Project ASTHMA - Aligning with Schools to Help Manage Asthma and Decrease Health Inequities

项目总结/文摘

PROJECT SUMMARY/ABSTRACT Multicomponent interventions delivered in school-based health centers (SBHCs) have the potential to decrease asthma morbidity in children from communities that experience health inequities. Asthma is the most common chronic disease in children. Black and Hispanic children from low-socioeconomic communities account for a disproportionate percentage of asthma exacerbations, emergency department (ED) visits, and hospitalizations. These children often do not receive guideline-based asthma care, and adherence to daily preventive asthma medication is poor. Traditional health service delivery models where care is received in physicians’ offices have limited success in improving asthma outcomes in vulnerable populations. This is attributable to multiple social determinants of health that interrupt consistent comprehensive care, including limited availability of health services, lack of transportation, and caregiver employment demands. As a result, these children often receive crisis-driven care rather than prevention-driven care. SBHCs can serve as a safety net for children living in poor communities and improve health outcomes. SBHCs are staffed by advanced practice providers (APPs) who can assess and manage diseases. There are therefore minimal costs to integrating an asthma management program within this existing health care delivery model. Project ASTHMA (Aligning with Schools To Help Manage Asthma) is a prospective, stepped wedge cluster randomized trial based on a successful pilot study, that aims to assess the effectiveness of SBHCs as a cost effective health care delivery model to reduce asthma symptoms, exacerbations, ED visits, and hospitalizations in children with uncontrolled asthma who live in communities with health inequities. The intervention will take place in SBHCs located in 10 Buffalo Public Schools. The APPs at the SBHCs randomized to Project ASTHMA that year will be trained and supported to deliver guideline-based chronic asthma care. Students enrolled in Project ASTHMA will receive asthma assessments and preventive medication management from the APPs, directly observed therapy of their preventive asthma medication from school nurses to support adherence, and self-management support to improve adherence to home doses of asthma medication. Students enrolled at the SBHCs randomized to the control that year will be in an enhanced usual care group who will receive an asthma assessment by the research team and then be referred to their primary care provider for assessment and medication management. SBHCs are a financially and clinically sustainable health care delivery model, and have the potential to substantially decrease inequities in asthma morbidity. If disseminated, Project ASTHMA has the potential to improve the health of children in high-poverty schools throughout the country. These improvements are likely to be cost-effective for state and county health departments because over 2,500 SBHCs already exist in hundreds of communities in the United States. Evidence generated through our findings can assist public health policymakers in determining priorities and allocating resources to SBHCs.