The Asthma Action at Erie Trial

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 DESCRIPTION (provided by applicant): Asthma Action at Erie Trial Asthma prevalence and morbidity has been increasing among children over the last three decades despite significant advances in environmental control and asthma care. The annual costs for children with asthma range between $2.0 and $3.2 billion. Asthma morbidity and its associated costs are not borne equally; they are highest for urban, low income, African American and Puerto Rican children. Community health workers (CHWs) have been growing in popularity as a potential intervention to combat these asthma disparities. CHWs are frontline public health workers who serve as liaisons between health and social services and communities to facilitate access to services and improve the quality and cultural competence of service delivery. The evidence on CHW asthma intervention efficacy has been growing but several critical gaps still exist. The Asthma Action at Erie Trial will test the ability of a CHW intervention with three important modifications to achiev asthma control in high-risk children: 1) CHWs will be integrated into both the clinical and the home setting, 2) A system for directly addressing mental health and psychosocial barriers will be provided, and 3) Participants will be provided only materials and equipment for trigger remediation that are supported by the current medical reimbursement system. A two-arm behavioral randomized controlled trial (N=220) will be conducted in partnership with a federally- qualified health center (FQHC) serving a low income, minority population that is at high-risk for significant asthma morbidity. The intervention arm will receive an integrated CHW home intervention for pediatric asthma education. The comparison arm will received clinic-based certified asthma educator (AE-C) services. Primary Aim 1 is to assess the efficacy of the integrated CHW home asthma intervention, relative to clinic-based AE-C education over 12-months, as demonstrated by asthma control. We hypothesize that the CHW arm will have at least 30% fewer days with activity limitation than the AE-C arm at 12-months. Specific Aim 2 is to assess maintenance of intervention efficacy, as demonstrated by asthma control at 18 and 24 months after randomization. Specific Aim 3 is to determine the cost-effectiveness at 12-months of CHW and AE-C intervention delivery, and additional costs or savings related to asthma exacerbations at 12- and 24-months. Specific Aim 4 is to assess the efficacy of the integrated CHW home asthma intervention relative to clinic- based AE-C education, as demonstrated by asthma control, among those experiencing depression, stress, and/or a post-traumatic stress disorder. This trial compares the current best practice in asthma self- management education (AE-C services) to an integrated CHW home intervention in which the real-life challenges of patients and the health care system are taken fully into account. This trial will provide clarity a to the expected effect size, cost savings, and resources needed to integrate asthma CHWs into clinical practice. .