The Community Asthma Prevention Program (CAPP) has a two-decade history of utilizing CHWs to improve asthma outcomes of children in Philadelphia. Building on this foundation, we established a network of stakeholders, The West Philadelphia Asthma Care Collaborative (WEPACC), with representation from public housing, healthcare, community, and schools. As a result of assessment of local needs, resource mapping, and months of planning, we designed an asthma care implementation program with the broad objective of integrating home, school, healthcare system, and community for school-aged asthmatic children in West Philadelphia. We will accomplish this goal using CHWs to deliver sustainable patient-centered evidence- based interventions. The evidence-based interventions include (1) a primary care-based Yes We Can intervention with home visitation and (2) a comprehensive and rigorously evaluated school-based intervention, Open Airways for schools and School Based Asthma Therapy. CHWs will function as the hub of each interventions, serving either as primary care CHWs or school CHWs to provide a network of education, care coordination support, and to facilitate communication for families of children with asthma between the four sectors. This project is innovative in that it seeks to integrate interventions in a comprehensive and sustainable manner to reduce asthma disparities in poor, minority children. Using a factorial design, we will recruit and randomize 600 asthmatic children (ages 6-12 years) from three inner-city primary care clinics who attend one of 23 West Philadelphia schools to one of four study conditions: both interventions (both primary care and school CHWs intervention), primary care CHW or school- CHW alone, or control and follow for one year. We will accomplish the following objectives:
Specific Aim 1. Compare effectiveness of the primary care and school interventions to improve asthma control and reduce symptom days using main and simple effects from the factorial design.
Specific Aim 2. Explore moderators and mechanisms of effectiveness and sustainability of the interventions.
Specific Aim 3. Use mixed methods to explore implementation determinants and outcomes of school intervention that promote effectiveness, fidelity and sustainability Specific Aim 4. Examine the costs, savings, and cost effectiveness associated with the intervention and implementation strategies to promote sustainability 1
This project uses community health workers or lay health educators to implement asthma interventions that have been proven to work in order to connect the caregiver, community, school and health sectors. The primary outcomes are asthma control, symptom days, school absenteeism.