This 3-year, multi-site intervention study focuses on the translation of effective and affordable methods to bring a chronic care model to the primary care of poor, minority, inner- city children with asthma who are at great risk of the worst outcomes for the leading chronic disease of children.
The specific aims are to: 1) develop a method to deliver peer-driven, patient-linked Guideline prompts at the point of care using affordable information technology; 2) evaluate the effect of a peer-driven, patient-linked Guideline prompt system on the process and outcomes (symptom control, health-related-quality-of life, emergency department and hospitalizations for asthma) of pediatric asthma care; and 3) evaluate the additional effect on patient outcomes of a family-focused, supportive educational intervention delivered by a community health worker. The project also supports the development of an organizational environment capable of delivering chronic care including the development of a computer support system. The key product of the system is a guideline prompt that serves as the mechanism for integrating patient specific data with standards of care. Six hundred nine (609) children, ages 5-18, with physician diagnosed asthma, enrolled in one Medicaid Managed Care Organization in Connecticut, and receiving care at one of four Federally Qualified Community Health Centers will be recruited. All sites will have access to the computer support system the to-be- developed, Guideline-Driven Clinical Standards of Asthma Care. In Phase I (12 months), the effect of Guideline prompts delivered at the point of care on patient outcomes will be compared to the effect of no-prompt care. In Phase II (6 months), the effect of a family-focused, supportive educational intervention delivered by a community health worker will be assessed in combination with prompted care compared to no-prompt care and compared to no education. All patients will receive standard screening and outreach to keep appointments. Data will be obtained from medical records, medical and pharmacy claims data as well as patient and parent interviews at baseline and quarterly for 18 months.
| Fifield, Judith; McQuillan, Julia; Martin-Peele, Melanie et al. (2010) Improving pediatric asthma control among minority children participating in medicaid: providing practice redesign support to deliver a chronic care model. J Asthma 47:718-27 |
