SINAI Urban Health Institute

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Research / Evaluation


Project:Pediatric Asthma Initiatives

Project plan:
 
Phase 1
The Sinai Urban Health Institute in collaboration with Sinai Children’s Hospital began their first Pediatric Asthma Intervention (PAI -1) in July 2000 with a grant from the Michael Reese Health Trust. The purpose of PAI-1 was to compare 3 pediatric asthma interventions, with increasing intensities of asthma education at their base, for their impact on improving the health status of inner-city children with asthma and achieving cost-savings.
 
Study participants included children (1-16 years) with asthma who were randomized into three groups: Group One (G1) received a single, one-on-one asthma education session with a trained asthma educator; Group Two (G2) received the same initial asthma education session, but that education was reinforced on a monthly basis (via phone calls); Group Three (G3) received reinforced asthma education with the addition of case management. 
 
Key findings:
  • 165 children (78%) completed the 9 months of follow-up.
  • Participants in all 3 groups utilized significantly fewer emergency health care services for asthma in the follow-up year.
  •  Averaged across all 3 groups, the magnitude of the decline in utilization was enormous: 81% for hospitalizations, 64% for ED visits
  • The more intensive the intervention, the greater the degree of improvement: G3 consistently improved to a greater degree than G1 or G2.
  • All 3 interventions were associated with substantial cost-savings (~$4500/patient/year)
  • Findings of PAI clearly support the utility and cost-benefit associated with the combined provision of health education and case management services for pediatric asthma patients who are high utilizers of urgent healthcare services.
The entire study is available at:
Karnick P, Margellos-Anast H, Seals G, Whitman S, Aljadeff G, Johnson D. The Pediatric Asthma Intervention: A Comprehensive Cost-Effective Approach to Asthma Management in a Disadvantaged Inner-city Community. Journal of Asthma 2007; 44:39-44.
 
Phase 2:
Use of a Lay Health Education to Improve Asthma Management Among African American Children (PAI-2)
 
Building on the work of PAI -1, in 2004 we received pilot funding from Illinois Department of Public Health (IPDH) to develop, implement and evaluate an intervention intended to improve asthma management among African American children with severe asthma living in the inner-city.  The pilot project used Community Lay Health Educators (LHEs) as a means of intervening to reduce asthma morbidity and improve quality of life. The LHEs were recruited from targeted communities. Once trained, LHEs provided individualized asthma education during three home visits over a six month period. The LHE also served as a liaison between the family and the medical system. Participants were followed for one year. Seventy children participated in the pilot phase of this project.
 
Key Findings:
  • A significant decrease in symptom frequency was noted after participation in the intervention. Specifically, daytime symptoms decreased from 3.9 days over the past 2 weeks at the time of the baseline visit to 1.8 days (p<0.05) at the 12-month follow-up.  
  • Asthma-related urgent health resource utilization dropped two- to three-fold after participation in the intervention. For example, the average number of ED visits per participant decreased from 3.4 times in the year prior to the study to 0.9 in the year following (p < 0.05). 
  • Caregiver Quality of Life Scores improved significantly by month 6 and that improvement was maintained through month 12.  
  • Asthma-related knowledge improved, and the improvement was maintained through month 12
  • Proportion of caregivers reporting that their child was exposed to cigarette smoke at least twice/week decreased significantly from 65.9% at baseline to 38.3% by month 6 and 36.2% by month 12
 
Conclusion:
Individualized, one-on-one, asthma education provided by a trained, culturally competent, LHE in the home environment may prove an effective means of educating children with poorly controlled asthma and their families to better manage asthma.
 
Publications:
Contact information:

For more information regarding this project, please send an e-mail to Helen Margellos-Anast at suhi@sinai.org