We propose to demonstrate that the New York City Department of Health Child Health Clinics can improve the health status of Black and Hispanic children with asthma by providing them with a comprehensive system of continuity of care that includes pharmacologic treatment, family health education and community outreach. To develop this comprehensive care system, we will provide training for Health Department physicians and nurses in up-to-date methods of diagnosing asthma, and providing clinical care and health education to patients and families as part of a series of regular 20 minute patient visits. Nurses and public health assistants will also be trained to supplement this by teaching our Open Airways self-management program to groups of families. A 24-hour telephone advice service for families of asthma patients will be staffed by trained Health Department physicians. The intervention will be based on social cognitive theory, especially self-regulation. In Phase I, the Health Department medical and nursing staff will be taught by Columbia University faculty with reinforcement by Health Department physician and nurse supervisors. Self-regulation will be fostered in physicians by use of an Asthma Visit Record and in families by use of an Asthma Diary. Seven pairs of matched clinics will be randomized to be controls or receive the intervention. We will test the following hypotheses: that a comprehensive system of continuity of care, including medical care, family health education and community outreach will (1) increase staff confidence to diagnose and treat childhood asthma; (2) attract and retain families who have children with asthma in continuing care relationships in the Health Department clinics; and (3) improve the health status of patients and the quality of life of their families. Phase II will test whether this comprehensive system can be made self-sustaining within the Health Department by having physician and nurse super-visors who took part in Phase I teach the program to staff from a second set of matched clinics. This program has the potential to reach > 5000 minority children with asthma. If successful it could be generalized to other health departments in the country.
