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 - 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 -