West Philadelphia Controls Asthma

The Community Asthma Prevention Program (CAPP) at the Children's Hospital of Philadelphia has
a two-decade history of utilizing CHWs to improve asthma outcomes of children in
Philadelphia. Building on this foundation, a network of stakeholders was established
including, The West Philadelphia Asthma Care Collaborative (WEPACC), with representation from
public housing, healthcare, community, and schools. As a result of assessment of local needs,
resource mapping, and months of planning, Investigators designed an asthma care
implementation program with the broad objective of integrating home, school, healthcare
system, and community for school-aged asthmatic children in West Philadelphia. Investigators
seek to accomplish this goal using CHWs to deliver sustainable patient-centered
evidence-based interventions. The evidence-based interventions include (1) a primary
care-based Yes We Can intervention with home visitation and (2) a comprehensive and
rigorously evaluated school-based intervention, Open Airways for schools and School Based
Asthma Therapy. CHWs will function as the hub of each interventions, serving either as
primary care CHWs or school CHWs to provide a network of education, care coordination
support, and to facilitate communication for families of children with asthma between the
four sectors. This project seeks to integrate interventions in a comprehensive and
sustainable manner to reduce asthma disparities in poor, minority children.

Using a factorial design, Investigators will recruit and randomize 600 asthmatic children
(ages 6-12 years) from three inner-city primary care clinics who attend one of 23 West
Philadelphia schools to one of four study conditions: both interventions (both primary care
and school CHWs intervention), primary care CHW or school-CHW alone, or control and follow
for one year. As a part of this project the Investigators seek to accomplish the following
objectives:

Objective 1. Compare effectiveness of the primary care and school interventions to improve
asthma control and reduce symptom days using main and simple effects from the factorial
design.

Objective 2. Explore moderators and mechanisms of effectiveness and sustainability of the
interventions.

Objective 3. Use mixed methods to explore implementation determinants and outcomes of school
intervention that promote effectiveness, fidelity and sustainability

Objective 4. Examine the costs, savings, and cost effectiveness associated with the
intervention and implementation strategies to promote sustainability.

Inclusion Criteria:

1. Children 6-12 years of age and their parents/guardians

2. Children with a diagnosis of asthma

3. Children with uncontrolled asthma (as evidenced within the previous 12 months by 2 or
more asthma exacerbations requiring oral steroids -OR- 2 or more ED visits for asthma
-OR- 1 inpatient admission for asthma)

4. West Philadelphia residence in zip code 19104, 19131, 19139, 19143 or 19151

5. Children in grades 1-6

6. Pediatric primary care received at Children's Hospital of Philadelphia Care Network
(CN) Karabots, Cobbs Creek, or South Philadelphia locations or pediatric care received
at up to two Federally Qualified Health Centers (FQHCs) serving West Philadelphia
residents

7. Parental/guardian permission (informed consent) and, if appropriate, child assent

8. English Language Speaking

Exclusion Criteria:

1. Subjects with other chronic respiratory illnesses such as cystic fibrosis

2. Cyanotic congenital heart disease

3. Mental retardation and/or cerebral palsy (MRCP)

4. Severe Neurological Disorder

5. Cyanotic congenital heart disease

6. Parents/guardians or subjects who, in the opinion of the Investigator, may be
non-compliant with study schedules or procedures