Evaluating the effectiveness of remote telephone application
‘Asthma Action Hero’ intervention to reduce emergency revisits among
adolescents with asthma
Remote monitoring of patients through the ‘Asthma Action
Hero’ mobile phone application will help adolescent patients better control
their asthma, thereby reducing emergency visits and improving health outcomes
and in the long run, improving their quality of life.
The objective of this evaluation is to establish that indeed
the use of a mobile phone application ‘Asthma Action Hero’ by adolescent asthma
patients will result in a decrease in emergency visits post-discharge from
hospital. In this case, the independent variable is the use of a mobile phone
application, and the dependent variable will be frequency of emergency room
visits among adolescents with asthma that are enrolled to use ‘Asthma Action
Hero’. As such, several variables to consider for this study will include: 1)
data on patients who have downloaded the phone application and clinical follow
up; 2) engagement with the process- measured through data on actual use of the
mobile phone application after it has been downloaded; 3) types of
interventions delivered through the application (i.e. follow up calls by
physicians); 4) number of visits to the emergency room over the course of the
year (i.e. from January 2018 to December 2018).
The patients recruited would be children ages 12 to 17 years
admitted at Children’s Healthcare of Altanta (Scottish Rite) for poorly
controlled asthma (which can be determined by the use of an asthma control
questionnaire), and either the patient or the caregiver has a smart phone, and
have indicated willingness to participate in the study (signed consent).
Children with major social or clinical problems would be excluded (this would
be based on the physicians advise or for patients receiving specialist care).
Determination of eligibility would be done through a review of medical records
and if needed consultation with the physician.
After an initial screen is done to determine eligibility,
potential participants would be invited to participate in a baseline assessment
visit at which they can be provided further information about the study and
eligibility can be confirmed. During this visit, some baseline information
would also be determined from the patient through a simple assessment (e.g. asthma
history, current smoking status, presence of comorbidities, etc.).
Collection & Analysis
Outcome measures to be considered are as follows:
Preliminary data on patients who have downloaded
the phone application can be obtained through a clinical follow up;
Subsequent engagement with the process can be
measured through data on actual use of the mobile phone application after it
has been downloaded
Occurrence of adverse events (i.e. acute
deteriorations of asthma for which the patient sought advice from their
physician) can be obtained from hospital records including unscheduled
consultations, hospital admission due to asthma exacerbations, or
administration of oral steroids, and visits to the emergency room (i.e. from
January 2018 to December 2018).
A researcher would be assigned and blinded to the random allocation
of patients who are using the mobile phone application and patients who are
receiving clinical follow up through other means. The researcher will extract
data on adverse events from healthcare resources over the twelve-month study period
and enter them manually into an excel database. Asthma control questionnaire
data will be scanned and entered into an excel database. Clinical follow ups
for patients would be done every month to monitor use of the mobile
At baseline, the patients will be grouped according to sociodemographic
factors, history of asthma, and responses to the asthma control questionnaire. A
comparison will be drawn on frequency of occurrence of adverse events between
the groups of patients using ‘Asthma Action Hero’ and those not using the
mobile phone application. This outcome will also be compared between the
proportion of patients who whose asthma remained poorly controlled based on the
Asthma Control Questionnaire versus those whose asthma was “well controlled”.
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