MULTIDIMENSIONAL APPROACH TO INNER CITY PEDIATRIC ASTHMA

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DESCRIPTION (adapted from applicant's Abstract): Asthma morbidity and mortality, including rates of hospitalizations and emergency room (ER) visits have been rising dramatically in the U.S. over the last decade, particularly in minority, underserved populations. The applicants' proposed study will assess the effectiveness of two components, a bilingual asthma education intervention and an environmental intervention aimed at reducing pertinent avoidable aeroallergens in the home, on asthma-associated morbidity. The program will be targeted to inner-city asthmatic children (ages 4-12), who have moderate to severe disease, and their families. Eligible children will be recruited from the emergency department and inpatient services at Children's Medical Center (CMC) as well as from the inpatient services of Parkland Memorial Hospital (PMH), a physically-adjacent, 940-bed, county hospital. Children will be randomly assigned to a group that is to receive either primary care or "usual care" (no additional intervention), and those who are to receive primary care will undergo a secondary randomization based upon skin test results to avoidable aeroallergens. Following the establishment of primary care, skin test-negative children will be randomly assigned to a group that either does or does not receive the educational intervention. Skin test-positive children will be randomly assigned to one of four groups: primary care alone, primary care and an educational intervention, primary care and an environmental intervention, or primary care and both interventions. Primary care initially will be established at the CMC and will be provided by pediatric residents educated according to the National Asthma Education Program (NAEP) Asthma Management Guidelines. Subsequently, primary care will be transferred to one of the Parkland-affiliated Community Oriented Primary Care (COPC) Clinics near the patient's home. Outcomes to be assessed will include medical facility utilization, lung function, functional status, behavior as it relates to asthma, and self-management practices. While the investigators expect a modest degree of improvement in the children who receive primary care alone, the investigators expect marked improvement in those children who receive both the educational and environmental interventions. The applicants also intend to address social, psychological and economic factors, and health care delivery and management issues that contribute to the morbidity associated with asthma in this population.