Internet-based home monitoring and education of children with asthma is comparable to ideal office-based care: results of a 1-year asthma in-home monitoring trial.

OBJECTIVE: The goal was to determine whether home asthma telemonitoring with store-and-forward technology improved outcomes, compared with in-person, office-based visits. METHODS: A total of 120 patients, 6 to 17 years of age, with persistent asthma were assigned randomly to the office-based or virtual group. The 2 groups followed the same ambulatory clinical pathway for 12 months. Office-based group patients received traditional in-person education and case management. Virtual group patients received computers, Internet connections, and in-home, Internet-based case management and received education through the study Web site. Disease control outcome measures included quality of life, utilization of services, and symptom control. RESULTS: A total of 120 volunteers (45 female) were enrolled. The groups were clinically comparable (office-based: 22 female/38 male; mean age: 9.0 +/- 3.0 years; virtual: 23 female/37 male; mean age: 10.2 +/- 3.1 years). Virtual patients had higher metered-dose inhaler with valved holding chamber technique scores than did the office-based group at 52 weeks (94% vs 89%), had greater adherence to daily asthma symptom diary submission (35.4% vs 20.8%), had less participant time (636 vs 713 patient-months), and were older. Caregivers in both groups perceived an increase in quality of life and an increase in asthma knowledge scores from baseline. There were no other differences in therapeutic or disease control outcome measures. CONCLUSIONS: Virtual group patients achieved excellent asthma therapeutic and disease control outcomes. Compared with those who received standardized office-based care, they were more adherent to diary submission and had better inhaler scores at 52 weeks. Store-and-forward telemedicine technology and case management provide additional tools to assist in the management of children with persistent asthma.

Effectiveness of an Internet-based store-and-forward telemedicine system for pediatric subspecialty consultation.

BACKGROUND: Pediatric subspecialists are often separated from the children who need them by distance, time, or socioeconomic factors. The Electronic Children's Hospital of the Pacific is an Internet-based store-and-forward pediatric consultation system established to overcome these barriers. OBJECTIVE: To characterize the use of the Electronic Children's Hospital of the Pacific and its impact on access to specialty care, the quality of the care provided, and cost savings. DESIGN: Prospective trial. SETTING: Twenty-two military treatment facilities in the Pacific. PARTICIPANTS: Primary care providers, pediatric consultants, and 5 reviewers. MAIN OUTCOME MEASURES: Consult response time, physician panel review, and evacuation cost avoidance. RESULTS: There were 267 cases from 16 sites. The mean +/- SD response time by a consultant was 32 +/- 8 hours. The panel review deemed that the initial diagnosis was changed or modified in 15% (39/267) of the cases, the diagnostic plan was changed or modified in 21% (57/267), and the treatment plan was changed or modified in 24% (64/267) (P < .01 for all). Routine air evacuations to a tertiary care medical center were avoided in 32 cases (12%), with an estimated cost savings of $185 408. CONCLUSIONS: The Electronic Children's Hospital of the Pacific improved the quality of patient care by providing expeditious specialty consultation. Significant cost avoidance in this military pediatric population was documented. Store-and-forward Internet-based teleconsultation is an effective means of providing pediatric subspecialty consultation to a population of underserved children.

Caring for children with asthma through teleconsultation: "ECHO-Pac, The Electronic Children's Hospital of the Pacific".

A Web-based store-and-forward teleconsultation asthma management system was implemented to provide subspecialty asthma care to military children with asthma living in the Western Pacific. Seven children with moderate to severe asthma (mean age 11.9 +/- 3.7 years) were followed for 1 year by their primary care provider (PCM) using a Web-based asthma pathway, with regular pediatric pulmonary teleconsults to Tripler Army Medical Center. Therapeutic monitoring included MPEG video recording of patient using metered-dose inhaler (MDI) technique submitted to the pulmonologist at specified intervals. Utilization of services for unscheduled asthma-related visits was monitored. PCMs were surveyed regarding their asthma practice before and after the intervention. Data were analyzed using Student's t test for continuous variables and Wilcoxon signed-rank or chi-square for noncontinuous variables. Therapeutic adherence was evidenced by improved inhaler technique in all patients. There were fewer ED visits for asthma (3.85 +/- 5.14, range 0-15 vs. 0 visits, p < 0.05) and fewer unscheduled acute clinic visits (1.57 +/- 1.27, range 0-4 vs. 0.286 +/- 0.48, p < 0.05) in the study year versus the preceding year. There were two hospitalizations in the year prior to the study; however, no patients were hospitalized during the study PCM use of an asthma action plan increased from 24% to 73% (p < 0.01) and provision of asthma education increased from 18% to 73%, (p < 0.01). However, PCMs reported that they were not more likely to watch their patient's MDI technique themselves (29% vs. 45%) nor order or interpret spirometry on their patients (12 vs. 18%). In this project, children with asthma followed by teleconsultation had improved outcomes. Store-and-forward teleconsultation can be used to follow children with chronic disease such as asthma over time.

An Internet-based store-and-forward video home telehealth system for improving asthma outcomes in children.

The adherence and disease-control outcomes associated with the use of an Internet-based store-and-forward video home telehealth system to manage asthma in children were studied. Pediatric patients with persistent asthma were provided with home computers and Internet access and monitored biweekly over the Internet. All patients were seen in the pediatric clinic at 0, 2, 6, 12, and 24 weeks. Half of the patients received asthma education in person and half via an interactive Web site. Adherence measures were assessed by therapeutic and diagnostic monitoring. Therapeutic monitoring included digital videos of patients using their controller medication inhaler. Diagnostic monitoring included an asthma symptom diary and a video of peak flow meter use. Videos were submitted electronically twice a week by using in-home telemonitoring with store-and-forward technology. Feedback was provided electronically to each patient. Disease control was assessed by examining quality of life, utilization of services, rescue-therapy use, symptom control, satisfaction with home telemonitoring, and retention of asthma knowledge. Patients were randomly assigned to an asthma education group (Internet versus office), and the data were analyzed by comparing results for study days 0-90 and 91-180. Ten children participated. A total of 321 videos of inhaler use and 309 videos of peak flow meter use were submitted. Inhaler technique scores improved significantly in the second study period. Submission of diagnostic monitoring videos and asthma diary entries decreased significantly. Peak flow values as a percentage of personal best values increased significantly. Overall, there was no change in quality of life reported by patients. However, the caregivers in the virtual-education group reported an increase in the patients' quality-of-life survey scores. Emergency department visits and hospital admissions for asthma were avoided. Rescue therapy was infrequent. A high rate of satisfaction with home telemonitoring was reported. Internet-based, store-and-forward video assessment of children's use of asthma medications and monitoring tools in their homes appeared effective and well accepted.

Report of the first annual Hawaii Asthma Research Consortium.

The first Hawaii Asthma Research Consortium was held on 7 May 2001 at Tripler Army Medical Center. Researchers investigating asthma-related problems and program directors of asthma projects were solicited statewide to present their projects. Ten lecturers focused on research and asthma projects in Hawaii in 20-minute presentations. An informal ten-minute discussion followed each presentation to encourage audience questions about the project and to discuss possible collaboration efforts between institutions. The institutions that were represented include: American Lung Association-Hawaii, Kaiser Permanente Center for Health Research Hawaii, Kapiolani Medical Center, Tripler Army Medical Center, University of Hawaii at Manoa, and Waianae Coast Comprehensive Health Center.