A four-year project is proposed to evaluate the efficacy of a community- based intervention to improve asthma management for parents, children and health care providers. Forty-two (42) elementary schools in urban Baltimore and Washington, DC, will serve as recruitment sites and approximately 300 students with moderate to severe asthma will be enrolled. All participants will be enrolled in the A+ Asthma Program. Primary care practitioners of these students will be randomized to a minimal contact program or to the A+ asthma physician partnership. They will be offered a menu of educational offerings to improve their knowledge and skills. The primary outcome measure will be emergency care use. Secondary measures include physician practices, hospitalization, health care utilization, restricted activities, medication use, school absences and coping skills. The proposal addresses a very important topic and target population, asthma management in minority children. The research team is outstanding, with an admirable track record in the field and a strong relationship with the schools and community. They have an excellent opportunity to carry out this worthwhile study. The intervention involving the school, home, and physician is well designed, and the use of multiple educational modalities should facilitate implementation. The linkage with the emergency room for data collection is excellent. Further development of the physician educational tutorial and stronger data management procedures are needed. The Review Committee is very enthusiastic about the tremendous potential of this study to improve asthma management in inner-city children.
