This application is one of four collaborative research proposals by investigators from Harlem Hospital Center and Columbia Presbyterian Medical Center (CPMC). In this proposal, three divisions of CPMC, i.e., Pulmonary, Allergy, and General Pediatrics, have joined together to study how best to improve the health status of minority children who make frequent visits to the emergency department (ED) for asthma care. In Phase 1 of the research we will conduct a case-control study of 300 children with asthma to learn why some families make frequent visits to the ED for asthma. We will compare children who make three or more ED visits for asthma per year with children who made ED visits for other conditions, but not for asthma to test the hypotheses that frequent use of ED services for asthma care is associated with (1) absence of a continuing relationship with a primary care provider; (2) severity of asthma; (3) lack of adequate medical therapy to control asthma at home or the knowledge to use it correctly; (4) exposure to allergens and irritants in the home; (5) social or demographic characteristics of the family; and (6) social disruption or stress experienced by the child's caretaker. In Phase 2 we will develop a model for reducing asthma morbidity in minority children by conducting pilot studies to determine the best method for enrolling and retaining families whose children make frequent ED visits into continuing primary care relationships delivered by the Ambulatory Care Network Corporation (ACNC), a pediatric faculty practice at CPMC. In Phase 3 we will undertake a controlled study of 150 children comparing a control group that receives usual ED care and referral practices with an experimental group that receives an intervention by a case manager/health educator to enroll and retain children in continuing primary care with ACNC. We hypothesize that children and their families in the experimental group will be more likely than controls to (1) enroll and remain in continuing care relationships, and (2) have improved health status and quality of life, as measured by reduced frequency of symptoms and ED visits, improved peak flow rates, improved self-management skill, and reduced disruption of family life.
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