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Published on: November 4, 2010
Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan
Jerry A Krishnan1,2, Helen Margellos-Anast3, Rajesh Kumar4
1Office of the Vice Chancellor for Health Affairs, University of Illinois Chicago.
Insights
Emergency department interventions for uncontrolled asthma in children did not significantly improve primary outcomes. However, guideline-recommended care and self-management behaviors showed improvement, warranting further study.
Area of Science:
- Pediatric Pulmonology
- Public Health
- Clinical Trials
Background:
- Uncontrolled asthma in minority children discharged from the emergency department (ED) requires evidence-based strategies for improved outcomes.
- Minority children, particularly Black and Latino populations, face significant asthma burdens.
Purpose of the Study:
- To compare the effectiveness of an ED-only intervention, an ED intervention combined with home visits, and enhanced usual care for children with uncontrolled asthma.
- To evaluate the impact of interventions on asthma control, patient-reported outcomes, and caregiver satisfaction.
Main Methods:
- A multicenter pragmatic clinical trial enrolled children aged 5-11 years with uncontrolled asthma.
- Primary outcomes included changes in the Asthma Impact Scale and caregiver Satisfaction with Participation in Social Roles over 6 months.
- Secondary outcomes assessed guideline-recommended ED discharge care and self-management behaviors.
Main Results:
- Recruitment was lower than expected, with 373 children enrolled and 63% completing follow-up.
- No significant differences were found in primary clinical outcomes between intervention and usual care groups.
- Guideline-recommended ED discharge care improved in intervention groups, and self-management improved in the ED-plus-home group.
Conclusions:
- ED-based interventions did not significantly improve primary asthma control outcomes, potentially due to underpowering.
- Improvements in guideline-recommended discharge care and self-management were observed but require further investigation for clinical impact.
- Further research is needed to understand the long-term effects of these interventions on children's asthma outcomes.
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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