The Asthma Neighborhood: Collaborative for Asthma Equity (CASE) in Children

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 DESCRIPTION (PROVIDED BY APPLICANT): Hartford, CT is a city of health disparity and inequity with high rates of poverty, unemployment and old housing stock. Hartford children (43% Hispanic (predominantly Puerto Rican) and 38% African American) suffer disproportionately from childhood asthma with high asthma morbidity. The goal of this planning grant is to create an Asthma Care Implementation Program (ACIP) that engages multiple asthma sectors in Hartford to maximize programmatic synergies and to conduct a community needs assessment, the results of which will be used to refine a clinical trial to evaluate the ACIP. The ACIP identifes children with asthma at risk for poor outcomes, is community-based, grounded in theory and uses electronic technology and community-based participatory research (CBPR) methodologies to create a cross-sector asthma care program. To achieve this goal, this planning grant will create the Hartford Collaborative for Asthma Equity (CASE) (the "Collaborative"), composed of researchers, families, children with asthma, schools, school-based health clinics, local pharmacy, primary care clinicians, asthma specialists, local and state health departments, community organizations, payers of medical services and housing operators. From each member's individual perspective, the Collaborative will create an asthma neighborhood that collectively supports families. Features of the asthma neighborhood include identifying children with asthma at high risk for poor outcomes; cross-sector, consistent asthma education; and creation of a communication/information sharing platform that includes the child's asthma treatment plan and medical services utilization data. Informed by secondary data and the results of the community needs assessment, the Collaborative will refine a clinical trial that integrates 4 evidence-based interventions (Easy Breathing, an asthma management program for primary care clinicians; a school-based asthma program; a Community Health worker home visitation program adapted to asthma; and Healthy Homes, a home environmental remediation program) into a new model of care for children at risk of poor asthma outcomes. We hypothesize that a cross-sector, integrated system of asthma care will decrease asthma ED visits, hospitalizations and school absences (primary outcomes), will be sustained, reproducible and reach large numbers of children with asthma (process outcomes) and will be effective both in African American and Hispanic/Puerto Rican children, two groups with high asthma morbidity. The specific aims are: 1) to create the Hartford Collaborative for Asthma Equity composed of diverse stakeholders, 2) to conduct a community needs assessment from multiple perspectives and 3) to use the results of the community needs assessment to refine a novel integrated program of care to achieve health equity. (End of Abstract)