Asthma Action at Erie Trial
Asthma prevalence and morbidity have 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. The burden of asthma falls heaviest on urban, low income, African American and Puerto Rican children.
Interventions to fight asthma and these disparities increasingly involve community health workers (CHWs). On the frontline of public health, these workers serve as liaisons between communities and the health and social service agencies that serve them to improve both access to care and quality of care while increasing cultural competence of service delivery.
The evidence on the efficacy of asthma interventions with these workers has been growing, but several critical gaps exist. The Asthma Action at Erie 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 test the ability of a CHW intervention with three important modifications to achieve asthma control in high-risk children:
- CHWs will be integrated into both the clinical and the home setting.
- A system for directly addressing mental health and psychosocial barriers will be provided.
- Only materials and equipment for trigger remediation that are supported by the current medical reimbursement system will be provided to participants.
This trial will provide clarity as to the expected effect size, cost savings, and resources needed to integrate asthma CHWs into clinical practice.
A two-arm, behavioral randomized controlled trial (N=220) will be conducted in partnership with Erie Family Health Center, a federally qualified health center (FQHC) that serves a low-income, minority population in Chicago 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.
The primary aims of this study are:
- 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% less days with activity limitation than the AE-C arm at 12-months.
- Assess maintenance of intervention efficacy, as demonstrated by asthma control at 18 and 24 months after randomization.
- 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.
- Assess the efficacy of the integrated CHW home asthma intervention relative to clinicbased AE-C education, as demonstrated by asthma control, among those experiencing depression, stress, and/or a post-traumatic stress disorder.