Telemedicine Enhanced Asthma Management - Uniting Providers for Teens (TEAM-UP for Teens)
Telemedicine Enhanced Asthma Management - Uniting Providers for Teens (TEAM-UP for Teens)
Low-income, minority teenagers have disproportionately high rates of asthma morbidity,
 including excess risk of emergency department visits, hospitalizations, and death from
 asthma. Despite well established guidelines, under-treatment for asthma is common,
 particularly for poor urban teens. This study aims to test a novel, developmentally
 appropriate and scalable model of care to ensure optimal guideline-based treatment for urban
 teens with difficult to control asthma. The Telemedicine Enhanced Asthma Management-Uniting
 Providers for Teens (TEAM-UP for Teens) program includes 3 core components: 1- An
 individualized asthma management plan developed at the start of the school year via a
 real-time, synchronous school-based telemedicine visit that directly connects the teen to an
 asthma specialist, 2- School-based directly observed therapy (DOT) to implement the
 medication plan and allow for teens to experience the benefits of consistent therapy, 3-
 Follow-up telehealth visits with a nurse asthma educator to facilitate ongoing care and
 provide developmentally appropriate self-management support. This study is a randomized trial
 of TEAM-UP for Teens vs an enhanced care (EC) control group (n=360, 12-16 years). We will
 assess the effectiveness of the program in reducing morbidity and improving guideline-based
 asthma care. Our main hypothesis is that Teens receiving the TEAM-UP for Teens intervention
 will have more symptom-free days at 3, 6, 9, and 12-months compared to EC. We will assess a
 number of secondary outcomes, including additional clinical outcomes, functional outcomes,
 airway inflammation, and receipt of specific care measures including medication adjustments
 and treatment of and other comorbidities. We will also identify potential mediators and
 moderators of the intervention effect, and will evaluate the process of intervention
 implementation. At the completion of the study, the program will be better defined as a
 sustainable means to improve care and reduce morbidity for high risk teens with difficult to
 control asthma.
Inclusion Criteria:

 1. Physician-diagnosed asthma (based on caregiver report with validation from teen's
 physician).

 2. Moderate-severe persistent severity (requiring Step 3 or higher care) or asthma that
 is uncontrolled despite therapy

 3. Age >=12 and =<16 years

 4. Residence in the City of Rochester

 Exclusion Criteria:

 1. Inability to speak and understand either English or Spanish. (*Participants unable to
 read will be eligible, and all instruments will be given verbally.)

 2. Current participation in an asthma study

 3. Received specialist care in prior 3 months

 4. Planning to move outside of Rochester in less than 6 months

 5. Having other significant medical conditions (congenital heart disease, cystic
 fibrosis, other chronic lung disease) that could interfere with the assessment of
 asthma-related measures

 6. In foster care or other situations in which consent cannot be obtained from a guardian