Journal of Allergy and Clinical Immunology: Global (Aug 2023)

Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan

  • 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

Journal volume & issue
Vol. 2, no. 3
p. 100100

Abstract

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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.

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