# Telemedicine Enhanced Asthma Management - Uniting Providers (TEAM-UP)

> **NIH NIH R01** · UNIVERSITY OF ROCHESTER · 2020 · $708,289

## Abstract

In the US, children from minority ethnic and racial backgrounds suffer disproportionately from asthma. Despite
well established guidelines, under-treatment for asthma is common, especially for poor and minority
populations. Our prior work has demonstrated that school-based directly observed therapy (DOT) of preventive
asthma medications can improve outcomes for poor, urban children with persistent asthma. We have also
found that school-based telemedicine can effectively facilitate assessments by primary care providers (PCPs)
for preventive medication prescriptions for DOT and for follow-up care. However, to our concern we have
found that children do not benefit equally from our programs. Specifically, among the subgroup of children with
moderate to severe persistent or difficult to control asthma at baseline, the majority did not achieve control
despite these school-based interventions. In fact, despite telemedicine follow-up assessments with PCP
prompting for guideline-based step-ups in treatments, many of these children remained under-treated. We
realize that our existing programs may be insufficient for these children, since they do not include specialist
consultation for optimization of medication management or for identification and treatment of co-morbid
conditions and triggers. Importantly, specialist care is substantially underutilized by poor and minority children
who bear the greatest morbidity burden from asthma, leading to inconsistent delivery of guideline-based
treatments and continued disparities. In response to PAR-15-279, we propose an innovative school-based
program for urban children with moderate to severe persistent or difficult to control asthma. The Telemedicine
Enhanced Asthma Management-Uniting Providers (TEAM-UP) program enhances our school-based,
primary care directed asthma program with specialist-supported care to ensure optimal guideline-based
treatment. We propose a randomized trial of TEAM-UP versus an enhanced care comparison group. We will
prompt PCPs of all enrolled children (n=360, 4-12 years) to initiate school-based DOT of preventive asthma
medication and will recommend referral to an asthma specialist. For children in TEAM-UP, the specialist visits
will be facilitated via telemedicine at school. The initial telemedicine specialist visit will be scheduled after 4
weeks of DOT, in order to allow for accurate guideline-based assessments of medication and care needs once
adherence with a daily controller medication is established. There will also be 2 telemedicine follow-up
specialist visits to assess the child's response to treatment and make needed adjustments. We will capitalize
on the existing community infrastructure by implementing both telemedicine and DOT in schools, and
maintaining collaboration with the PCP. We will assess the clinical and cost-effectiveness of TEAM-UP in
reducing morbidity and improving guideline-based care (primary outcome: symptom-free days at 3, 6, 9, and
12 months) versus enhanced...

## Key facts

- **NIH application ID:** 10003390
- **Project number:** 5R01HL142691-03
- **Recipient organization:** UNIVERSITY OF ROCHESTER
- **Principal Investigator:** Jill S Halterman
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $708,289
- **Award type:** 5
- **Project period:** 2018-07-15 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10003390

## Citation

> US National Institutes of Health, RePORTER application 10003390, Telemedicine Enhanced Asthma Management - Uniting Providers (TEAM-UP) (5R01HL142691-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10003390. Licensed CC0.

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