# Recordable Cards for Optimizing Outcomes and Reducing Disparities after ED Discharge: The RECORD-ED Pilot Study

> **NIH NIH R21** · SEATTLE CHILDREN'S HOSPITAL · 2021 · $193,401

## Abstract

Project Summary
 Families with low income and/or limited English proficiency (LEP) experience multiple communication- and
comprehension-related barriers to receiving high quality, safe, and effective medical care when their children
are ill. Limited education and low literacy also contribute, leading to difficulties understanding and implementing
discharge instructions. Few system-based interventions exist to improve discharge instruction comprehension
and most that exist rely on some combination of reading ability, health literacy, and English language skills,
limiting their ability to reach the families most at risk for poor understanding and adverse outcomes.
 Paper-based, audio-recordable greeting cards offer a low-tech, inexpensive, and readily available
approach to addressing comprehension-based disparities. Cards can be shared with multiple caregivers,
including those not present at discharge, and can remain with the ill child for quick reference. The overall goal
of this study is to determine the feasibility, acceptability, and potential effect of the RECORD-ED intervention,
which consists of usual care augmented by a card with audio-recorded instructions in the parent's preferred
language for care (English or Spanish). The recorded instructions were developed collaboratively with parents
and clinical personnel, to ensure the information is useful and culturally and linguistically tailored. The goal is to
improve parent comprehension, recall, and implementation of discharge instructions, as families transition from
care in the emergency department (ED) to managing the child's medical care at home. The specific aims of the
study are to: 1) test the feasibility, acceptability, and potential effectiveness of the RECORD-ED intervention for
improving parent, child, and utilization outcomes among low-income children with asthma and their parents,
with and without LEP; and 2) characterize parent and provider experience with the RECORD-ED intervention,
to inform future implementation. To accomplish these aims, the investigators propose a pilot randomized
controlled trial, enrolling 100 families of children with asthma being discharged home from Seattle Children's
Hospital ED. Families will be contacted to complete telephone or email surveys two days, one week, and three
months after ED discharge. Intervention feasibility and acceptability will be primary outcomes, as
recommended for pilot studies. Potential effectiveness will be determined by assessing for clinically important
differences in instruction recall, medication adherence, comfort with home care, quality of life, primary care
follow-up, asthma control, and 3-month re-utilization between assigned study arms, in an intention-to-treat
analysis. Providers and nurses will be surveyed regarding intervention acceptability and perceived effect.
Parents and nurses will be interviewed to understand experiences using the card-based instructions. Study
results will inform a multi-site R01 proposal ...

## Key facts

- **NIH application ID:** 10236524
- **Project number:** 5R21NR018914-02
- **Recipient organization:** SEATTLE CHILDREN'S HOSPITAL
- **Principal Investigator:** Katherine Casey Lion
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $193,401
- **Award type:** 5
- **Project period:** 2020-08-11 → 2023-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10236524

## Citation

> US National Institutes of Health, RePORTER application 10236524, Recordable Cards for Optimizing Outcomes and Reducing Disparities after ED Discharge: The RECORD-ED Pilot Study (5R21NR018914-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10236524. Licensed CC0.

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