Community Healthcare for Asthma Management and Prevention of Symptoms
| Status: | Completed |
|---|---|
| Conditions: | Asthma |
| Therapuetic Areas: | Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 5 - 12 |
| Updated: | 4/21/2016 |
| Start Date: | October 2010 |
| End Date: | March 2016 |
A Study of the Feasibility and Effectiveness of Implementing and Diffusing an Evidence-based Childhood Asthma Management Intervention in Community Health Centers
The purpose of this study is to systematically investigate across health center study sites
participating in this study the process of adopting, integrating, implementing, and
diffusing a minimum set of evidence-based interventions for the management of childhood
asthma. Investigators hypothesized that an intervention that is evidence- and
consensus-based (i.e., minimum elements to be integrated into existing practice, dosing of
each element) would be implemented effectively, as measured by health center performance
improvement on child health outcomes, health care utilization, and other measures (e.g.,
avoidable costs).
participating in this study the process of adopting, integrating, implementing, and
diffusing a minimum set of evidence-based interventions for the management of childhood
asthma. Investigators hypothesized that an intervention that is evidence- and
consensus-based (i.e., minimum elements to be integrated into existing practice, dosing of
each element) would be implemented effectively, as measured by health center performance
improvement on child health outcomes, health care utilization, and other measures (e.g.,
avoidable costs).
In this study, investigators combined childhood asthma counseling and environmental
interventions proven effective in previous NIH-funded clinical trials, the National
Cooperative Inner-City Asthma Study (NCICAS) and the Inner-City Asthma Study (ICAS), and a
third study, Head-off Environmental Asthma in Louisiana (HEAL). These studies demonstrated
that participant-tailored interventions reduce asthma morbidity. Through a process of
consensus building, investigators adapted a hybrid of these interventions for use in primary
care clinics located in medically underserved areas (FQHCs). Investigators recruited
participants ages 5-12 years with poorly controlled, moderate-to-severe asthma to ensure
comparability with previous studies. Unlike the earlier clinical trials, which limited
eligibility to inner-city children in stable housing, CHAMPS enrolled participants
regardless of housing situation (e.g., temporary/shared homes) and location (e.g.,
urban/rural). Investigators collaborated with 3 FQHCs in Arizona, Michigan, and Porto Rico
to enroll children and implement the CHAMPS intervention but otherwise granted them
discretion to make decisions about staffing, patient flow and other process determinations,
while tracking what those entailed. Investigators also invited 3 additional FQHCs to recruit
and enroll children in a comparison group that did not receive the intervention.
The primary aim is to identify and understand barriers and solutions to the adaptation of an
evidence-based asthma intervention at the system-level. The evaluation consists of
determining how a system makes room for an intervention, identifying stakeholders to make it
happen, documenting the process for replication, and monitoring processes and outcomes to
ensure the integrity of the intervention remains intact. The process of implementation in
the unique clinical settings presented by health centers will be described, including the
facilitators and the barriers to the systematic adoption of an evidence-based childhood
asthma intervention into routine practice. Of particular importance are those determinants
related to in-home and community-based environmental risks, the limits of understanding on
the part of parents and caretakers, and community-wide policies and practices that may
create health risks.
The secondary aim is to assess the effectiveness and cost-effectiveness of the
evidence-based asthma intervention as implemented in health centers.
The third and final aim is to develop a dissemination strategy and some tools for further
take up of the intervention.
interventions proven effective in previous NIH-funded clinical trials, the National
Cooperative Inner-City Asthma Study (NCICAS) and the Inner-City Asthma Study (ICAS), and a
third study, Head-off Environmental Asthma in Louisiana (HEAL). These studies demonstrated
that participant-tailored interventions reduce asthma morbidity. Through a process of
consensus building, investigators adapted a hybrid of these interventions for use in primary
care clinics located in medically underserved areas (FQHCs). Investigators recruited
participants ages 5-12 years with poorly controlled, moderate-to-severe asthma to ensure
comparability with previous studies. Unlike the earlier clinical trials, which limited
eligibility to inner-city children in stable housing, CHAMPS enrolled participants
regardless of housing situation (e.g., temporary/shared homes) and location (e.g.,
urban/rural). Investigators collaborated with 3 FQHCs in Arizona, Michigan, and Porto Rico
to enroll children and implement the CHAMPS intervention but otherwise granted them
discretion to make decisions about staffing, patient flow and other process determinations,
while tracking what those entailed. Investigators also invited 3 additional FQHCs to recruit
and enroll children in a comparison group that did not receive the intervention.
The primary aim is to identify and understand barriers and solutions to the adaptation of an
evidence-based asthma intervention at the system-level. The evaluation consists of
determining how a system makes room for an intervention, identifying stakeholders to make it
happen, documenting the process for replication, and monitoring processes and outcomes to
ensure the integrity of the intervention remains intact. The process of implementation in
the unique clinical settings presented by health centers will be described, including the
facilitators and the barriers to the systematic adoption of an evidence-based childhood
asthma intervention into routine practice. Of particular importance are those determinants
related to in-home and community-based environmental risks, the limits of understanding on
the part of parents and caretakers, and community-wide policies and practices that may
create health risks.
The secondary aim is to assess the effectiveness and cost-effectiveness of the
evidence-based asthma intervention as implemented in health centers.
The third and final aim is to develop a dissemination strategy and some tools for further
take up of the intervention.
Inclusion Criteria:
- Diagnosis of asthma
- Currently receiving long-term asthma control therapy and either has symptoms
consistent with persistent asthma or has evidence of uncontrolled disease or is not
currently receiving long-term asthma control therapy and has symptoms consistent with
persistent asthma and also has evidence of uncontrolled disease
- Caretaker speaks English or Spanish
Exclusion Criteria:
- Younger or older children
- Mild, intermittent asthma
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