Feasibility of an ED Initiated Online Asthma Management Program for Urban Teens
Feasibility of an ED Initiated Online Asthma Management Program for Urban Teens
The objective of this study is to determine the feasibility of conducting a randomized
 controlled trial to evaluate the effectiveness of an online, Emergency Department-initiated
 asthma management intervention designed to reduce asthma-related morbidity among urban
 teenagers aged 13-19 years with uncontrolled asthma. The study will examine issues around
 recruitment, participant compliance with the study protocol, Internet access, and attrition.
 Investigators will first develop a protocol for recruiting 13-19 year old patients with acute
 asthma into an ED-initiated pilot trial of an online asthma management program, describing
 recruitment and refusal rates. Investigators will measure participant compliance with the
 pilot study protocol including 4 online sessions and a 6 month survey. Investigators will
 also measure compliance of the participants parents at baseline and a six month follow up.
 Investigators will then use pilot study results to describe the intervention effect on
 selected outcomes including ED visits, asthma control as measured by Asthma Control
 Questionnaire, functional limitations, quality of life, and behavior change.
Participating emergency departments include Henry Ford Main, Henry Ford Fairlane, and Detroit
 Medical Center Children's hospital. Eligible teens will be 13-19 years of age. (Including 19
 year olds in the the proposed sample means the data is comparable to age categories used by
 many federal agencies). Eligibility criteria include: a physician diagnosis of acute asthma
 at the ED visit and parent and teen written informed consent/assent. Eligibility criteria can
 be confirmed with the help of the ED nursing staff as some teens presenting with symptoms of
 acute asthma, may receive an asthma diagnosis for the first time in the ED. Using the
 investigator's data from the school-based trial of Puff City, investigators observed that
 12.9% (20/155) of teens reporting an ED visit at baseline also reported no physician
 diagnosis. This is used as an approximation of the number of participants in the ED pilot
 that may be newly diagnosed. Teens previously enrolled in the school-based version of Puff
 City will not be eligible to participate in this pilot. Eligible teens are approached by a
 recruiter during down time in the ER (while waiting during receiving treatment or while
 waiting to be discharged). A study recruiter will provide the teen with an enrollment packet
 that includes an informational brochure (SD 1), a consent (SD 2), and an assent form (SD 3).
 The recruiter will go through these materials with the parents and teens and answer any
 questions they may have about the program. The recruited teens who enroll are randomized to
 either treatment or control. Both groups will be asked to complete an online baseline
 questionnaire before leaving the ED. An example of this questionnaire has been included with
 this application (SD 4). Once the baseline questionnaire is finished, teens will then be
 completing 4 online sessions of web-based asthma education on their own time on a computer
 with Internet access. Control group will receive commercial websites such as those sponsored
 by the American Lung Association; the American Academy of Allergy, Asthma and Immunology; the
 Asthma and Allergy Foundation, and others. Treatment group receives the 4 online, tailored
 educational sessions. Teens will be encouraged to complete the 4 sessions within 90 days,
 with a minimum of 7 days between sessions to allow for behavior change. To regulate dosage,
 control participants receive a "time expired" message after 30 minutes of browsing; this time
 limit is commensurate with the estimated time needed to complete a tailored session. Teens
 will also be asked to complete a 6-month follow-up survey (SD 5).Parents/Guardians of the
 enrolled teens will also be asked to complete a baseline questionnaire and a follow-up at 6
 months (SD 6-7) in the form of a telephone interview with a trained interviewer.

 In YR1 investigators will develop the recruitment protocol, hire and train recruiters, and
 establish a study database. Investigators will get on the agenda of CHM ED staff meetings to
 orient clinic staff to the intervention, obtain input/feedback, discuss logistics, address
 concerns, and answer questions about the project. Prior to recruitment Investigators will
 develop signage about the study (as appropriate) for the ED. Recruitment will start in month
 six of YR1, with at least two practice runs of the protocol. In YR2, investigators will
 continue recruitment and begin 6 month follow-up surveys. Recruitment will end in the fall of
 YR2 leaving 6-8 months for completion of follow-up, analysis and write-up. At the end of YR1
 and again at the end of YR2, investigators will conduct short, qualitative interviews with ED
 and research staff to ensure identification of issues, barriers, and obstacles to conducting
 a trial of an ED-initiated version of Puff City.
Inclusion Criteria:

 -  13-19 years of age

 -  Physician diagnosis of acute asthma at the Emergency Department visit

 -  Parent written informed consent

 -  Teen written informed assent

 Exclusion Criteria:

 -  Inability to provide informed consent/assent

 -  No physician diagnosis of asthma

 -  Other co-morbidities that make it impossible for individual to participate.