TY - JOUR
T1 - Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan
AU - CHICAGO Plan Consortium
AU - Krishnan, Jerry A.
AU - Margellos-Anast, Helen
AU - Kumar, Rajesh
AU - Africk, Joel J.
AU - Berbaum, Michael
AU - Bracken, Nina
AU - Chen, Yi Fan
AU - DeLisa, Julie
AU - Erwin, Kim
AU - Ignoffo, Stacy
AU - Illendula, Sai Dheeraj
AU - Kim, Hajwa
AU - Lohff, Cortland
AU - MacTavish, Tom
AU - Martin, Molly A.
AU - Mosnaim, Giselle S.
AU - Nguyen, Hannah
AU - Norell, Sarah
AU - Nyenhuis, Sharmilee M.
AU - Paik, S. Margaret
AU - Pittsenbarger, Zachary
AU - Press, Valerie G.
AU - Sculley, Jennifer
AU - Thompson, Trevonne M.
AU - Zun, Leslie
AU - Gerald, Lynn B.
AU - McDermott, Michael
AU - Ali, Sana
AU - Flores, Janet
AU - Gantiwala, Shahina
AU - Goralski, Carmen
AU - Ortega, Jacqueline
AU - Wilson, Isabelle
AU - MacTavish, Thomas
AU - Damitz, Maureen
AU - Massaquoi, David
AU - Soyemi, Kenneth
AU - Senko, Thomas
AU - Thompson, Trevonne
AU - McMahon, Kate
AU - Africk, Joel
AU - O'Rourke, Amy
AU - Codispoti, Christopher
AU - Kramer, Jane
AU - Malik, Rabia
AU - Manning, Pamela
AU - Mosnaim, Giselle
AU - Avila, Jeanette
AU - Padron, Fatima
AU - Ramsay, Jessica
N1 - Funding Information:
The CHICAGO plan was funded by a Patient-Centered Outcomes Research Institute (PCORI) contract (AS-1307-05420); the plan was also partially funded by the University of Illinois Chicago Center for Clinical and Translational Science and an award from the National Institutes of Health (NIH) National Center for Advancing Translational Sciences (grant UL1TR002003). The statements in this report are solely the responsibility of the authors and do not necessarily represent the views of PCORI or NIH, the PCORI Board of Governors, or the PCORI Methodology Committee.
Publisher Copyright:
© 2023 The Author(s)
PY - 2023/8
Y1 - 2023/8
N2 - 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.
AB - 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.
KW - Pragmatic clinical trial
KW - asthma
KW - community health worker
KW - emergency department
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U2 - 10.1016/j.jacig.2023.100100
DO - 10.1016/j.jacig.2023.100100
M3 - Article
AN - SCOPUS:85164807698
SN - 2772-8293
VL - 2
JO - Journal of Allergy and Clinical Immunology: Global
JF - Journal of Allergy and Clinical Immunology: Global
IS - 3
M1 - 100100
ER -