Telephone Coaches to Improve Control of Asthma in Children ( PARTNER) Study)

Asthma is the most common long-term disease among children. Each year, most children with
asthma will have at least one asthma exacerbation, experience asthma symptoms on
approximately 100 days, and miss 4 days of school because of asthma. Surveys of primary care
physicians (PCPs) and asthma patients have indicated that asthma care is episodic, effective
asthma controller medications are underused, and few PCPs provide self-management education
or support for parents of children with asthma. Previous research showed that when an asthma
coach worked with parents of children from low-income, urban neighborhoods, there were
multiple benefits: improved self-management behaviors, reduced asthma hospitalizations, and
improved rates of follow-up with a PCP after an emergency department visit for asthma
symptoms. In this study, researchers will evaluate the effectiveness of an asthma coach
program in a larger, general asthma population. Trained asthma coaches will work with parents
of children with asthma to provide education about the goals of asthma care, and they will
encourage and facilitate an active partnership between the family and PCP to enhance asthma
care and improve self-management behaviors. Study researchers will then evaluate the
effectiveness of this program at improving asthma control and quality of life among children
with asthma. The cost effectiveness of the program will also be analyzed.

This study will enroll pediatricians and parents of children between 5 and 12 years old who
have persistent asthma. Pediatricians will be randomly assigned to either the asthma coach
program or usual care. All pediatricians will receive access to the Education in Quality
Improvement for Pediatric Practice (eQIPP) module for asthma care provided by the American
Academy of Pediatrics. They will also receive articles about effective doctor-parent
communication on asthma and asthma billing practices. In addition, pediatricians taking part
in the asthma coach program will attend two meetings to learn about asthma coaching and how
the program can be implemented into their practice. For 12 months, an asthma coach will work
directly with the parents of children who see doctors participating in the asthma coaching
group. Telephone calls with the asthma coach will be arranged at times convenient for the
parent and will occur anywhere between once a week to once a month. At Months 12 and 24,
about 40 parents of children in each pediatrician's practice will participate in telephone
interviews and their children's medical charts will be reviewed to assess asthma control,
asthma-related quality of life factors, and urgent care events.

Inclusion Criteria for Pediatricians:

- Affiliated with St. Louis Children's Hospital and/or Washington University in St.
Louis

- Provides asthma care for at least 40 asthmatic children from the target population

Inclusion Criteria for Parents:

- Has a child who is between 3 and 12 years old with persistent asthma and who is cared
for by a study pediatrician

Exclusion Criteria for Pediatricians:

- Spends less than 50% of their time in general pediatrics

- Is an asthma specialist (allergist or pulmonary specialist)

- Another physician in their practice is participating in the study

Exclusion Criteria for Parents:

- Their asthmatic child is less than 3 years old or is 13 years or older at the time of
study entry

- Their child has not had a physician diagnosis of asthma before study entry

- Their child has a significant comorbid condition

- Cannot speak English

- Does not have a phone