Pediatric Asthma Care Coordination in Underserved Communities: A Quasiexperimental Study

Area of Science:

• Pediatric Pulmonology
• Health Services Research
• Community Health

Background:

• Asthma is a major chronic respiratory disease affecting children, particularly in underserved urban communities.
• Poorly controlled asthma leads to significant morbidity, healthcare utilization, and health disparities.
• Existing interventions often lack integrated medical and social care coordination.

Purpose of the Study:

• To evaluate the impact of a medical-social care coordination program on asthma outcomes in children residing in underserved urban areas.
• To assess the effect of care coordination on asthma symptom frequency and healthcare utilization.

Main Methods:

• A cohort of 805 children (mean age 7 years) with poorly controlled asthma were enrolled in care coordination programs across four US urban sites and Puerto Rico (2011-2014).
• Asthma symptoms and healthcare utilization were assessed via parent interviews at baseline and 12-month follow-up.
• A comparison group was constructed using bootstrap resampling of matched control cases from prior pediatric asthma trials to mitigate overestimation of intervention effects.

Main Results:

• Intervention participants experienced a significant reduction in asthma symptoms, with 2.2 fewer symptom days per month and 1.9 fewer symptom nights per month compared to the control group (P < .01).
• The intervention was associated with a reduced relative risk for emergency department visits (RR=0.63, 95% CI=0.45-0.89) and hospitalizations (RR=0.69, 95% CI=0.47-1.01) in the past year.

Conclusions:

• Care coordination programs demonstrate potential for improving pediatric asthma symptom control.
• This intervention can effectively reduce emergency department visits, a key indicator of asthma exacerbation and healthcare burden.
• Findings suggest that care coordination is a valuable strategy for managing pediatric asthma in vulnerable populations.