학술논문
Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan
Document Type
article
Author
Jerry A. Krishnan, MD, PhD; Helen Margellos-Anast, MPH; Rajesh Kumar, MD; Joel J. Africk, JD; Michael Berbaum, PhD; Nina Bracken, MSN, NP; Yi-Fan Chen, PhD; Julie DeLisa, MA; Kim Erwin, MDes; Stacy Ignoffo, MSW; Sai Dheeraj Illendula, MS; Hajwa Kim, MS; Cortland Lohff, MD, MPH; Tom MacTavish, MLIS; Molly A. Martin, MD, MAPP; Giselle S. Mosnaim, MD, MS; Hannah Nguyen, MPH; Sarah Norell, MDes, MFA; Sharmilee M. Nyenhuis, MD; S. Margaret Paik, MD; Zachary Pittsenbarger, MD; Valerie G. Press, MD, MPH; Jennifer Sculley, MDes; Trevonne M. Thompson, MD; Leslie Zun, MD, MBA; Lynn B. Gerald, PhD, MSPH; Michael McDermott, MD; Sana Ali; Janet Flores; Shahina Gantiwala; Carmen Goralski; Rajesh Kumar; Jacqueline Ortega; Zachary Pittsenbarger; Isabelle Wilson; Cortland Lohff; Michael McDermott; Kim Erwin; Thomas MacTavish; Sarah Norell; Maureen Damitz; David Massaquoi; Kenneth Soyemi; Thomas Senko; Trevonne Thompson; Kate McMahon; Joel Africk; Amy O’Rourke; Christopher Codispoti; Jane Kramer; Rabia Malik; Pamela Manning; Giselle Mosnaim; Jeanette Avila; Helen Margellos-Anast; Fatima Padron; Jessica Ramsay; Nazia Saiyed; Tala Schwindt; Gloria Seals; Leslie Zun; Susannah Butters; Ashley Hull; John Kim; S. Margaret Paik; Valerie Press; Crystal Stevenson; Nicole Twu; Nicole Woodrick; Michael Berbaum; Nina Bracken; Jennifer Buenrostro; Lauren Castro; Yi-Fan Chen; Julie DeLisa; David De La Torre-Dorado; Dameka Edwards; Alexander Frye; Maciej Grabarek; Sai Dheeraj Illendula; Hajwa Kim; Jerry Krishnan; Molly Martin; Melissa Morales- Perez; Hannah Nguyen; Sharmilee Nyenhuis; Jennifer Sculley; Bruce Bender, PhD; Francine Ducharme, MD; Sheri Hurdle; Xue Li, PhD; Sande Okelo, MD, PhD
Source
Journal of Allergy and Clinical Immunology: Global, Vol 2, Iss 3, Pp 100100- (2023)
Subject
Language
English
ISSN
2772-8293
Abstract
Background: Evidence-based strategies to improve outcomes in minority children with uncontrolled asthma discharged from the emergency department (ED) are needed. Objectives: This multicenter pragmatic clinical trial was designed to compare an ED-only intervention (decision support tool), an ED-only intervention and home visits by community health workers for 6 months (ED-plus-home), and enhanced usual care (UC). Methods: Children aged 5 to 11 years with uncontrolled asthma were enrolled. The change over 6 months in the Patient-Reported Outcomes Measurement Information System Asthma Impact Scale score in children and Satisfaction with Participation in Social Roles score in caregivers were the primary outcomes. The secondary outcomes included guideline-recommended ED discharge care and self-management. Results: Recruitment was significantly lower than expected (373 vs 640 expected). Of the 373 children (64% Black and 31% Latino children), only 63% completed the 6-month follow-up visit. In multivariable analyses that accounted for missing data, the adjusted odds ratios and 98% CIs for differences in Asthma Impact Scores or caregivers’ Satisfaction with Participation in Social Roles scores were not significant. However, guideline-recommended ED discharge care was significantly improved in the intervention groups versus in the UC group, and self-management behaviors were significantly improved in the ED-plus-home group versus in the ED-only and UC groups. Conclusions: The ED-based interventions did not significantly improve the primary clinical outcomes, although the study was likely underpowered. Although guideline-recommended ED discharge care and self-management did improve, their effect on clinical outcomes needs further study.