Asthma is the most common chronic disease of childhood, and despite evidence-based guidelines from the National Institutes of Health, overall morbidity from the disease has decreased only modestly. In addition, striking and unacceptable disparities in care and outcomes persist that disproportionately affect poor, urban, and minority children and adolescents. Addressing these disparities is a central priority for multiple federal agencies, local communities, parents and patients, and investigators. There are notable examples of evidence- based interventions that do reduce pediatric asthma morbidity and disparities. The validated IMPACT DC intervention, for example, has improved multiple measures of pediatric asthma care and outcomes in Washington, DC. Nevertheless, pediatric asthma morbidity in DC remains high, and further improving pediatric asthma care and outcomes in DC and elsewhere will require moving beyond the largely medical model of interventions and incorporating additional evidence-based interventions from the domains of medical care, family, home, and community. The overall goal of our proposed project is therefore to use a community driven process to integrate such interventions into a highly patient and family-centered program ready for rigorous subsequent validation as a reproducible means to improve asthma outcomes among vulnerable urban youth. The Asthma Care Implementation Program for the District of Columbia (ACIP-DC) will incorporate the existing IMPACT DC intervention, but will expand it by adding a Community Asthma Navigator (based on a Community Health Worker model) to coordinate multiple other ongoing patient services and by using an electronic care coordination platform to integrate those services. The ACIP-DC proposal is highly significant in that it will create a new and highly collaborative program ready for rigorous evaluation in a randomized trial. If efficacious in Washington DC, the program will then be ready for dissemination elsewhere as a means to address disparities in similar communities burdened with high pediatric asthma morbidity. In order to achieve our overall goal, we will pursue three specific aims: (1) we will partner with our Child Health Advocacy Institute to conduct a community needs assessment focused on understanding the existing network of care for DC's children at high risk of poor asthma outcomes through an iterative process of engaging a diverse group of local stakeholders; (2) informed by this needs assessment, we will create, pilot test, and modify ACIP-DC by integrating evidence-based interventions from the domains of medical care, family, home, and community; and (3) we will plan and pilot the elements of a rigorous protocol for the evaluation of ACIP-DC in a prospective, randomized, single-blind clinical trial that compares it to the IMPACT DC intervention alone (usual care). In pursuing this goal, the experienced research team will leverage its existing network of local collaborators, and will engage new ones as well. Key elements of ACIP-DC will be pilot tested, and the entire intervention will be scripted with a high fidelity checklist ready to serve as the basis for a clincal trial.
Asthma is the most common chronic disease of childhood, with striking disparities in care and outcomes that disproportionately affect at-risk urban youth. Existing interventions have had limited success in reducing overall morbidity. We will build upon our IMPACT DC model by pursuing a community driven process to integrate other evidence-based interventions into it, yielding a highly patient and family-centered program (Asthma Care Implementation Program for the District of Columbia), in which care will be coordinated by a Community Asthma Navigator.
