CHICAGO INNER CITY ASTHMA STUDY

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Data from NCICAS indicate that a multiplicity of risk factors interact to increase the severity of asthma in poor, urban minority children. Any intervention to reduce morbidity in this Medicaid-dependent population should not only be multifaceted but also reasonably priced. Therefore, the Chicago Inner-City Asthma Study (CICAS) proposes to identify a cost- effective intervention that will reduce asthma morbidity in 4- to 12-year- old minority/low-income urban children with severe/moderately severe asthma. Primary outcome measures are reduction in mean symptom days and cost-effectiveness. Secondary measures include other morbidity measures (reductions in hospitalization, unscheduled acute-care visits including to ER, and school absences); improved patient/caretaker knowledge of asthma management, medications, and use of delivery devices/peak flow meters; increased primary-care physicians' practice effectiveness and asthma-care knowledge (including written asthma management plans); improved communication between physician and patient/caretaker leading to greater adherence; decrease in indoor allergens; and a reduction in behavior problems. The CICAS will evaluate three HMO-based interventions and compare them to a control group (Group I) in which patients receive usual care. The intervention groups are designed on an add-on principle. Each succeeding group receives all the interventions of the previous group(s) plus one additional intervention. Eight physician-provider clinic sites affiliated with United Health Care of Illinois (an HMO that serves a large proportion of Chicago's Medicaid population) will be randomized to one of the four groups. Children/families from these sites will be screened and recruited for the study. Patients will receive skin testing and spirometry, and they/caretakers will complete various written assessments of asthma risk and asthma knowledge. Groups II-IV will receive patient education taught by a clinic-based asthma mentor, including the proper use of medications and devices. Primary-care physicians in these groups will participate in a case-based physician education program that will also stress use of asthma-care guidelines and written management plans. An inspector will visit homes of patients in Groups III and IV to assess environmental risk factors. Targeted interventions will be provided for patients who are dust-mite (e.g., pillow, mattress covers) or cockroach (extermination) sensitive. Selected patients in Group IV (those with behavioral or other intractable problems) will receive intensive case management. Throughout the interventions, patients will be monitored bimonthly by telephone. The asthma mentor will also play a key role in problem-solving in each clinic. A successful cost-effective intervention that reduces morbidity among inner-city minority children would be a significant health benefit, and it would provide economic relief to the overburdened urban healthcare system. The CICAS believes that its study design permits the determination of the most effective intervention that is also cost-effective.