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Harper LJ, Kidambi P, Kirincich JM, Thornton JD, Khatri SB, Culver DA. Health Disparities: Interventions for Pulmonary Disease - A Narrative Review. Chest 2023; 164:179-189. [PMID: 36858172 PMCID: PMC10329267 DOI: 10.1016/j.chest.2023.02.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/17/2023] [Accepted: 02/18/2023] [Indexed: 03/02/2023] Open
Abstract
There is expansive literature documenting the presence of health disparities, but there are disproportionately few studies describing interventions to reduce disparity. In this narrative review, we categorize interventions to reduce health disparity in pulmonary disease within the US health care system to support future initiatives to reduce disparity. We identified 211 articles describing interventions to reduce disparity in pulmonary disease related to race, income, or sex. We grouped the studies into the following four categories: biologic, educational, behavioral, and structural. We identified the following five main themes: (1) there were few interventional trials compared with the breadth of studies describing health disparities, and trials involving patients with asthma who were Black, low income, and living in an urban setting were overrepresented; (2) race or socioeconomic status was not an effective marker of individual pharmacologic treatment response; (3) telehealth enabled scaling of care, but more work is needed to understand how to leverage telehealth to improve outcomes in marginalized communities; (4) future interventions must explicitly target societal drivers of disparity, rather than focusing on individual behavior alone; and (5) individual interventions will only be maximally effective when specifically tailored to local needs. Much work has been done to catalog health disparities in pulmonary disease. Notable gaps in the identified literature include few interventional trials, the need for research in diseases outside of asthma, the need for high quality effectiveness trials, and an understanding of how to implement proven interventions balancing fidelity to the original protocol and the need to adapt to local barriers to care.
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Affiliation(s)
- Logan J Harper
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
| | - Pranav Kidambi
- Michigan State University College of Human Medicine, Grand Rapids, MI; Division of Pulmonary and Critical Care Medicine, Corewell Health Medical Group, Grand Rapids, MI
| | - Jason M Kirincich
- Department of Internal Medicine, Community Care Institute, Cleveland Clinic, Cleveland, OH
| | - J Daryl Thornton
- Center for Reducing Health Disparities, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH; Population Health Research Institute, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH; Division of Pulmonary, Critical Care, and Sleep Medicine, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH
| | - Sumita B Khatri
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Daniel A Culver
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
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Dreisbach N, Wang H, Campbell S, Correa H, Dickson T, Brown-Dudley L, Escoffery D, Evtimova T, Fonseca A, Myers C, Plasencia S, Manyindo N. Improving childhood asthma outcomes in East Harlem: the East Harlem Asthma Center of Excellence's Asthma Counselor Program. J Asthma 2023; 60:339-347. [PMID: 35293833 DOI: 10.1080/02770903.2022.2051543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of the Asthma Counselor Program, a program of the New York City Department of Health and Mental Hygiene, designed to improve asthma outcomes among children. METHODS We used a pre-post study design among children who enrolled in the program. We included self-reported outcome measures by comparing the previous 12 months (captured at intake) to the 12 months following program enrollment. To calculate the 12 months after enrollment, we added the number of outcome events reported at each follow-up session, which are conducted approximately three months apart, to compute 12-month (or "year-end") post-enrollment outcomes. RESULTS We enrolled 136 children during the study period (2018); 85 children remained in the program for 12 months and 51 became lost-to-follow-up. Among those who remained in the program, at the "year-end" session, there were statistically significant reductions in the mean number of asthma-related unscheduled healthcare appointments or urgent-care visits (73%), uses of prednisone (65%), asthma-related school absences (60%), asthma-related ED visits (57%), and asthma-related hospitalizations (50%). CONCLUSIONS Twelve months after children enrolled in the program, they had significantly improved asthma outcomes. Our findings, along with results from similar studies, support multicomponent interventions, especially those led by masters-level social workers.
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Affiliation(s)
- Nicole Dreisbach
- New York City Department of Health and Mental Hygiene, Center for Health Equity and Community Wellness, New York, NY, USA
| | - Henry Wang
- New York City Department of Health and Mental Hygiene, Center for Health Equity and Community Wellness, New York, NY, USA
| | - Safiya Campbell
- New York City Department of Health and Mental Hygiene, Center for Health Equity and Community Wellness, New York, NY, USA
| | - Héctor Correa
- New York City Department of Health and Mental Hygiene, Center for Health Equity and Community Wellness, New York, NY, USA
| | - Teré Dickson
- New York City Department of Health and Mental Hygiene, Center for Health Equity and Community Wellness, New York, NY, USA
| | - La'Shawn Brown-Dudley
- New York City Department of Health and Mental Hygiene, Center for Health Equity and Community Wellness, New York, NY, USA
| | - Dodrie Escoffery
- New York City Department of Health and Mental Hygiene, Center for Health Equity and Community Wellness, New York, NY, USA
| | - Teodora Evtimova
- New York City Department of Health and Mental Hygiene, Center for Health Equity and Community Wellness, New York, NY, USA
| | - Anthony Fonseca
- New York City Department of Health and Mental Hygiene, Center for Health Equity and Community Wellness, New York, NY, USA
| | - Christa Myers
- New York City Department of Health and Mental Hygiene, Center for Health Equity and Community Wellness, New York, NY, USA
| | - Stephanie Plasencia
- New York City Department of Health and Mental Hygiene, Center for Health Equity and Community Wellness, New York, NY, USA
| | - Noel Manyindo
- New York City Department of Health and Mental Hygiene, Center for Health Equity and Community Wellness, New York, NY, USA
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Chan M, Gray M, Burns C, Owens L, Woolfenden S, Lingam R, Jaffe A, Homaira N. Community-based interventions for childhood asthma using comprehensive approaches: a systematic review and meta-analysis. Allergy Asthma Clin Immunol 2021; 17:19. [PMID: 33588934 PMCID: PMC7885565 DOI: 10.1186/s13223-021-00522-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/29/2021] [Indexed: 12/21/2022] Open
Abstract
Objective We conducted a systematic review and meta-analysis to determine the effectiveness of comprehensive community-based interventions with ≥ 2 components in improving asthma outcomes in children. Methods A systematic search of Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (EMBASE), Cochrane Library and hand search of reference collections were conducted to identify any research articles published in English between 2000 and 2019. All studies reporting community-based asthma interventions with ≥ 2 components (e.g., asthma self-management education, home environmental assessment or care coordination etc.) for children aged ≤ 18 years were included. Meta-analyses were performed using random-effects model to estimate pooled odds ratio (OR) with 95% confidence intervals (CIs). Results Of the 2352 studies identified, 21 studies were included in the final analysis: 19 pre-post interventions, one randomised controlled trial (RCT) and one retrospective study. Comprehensive asthma programs with multicomponent interventions were associated with significant reduction in asthma-related Emergency Department (ED) visits (OR = 0.26; 95% CI 0.20–0.35), hospitalizations (OR = 0.24; 95% CI 0.15–0.38), number of days (mean difference = − 2.58; 95% CI − 3.00 to − 2.17) and nights with asthma symptoms (mean difference = − 2.14; 95% CI − 2.94 to − 1.34), use of short-acting asthma medications/bronchodilators (BD) (OR = 0.28; 95% CI 0.16–0.51), and increase use of asthma action plan (AAP) (OR = 8.87; 95% CI 3.85–20.45). Conclusion Community-based asthma care using more comprehensive approaches may improve childhood asthma management and reduce asthma related health care utilization.
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Affiliation(s)
- Mei Chan
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2031, Australia
| | - Melinda Gray
- Respiratory Department, Sydney Children's Hospital, Randwick, NSW 2031, Australia
| | - Christine Burns
- Respiratory Department, Sydney Children's Hospital, Randwick, NSW 2031, Australia
| | - Louisa Owens
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2031, Australia.,Respiratory Department, Sydney Children's Hospital, Randwick, NSW 2031, Australia
| | - Susan Woolfenden
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2031, Australia.,Respiratory Department, Sydney Children's Hospital, Randwick, NSW 2031, Australia
| | - Raghu Lingam
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2031, Australia.,Respiratory Department, Sydney Children's Hospital, Randwick, NSW 2031, Australia
| | - Adam Jaffe
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2031, Australia.,Respiratory Department, Sydney Children's Hospital, Randwick, NSW 2031, Australia
| | - Nusrat Homaira
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2031, Australia. .,Respiratory Department, Sydney Children's Hospital, Randwick, NSW 2031, Australia.
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Butz A, Morphew T, Lewis-Land C, Kub J, Bellin M, Ogborn J, Mudd SS, Bollinger ME, Tsoukleris M. Factors associated with poor controller medication use in children with high asthma emergency department use. Ann Allergy Asthma Immunol 2017; 118:419-426. [PMID: 28254203 PMCID: PMC5385291 DOI: 10.1016/j.anai.2017.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/03/2017] [Accepted: 01/09/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Understanding health and social factors associated with controller medication use in children with high-risk asthma may inform disease management in the home and community. OBJECTIVE To examine health and social factors associated with the Asthma Medication Ratio (AMR), a measure of guideline-based care and controller medication use, in children with persistent asthma and frequent emergency department (ED) use. METHODS Study questionnaires, serum allergen sensitization, salivary cotinine, and pharmacy record data were collected for 222 children enrolled from August 2013 to February 2016 in a randomized clinical trial that tested the efficacy of an ED- and home-based intervention. Logistic regression was used to examine factors associated with an AMR greater than 0.50, reflecting appropriate controller medication use. RESULTS Most children were male (64%), African American (93%), Medicaid insured (93%), and classified as having uncontrolled asthma (44%). Almost half (48%) received non-guideline-based care or low controller medication use based on an AMR less than 0.50. The final regression model predicting an AMR greater than 0.50 indicated that children receiving specialty care (odds ratio [OR], 4.87; 95% confidence interval [CI], 2.06-11.50), caregivers reporting minimal worry about medication adverse effects (OR, 0.50; 95% CI, 0.25-1.00), positive sensitization to ragweed allergen (OR, 3.82; 95% CI, 1.63-8.96), and negative specific IgE for dust mite (OR, 0.33; 95% CI, 0.15-0.76) were significantly associated with achieving an AMR greater than 0.50. CONCLUSION Clinical decision making for high-risk children with asthma may be enhanced by identification of sensitization to environmental allergens, ascertaining caregiver's concerns about controller medication adverse effects and increased referral to specialty care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01981564.
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Affiliation(s)
- Arlene Butz
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; School of Nursing, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | | | - Cassia Lewis-Land
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joan Kub
- School of Nursing, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Melissa Bellin
- School of Social Work, University of Maryland, Baltimore, Maryland
| | - Jean Ogborn
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shawna S Mudd
- School of Nursing, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary Elizabeth Bollinger
- Department of Pediatric Pulmonary and Allergy, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Mona Tsoukleris
- School of Pharmacy, University of Maryland, Baltimore, Maryland
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Auger KA, Kahn RS, Simmons JM, Huang B, Shah AN, Timmons K, Beck AF. Using Address Information to Identify Hardships Reported by Families of Children Hospitalized With Asthma. Acad Pediatr 2017; 17:79-87. [PMID: 27402351 PMCID: PMC5215728 DOI: 10.1016/j.acap.2016.07.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 06/23/2016] [Accepted: 07/03/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Socioeconomic hardship is common among children hospitalized for asthma but often not practically measurable. Information on where a child resides is universally available. We sought to determine the correlation between neighborhood-level socioeconomic data and family-reported hardships. METHODS Caregivers of 774 children hospitalized with asthma answered questions regarding income, financial strain, and primary care access. Addresses were geocoded and linked to zip code-, census tract-, and block group-level (neighborhood) data from the US Census. We then compared neighborhood median household income with family-reported household income; percentage of neighborhood residents living in poverty with family-reported financial strain; and percentage of neighborhood households without an available vehicle with family-reported access to primary care. We constructed heat maps and quantified correlations using Kendall rank correlation coefficient. Receiver operator characteristic curves were used to assess predictive abilities of neighborhood measures. RESULTS The cohort was 57% African American and 73% publicly-insured; 63% reported income <$30,000, 32% endorsed ≥4 financial strain measures, and 38% reported less than adequate primary care access. Neighborhood median household income was significantly and moderately correlated with and predictive of reported household income; neighborhood poverty was similarly related to financial strain; neighborhood vehicle availability was weakly correlated with and predictive of primary care access. Correlations and predictions provided by zip code measures were similar to those of census tract and block group. CONCLUSIONS Universally available neighborhood information might help efficiently identify children and families with socioeconomic hardships. Systematic screening with area-level socioeconomic measures has the potential to inform resource allocation more efficiently.
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Affiliation(s)
- Katherine A. Auger
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229,James M. Anderson Center for Health Systems Excellence, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
| | - Robert S. Kahn
- James M. Anderson Center for Health Systems Excellence, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229,Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
| | - Jeffrey M. Simmons
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229,James M. Anderson Center for Health Systems Excellence, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
| | - Bin Huang
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
| | - Anita N. Shah
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
| | - Kristen Timmons
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
| | - Andrew F. Beck
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229,James M. Anderson Center for Health Systems Excellence, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
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Lindsay S, Kingsnorth S, Mcdougall C, Keating H. A systematic review of self-management interventions for children and youth with physical disabilities. Disabil Rehabil 2013; 36:276-88. [PMID: 23614359 PMCID: PMC3934376 DOI: 10.3109/09638288.2013.785605] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 02/08/2013] [Accepted: 03/11/2013] [Indexed: 11/13/2022]
Abstract
PURPOSE Evidence shows that effective self-management behaviors have the potential to improve health outcomes, quality of life, self-efficacy and reduce morbidity, emergency visits and costs of care. A better understanding of self-management interventions (i.e. programs that help with managing symptoms, treatment, physical and psychological consequences) is needed to achieve a positive impact on health because most children with a disability now live well into adulthood. METHOD A systematic review of self-management interventions for school age youth with physical disabilities was undertaken to assess their effectiveness. Comprehensive electronic searches using international web-based reference libraries were conducted for peer-reviewed and gray literature published between 1980 and January 2012. Eligible studies examined the effectiveness of self-management interventions for children and youth between 6 and 18 years of age with congenital or acquired physical disabilities. Studies needed to include a comparison group (e.g. single group pre/post-test design) and at least one quantifiable health-related outcome. RESULTS Of the 2184 studies identified, six met the inclusion criteria; two involved youth with spina bifida and four with juvenile arthritis. The majority of the interventions ran several sessions for at least 3 months by a trained interventionist or clinician, had one-to-one sessions and meetings, homework activities and parental involvement. Although outcomes varied between the studies, all of the interventions reported at least one significant improvement in either overall self-management skills or a specific health behavior. CONCLUSIONS While self-management interventions have the potential to improve health behaviors, there were relatively few rigorously designed studies identified. More studies are needed to document the outcomes of self-management interventions, especially their most effective characteristics for children and youth with physical disabilities. Implications for Rehabilitation There is some evidence to suggest that self-management interventions for children and youth with spina bifida and arthritis can improve self-management behaviors and health outcomes. Parents' involvement should be considered in encouraging self-management behaviors at different stages of their child's development. Much work is needed to explore the longer term implications of self-management interventions for youth with physical disabilities as well as the impact on health care utilization.
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Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation HospitalToronto, ONCanada
- Department of Occupational Science and Occupational Therapy, Graduate Department of Rehabilitation Sciences, University of TorontoToronto, ONCanada
| | | | - Carolyn Mcdougall
- Department of Occupational Science and Occupational Therapy, Graduate Department of Rehabilitation Sciences, University of TorontoToronto, ONCanada
- Centre for Participation and Inclusion, Holland Bloorview Kids Rehabilitation HospitalONCanada
| | - Heather Keating
- Centre for Participation and Inclusion, Holland Bloorview Kids Rehabilitation HospitalONCanada
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Bollinger ME, Morphew T, Mullins CD. The Breathmobile program: a good investment for underserved children with asthma. Ann Allergy Asthma Immunol 2011; 105:274-281. [PMID: 20934626 DOI: 10.1016/j.anai.2010.07.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 07/15/2010] [Accepted: 07/25/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Breathmobile, a specialty-based mobile asthma clinic, provides free care to underserved children. The cost of symptom-free day (SFD) improvement in this population has not been previously reported. OBJECTIVE To examine the clinical impact and cost-effectiveness of the Baltimore Breathmobile. METHODS Existing computerized data were analyzed for Breathmobile patient visits between 2002 and 2007. All SFDs were calculated, and direct medical cost savings attributable to decreased emergency department visits and hospitalizations (after program utilization vs the previous year) were compared with annual operating costs. Incremental cost-effectiveness ratios were determined by calculating the incremental costs of Breathmobile care per additional SFD gained per child per year. RESULTS The analysis included 255 patients enrolled in the program for at least 1 year. Most participants were black (93.3%), and 54.9% were male. At baseline, patients reported a mean (SD) of 199 (118) SFDs in the year before enrollment. After 1 year in the program, patients had a mean (SD) improvement of 44 (9) SFDs. The program resulted in overall cost savings of $79.43 per SFD gained, with greater cost savings for children aged 5 to 11 years (-$116.84 per SFD gained) and those with intermittent asthma (-$126.71 per SFD gained). CONCLUSIONS The Baltimore Breathmobile program has demonstrated significant improvement in SFDs, with direct medical cost savings of the program outweighing the operational costs. These data support the need to continue to sustain and expand Breathmobile programs for children at high risk for asthma exacerbations and to conduct a randomized clinical trial to estimate the cost-effectiveness of the Breathmobile.
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Affiliation(s)
- Mary Elizabeth Bollinger
- Division of Pediatric Pulmonology/Allergy, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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Coughey K, Klein G, West C, Diamond JJ, Santana A, McCarville E, Rosenthal MP. The Child Asthma Link Line: a coalition-initiated, telephone-based, care coordination intervention for childhood asthma. J Asthma 2010; 47:303-9. [PMID: 20394515 DOI: 10.3109/02770900903580835] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Childhood asthma is a complex chronic disease that poses significant challenges regarding management, and there is evidence of disparities in care. Many medical, psychosocial, and health system factors contribute to recognized poor control of this most prevalent illness among children, with resultant excessive use of emergency departments and hospitalizations for care. Recent national guidelines emphasize the need for community-based initiatives to address these critical issues. To address health system fragmentation and impact asthma outcomes, the Philadelphia Allies Against Asthma coalition developed and implemented the Child Asthma Link Line, a telephone-based care coordination and system integration program, which has been in operation since 2001. This study evaluates the effectiveness of the Child Asthma Link Line integration model to improve asthma management by measuring utilization markers of morbidity. METHODS Medicaid Managed Care Organization claims data for 59 children who received the Link Line intervention in 2003 are compared to a matched sample of 236 children who did not receive the Link Line intervention. Children in the two study groups are ages 3 through 12 years and matched on 2003 emergency department visits, age, gender, and race/ethnicity. Primary outcome variables analyzed in this study are emergency department visits, hospitalizations, and office visit claims from the follow-up year (2004). RESULTS Link Line intervention children were significantly less likely to have follow-up hospitalizations than matched sample children (p = .02). Children enrolled in the Link Line were also more likely to attend outpatient office visits in the follow-up year (p = .045). In addition, Link Line children with multiple emergency department visits in 2003 were significantly less likely to have an emergency department visit in 2004 (p = .046). CONCLUSION This coalition-developed, telephone-based, system-level intervention had a significant impact on childhood asthma morbidity as measured by utilization endpoints of follow-up hospitalizations and emergency department visits. Telephone-based care coordination and service integration may be a viable and economic way to impact childhood asthma and other chronic diseases.
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Affiliation(s)
- Kathleen Coughey
- Department of Research and Evaluation, Public Health Management Corporation, Philadelphia, Pennsylvania, USA
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Affiliation(s)
- Candace Ramos
- Children's Mercy Hospitals and Clinics, Kansas City, Missouri 64108, USA
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Spiegel J, Love AS, Wood PR, Griffith M, Taylor KR, Williams SG, Redd SC. The Inner-City Asthma Intervention: description of a community-based implementation of an evidence-based approach to asthma management. Ann Allergy Asthma Immunol 2006; 97:S6-10. [PMID: 16892764 DOI: 10.1016/s1081-1206(10)60778-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND In 2000, the Centers for Disease Control and Prevention funded a 4-year project to implement the Inner-City Asthma Intervention (ICAI)-an asthma treatment and management project based on the protocol developed for the National Cooperative Inner-City Asthma Study (NCICAS) funded by the National Institutes of Health, National Institute of Allergy and Infectious Disease. OBJECTIVE To describe the ICAI's major components and implementation issues. METHODS Information contained in this article is based on project activity and management reports, site client tracking and data collection reports, site visit and other program oversight activity, and general subject matter knowledge. The site client tracking data collection process varied among sites during the intervention. Common definitions and processes were developed and implemented as needed. RESULTS Three of the 24 original sites discontinued participation. The remaining sites enrolled 4,174 children into the intervention. Although the project ended earlier than originally scheduled, 1,035 children completed the entire intervention. Of the 3,139 children who did not complete the entire protocol, 1,355 children and their families completed the core activities or the core activities plus one or more follow-up activities. CONCLUSION The ICAI project demonstrated that although there were a number of implementation issues to overcome, it is possible to implement effectively a proven National Institutes of Health protocol in the community setting.
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Affiliation(s)
- John Spiegel
- Alliance of Community Health Plans Foundation, Washington, DC 20036, USA.
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Wood P, Tumiel-Berhalter L, Owen S, Taylor K, Kattan M. Implementation of an asthma intervention in the inner city. Ann Allergy Asthma Immunol 2006; 97:S20-4. [PMID: 16892767 DOI: 10.1016/s1081-1206(10)60781-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite availability of asthma self-management interventions for children, few have been implemented in community-based settings. OBJECTIVE To describe implementation of the Inner-City Asthma Intervention and factors associated with higher rates of program completion by enrollees. METHODS Descriptive analyses of data from multiple data sources. Two-tailed Pearson correlation coefficients and analyses of variance were used to calculate associations of descriptive variables with the retention rate (percentage of enrolled children who completed the core intervention and had more than 1 follow-up visit) and with the percentage who had allergy testing done. RESULTS A total of 4,174 children were enrolled at 22 sites; 2,153 (52%) completed the core intervention and had more than 1 follow-up visit. A total of 2,014 enrolled children (48%) were tested for allergies. Retention was related to type and location of site, ease of obtaining written plans, language and ethnicity of asthma counselor, and on-site allergy testing. Higher rates of allergy testing were associated with the same factors, as well as flexibility in scheduling and selective enrollment of participants. CONCLUSIONS Inner-city children with asthma can be enrolled in the Inner-City Asthma Intervention outside a controlled research setting. However, completion of all intervention components is difficult to achieve. We identify having an asthma counselor who is representative of the community, access to asthma action plans, and on-site allergy testing as factors that facilitate the implementation of this intervention in community-based settings.
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Affiliation(s)
- Pamela Wood
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229-3900, USA.
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Williams SG, Redd SC. From research to reality: from the National Cooperative Inner-City Asthma Study to the inner-city asthma implementation. Ann Allergy Asthma Immunol 2006; 97:S4-5. [PMID: 16892763 DOI: 10.1016/s1081-1206(10)60777-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Several themes emerged from the information provided in this supplement. 1. Implementation of the protocol was feasible, although retention of participants was challenging and customization at each site was essential. 2. Master's degree level social workers were well suited to partnering with health care professionals to address the many issues involved in caring for children with asthma and their families. 3. Collaboration between team members and community partners was critical to successful implementation. 4. Sustainability beyond external funding is attainable if local funding is sought and outcome measures that are considered important to the community are measured and reported.
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