Other

Background: Asthma continues to be a significant public health issue for children. The extent to which tailored evidence-based interventions address the needs of children at varied levels of risk in the community is unclear.

Objective: Using data from five impoverished communities with high levels of pediatric asthma morbidity, this study assessed morbidity outcomes associated with tailored evidence-based interventions after stratifying children for risk based on two variables that reflect control, severity, and behavior: hospitalizations and daily use of a controller medication.

Methods: A pre/post evaluation (n=721) was used to categorize and analyze change in outcomes for four groups of patients: patients with one or more hospitalizations in the past 12 months with or without a baseline controller medication use, and no hospitalizations in the past 12 months with or without baseline controller medication use.

Results: Patients with one or more hospitalizations in the past 12 months and no baseline controller use made the biggest gains in several areas, including the largest percent increase in daily controller medication usage and asthma action plans, and the largest decrease in days and nights of symptoms. However, other groups made larger gains in reducing school days missed and emergency department visits and increasing parent confidence, consistent with the notion that community-based interventions can help a diverse set of patients make progress.

Conclusion: Practitioners in low-income communities where there are varying levels of resources and disease severity can tailor interventions to each child's needs and make substantial gains in outcomes across a range of risk profiles.

While some interventions have been successful in improving the care of children with asthma, disparities in asthma outcomes persist. In 2012, after representatives from nearly 20 Federal organizations reviewed prior, available, and projected efforts to reduce disparities in asthma, they created a Coordinated Federal Action Plan to Reduce Racial and Ethnic Asthma Disparities (http://www.epa.gov/childrenstaskforce/federal_asthma_disparities_action_plan.pdf ), concluding that multiple risk factors contribute to the persistence of disparities. The Action Plan, a key activity of the President’s Task Force on Children’s Environmental Health Risks and Safety Risks, advises that substantial progress in reducing disparities will require research to design, execute and evaluate implementation programs that maximize synergies among all key sectors to create a system of care that focuses on children most in need and reaches them where they live, learn and play.

This FOA will support research that addresses the Federal Coordinated Action Plan. Investigators who participate in this Cooperative Agreement must have collaborations within their communities to create an Asthma Care Implementation Program (ACIP) that integrates interventions from at least four different sectors that contribute to the care of children with asthma: medical care, families, home environment, and the community. For the purposes of this FOA, community refers to organizations/institutions whose primary purpose is not medical care (e.g., school, library). The interventions must have demonstrated efficacy based on prior research and be well integrated. Nevertheless the design and analysis plan for the study must account for the relative contributions of the components of care that impact asthma outcomes as well as the importance of specific components of the process of implementation. By evaluating the implementation process in the ACIP, investigators should define the determinants of implementation outcomes that might be modified, if needed, to meet other communities' needs. The metrics for the implementation process that will be used by all ACIPs that participate in this Cooperative Agreement will be determined by a Steering Committee composed of the Program Directors/Principal Investigators PD(s)/PI(s). The Steering Committee will also create a report of Best Practices that incorporates the results of their research with respect to implementation and the potential for dissemination in other settings.

To ensure the initial design of the ACIP addresses the needs of relevant stakeholders, investigators must have performed a recent (within 24 months prior to the receipt date) formal community needs assessment either through an NHLBI funding opportunity (RFA-HL-15-028 ; U34) or any other alternative source of support. Because this FOA will support research to address disparities in asthma outcomes, investigators' ability to identify and engage children at highest risk for poor asthma outcomes and follow them will be essential. Given the importance of engaging collaborators to make the multi-sector interventions possible, investigators must also have obtained a commitment of resources (including in-kind resources) from each of the four sectors who will participate in the ACIP. It is anticipated that the commitments of the collaborators may affect the sustainability of the program which will also be evaluated within this FOA.

- See more at: http://grants.nih.gov/grants/guide/rfa-files/RFA-HL-17-001.html#sthash.y...