This study will assess the morbidity due to asthma among an inner-city, minority population and will evaluate the effectiveness of an intensive educational program for asthmatic patients and their health care providers at four neighborhood health centers. Patients with moderate or severe asthma receiving their care at one of the participating health centers will be randomly assigned to one of three groups: education in the skills of asthma co-management; this same educational program with the addition of the use of home peak flow meters to self-monitoring lung function; and a control group receiving standard care. Asthmatic patients receiving their outpatient care in the General Medicine and Primary Care Division at the Brigham and Women's Hospital will serve as an additional control group. Health care providers at the neighborhood health centers will also receive education regarding modern concepts of asthma care, use of peak flow meters, and doctor-patient communication skills. The three primary outcomes to be assessed are: number of emergency room visits per year; number of asthma episodes in one month; and behavior compliance. Additional outcomes include level of lung function and global function status. The impact of the educational interventions will be monitored for one year of prospective analysis. We anticipate that asthma is a cause of serious morbidity among this target population, and we will explore the socioeconomic, medical, mental health, and health care delivery issues that contribute to this excessive morbidity. We further anticipate that our culturally appropriate interventions emphasizing patient-physician co- management skills will effectively reduce this observed morbidity; and the extent to which the use of home peak flow meters contributes to the educational intervention will be independently addressed. Finally, we will develop a model for collaboration between an academic medical institution and neighborhood health centers in the care of indigent, inner-city, minority patients.
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