with other chronic diseases that require well-informed home management to improve health.