Comprehensive case management by a specially trained nurse and home environmental evaluation and intervention by trained personnel have been proposed as interventions which can reduce childhood asthma morbidity. Both of these, however, are of unproven benefit among urban asthmatic children of low-income families. Furthermore, the impact if these interventions, which require an initial financial investment by health care organizations, on health care costs has not been established. The applicants propose to conduct a randomized, controlled trial of the effectiveness and cost impact of (a) case management by a specially trained nurse and (b) a home environment control intervention among four- to twelve-year-old children with moderate-to-severe asthma receiving care in five inner-city neighborhood health centers and in the Pediatric Clinic of Boston City Hospital (BCH). Using a factorial design, subjects will be randomized to receive one, both, or neither intervention. The following specific questions will be addressed: (1) Does case management by a nurse with special training in asthma care, working in concert with the primary care clinician, result in decreased utilization of acute care (i.e., hospitalization, emergency department care, and unscheduled clinic visits), decreased school absenteeism, and increased quality of life? (2) Does a home environment control intervention implemented by trained personnel visiting the patient's home result in the outcomes listed for Aim 1? (3) Does the combination of both interventions provide additional benefit beyond that provided by either intervention alone? (4) To what extent do these interventions lead to sustained reductions in the concentrations of important indoor allergens in house dust? To what extent are these reductions correlated with improvement in clinical outcomes? (5) What is the impact of these two interventions, alone or in combination, on direct health care costs?

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Research Project--Cooperative Agreements (U01)
Project #
3U01AI039769-02S1
Application #
2833154
Study Section
Special Emphasis Panel (ZAI1 (31))
Project Start
1996-08-01
Project End
2000-07-31
Budget Start
1997-08-01
Budget End
1998-07-31
Support Year
2
Fiscal Year
1998
Total Cost
Indirect Cost
Name
Boston University
Department
Pediatrics
Type
Schools of Medicine
DUNS #
604483045
City
Boston
State
MA
Country
United States
Zip Code
02118
Pongracic, Jacqueline A; O'Connor, George T; Muilenberg, Michael L et al. (2010) Differential effects of outdoor versus indoor fungal spores on asthma morbidity in inner-city children. J Allergy Clin Immunol 125:593-9
Pongracic, Jacqueline Ann (2010) Asthma in adolescents living in the inner city. Adolesc Med State Art Rev 21:34-43, viii
Pongracic, Jacqueline A; Visness, Cynthia M; Gruchalla, Rebecca S et al. (2008) Effect of mouse allergen and rodent environmental intervention on asthma in inner-city children. Ann Allergy Asthma Immunol 101:35-41
O'Connor, George T; Neas, Lucas; Vaughn, Benjamin et al. (2008) Acute respiratory health effects of air pollution on children with asthma in US inner cities. J Allergy Clin Immunol 121:1133-1139.e1
Stout, James W; Visness, Cynthia M; Enright, Paul et al. (2006) Classification of asthma severity in children: the contribution of pulmonary function testing. Arch Pediatr Adolesc Med 160:844-50
Kattan, Meyer; Crain, Ellen F; Steinbach, Suzanne et al. (2006) A randomized clinical trial of clinician feedback to improve quality of care for inner-city children with asthma. Pediatrics 117:e1095-103
Gruchalla, Rebecca S; Pongracic, Jacqueline; Plaut, Marshall et al. (2005) Inner City Asthma Study: relationships among sensitivity, allergen exposure, and asthma morbidity. J Allergy Clin Immunol 115:478-85
Kattan, Meyer; Stearns, Sally C; Crain, Ellen F et al. (2005) Cost-effectiveness of a home-based environmental intervention for inner-city children with asthma. J Allergy Clin Immunol 116:1058-63
O'Connor, George T (2005) Allergen avoidance in asthma: what do we do now? J Allergy Clin Immunol 116:26-30
Wright, Rosalind J; Mitchell, Herman; Visness, Cynthia M et al. (2004) Community violence and asthma morbidity: the Inner-City Asthma Study. Am J Public Health 94:625-32

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