Table 1.

Care Transition Intervention Studies in the Emergency Department for Pediatric Asthma

Lead Author	Population	Intervention	Comparison	Outcomes	Time	Setting
Baren 2006 25	N=384. Ages 2–54 years old, current asthma exacerbation in the ED, plan to discharge, receiving prednisone, English only.	Group B) Free prednisone, transportation vouchers for PCP, and reminder call. Group C) Same as Group B but with follow-up appointment scheduled.	Three arm RCT. Comparison (Group A) was usual discharge care.	Follow up with PCP. Results: Group C more likely to have a follow-up PCP visit (OR, 2.8; 95% CI, 1.5 to 5.1).	30 days. Secondary outcomes at 1 year.	9 EDs chosen for geographic and patient diversity.
Ducharme 2011 31	N=219. Ages 1–17 years old, clinical diagnosis of asthma, treated with albuterol in ED, discharged with albuterol and fluticasone, French or English only.	Treating ED physician recorded asthma management instructions using a structured paper template.	Two arm RCT. Comparison was usual discharge care. All participants received albuterol and fluticasone inhalers.	Fluticasone adherence. Results: Improved adherence to fluticasone in intervention group. No change in PCP follow up at 28 days. Slight improvement in PCP follow up at 90 days for intervention group. [RR1.37 (1.01, 1.85)]	28 days. Secondary outcomes at 90 days.	Montreal, Canada
Farber 2004 36	N=56. Ages 2–18 years old, history of asthma, receiving ED care for acute asthma, Medicaid insurance.	Education consisted of inhaler device instruction and action plans in the ED, followed by 3 phone calls to reinforce asthma management skills.	Two arm RCT. Comparison was brief education routinely used in ED.	Asthma severity and hospital/ED visits. Results: No changes.	1 month and 6 months.	New Orleans, LA
Gorelick 2006 26	N=352. Ages 2–18 years old, acute asthma, English only.	Group 2: Group 1 plus ED records faxed to PCP, PCP office called, patient called to remind about appointment, appointment scheduled for patient if needed. Group 3: Same as Group 2 with addition of care manager that made up to 6 home visits for education and social service referrals.	Three arm RCT. Usual care (Group 1) included asthma videotape, instruction on peak flow meter and inhaler use, proper medications use, instructions for follow-up with PCP, written asthma care plan.	ED utilization, health-related quality of life, and controller medication use. Results: No differences between groups.	6 months.	Milwaukee, WI
Scarfi 2009 30	N=77. Ages 2–12 years old, physician diagnosed asthma or at least 2 prior treated wheezing episodes.	Skin testing during ED visit for food and aeroallergens, parents given results and a written report.	Two arm controlled trial. Group determined by day in ED. Comparison was usual care.	Asthma clinic follow up rates. Results: Intervention group 2.6 (1.02–6.65) more likely to keep appointment.	1 week.	Urban public hospital
Smith 2006 29	N=92. Ages 2–12 years old, Medicaid or no insurance, presenting to ED with asthma exacerbation.	Asthma coach for follow up, monetary incentive. Discharge instructions using “Asthma 1-2-3 Plan”.	Two arm RCT. Comparison group received “Asthma 1-2-3 Plan”.	Asthma planning visit with PCP in 2 weeks. Results: No differences between groups.	2001	St. Louis, MO
Sockrider 2006 37	N=464 Age of 1 to 18 years, previous physician diagnosis of asthma, English or Spanish, presentation to a participating ED with asthma symptoms.	Tailored computer-based program on asthma self-management delivered by educator in ED, with follow-up telephone call	RCT. Comparison was usual care.	ED utilization. Results: Caregivers in intervention group reported more well-asthma visits [OR 1.85, (1.05,3.39)]. No difference in ED visits.	9 months.	4 sites in Texas
Zorc 2003 24	N=278. Ages 2–18 years old, history of asthma, symptoms requiring ED treatment, plan to discharge.	Study staff attempted to schedule follow up PCP appointment with caregiver in ED or after discharge.	Two arm RCT. Comparison was usual care which included faxing ED records to PCP.	PCP follow up. Results: Improved PCP follow up in intervention group [1.4 (1.1,1.7)].	4 weeks.	Philadelphia, PA
Zorc 2009 27	N=439. Age 1–18 years old, presented to ED with asthma exacerbation.	Intervention group watched educational video in ED and subgroup who screened positive for persistent asthma received a letter regarding the results to give to their PCP. All mailed reminder to schedule a follow up with PCP.	RCT. Comparison was usual care.	Follow-up rates with a PCP after an ED visit. Results: No differences between groups.	4 weeks.	Philadelphia, PA