Improving childhood asthma outcomes in the United States: a blueprint for policy action.
OBJECTIVE
Asthma is increasingly being recognized as an important public health concern for children in the United States. Effective management of childhood asthma may require not only improving guideline-based therapeutic interventions, but also addressing social and physical environmental risk factors. The objective of this project was to create a blueprint for improvement of national policy in this area.


METHODS
A nominal group process with nationally recognized experts and leaders (referred to as "the committee") in childhood asthma.


RESULTS
The committee identified 11 policy recommendations (numbered in order below) in 2 broad categories: Improving Health Care Delivery and Financing, and Strengthening the Public Health Infrastructure. Recommendations regarding Improving Health Care Delivery and Financing include the development and implementation of quality-of-care standards in 1) primary care, 2) self-management education, and 3) case-management interventions, and the expansion of insurance coverage and benefit design by 4) extending continuous health insurance coverage for all children, 5) developing model insurance benefits packages for essential childhood asthma services, and 6) educating health care purchasers in how to use them. Recommendations for Strengthening the Public Health Infrastructure include public funding of asthma services that fall outside the insurance system through establishing 7) public health grants to foster asthma-friendly communities and 8) school-based asthma initiatives. 9) Launching a national asthma public education campaign, 10) developing a national asthma surveillance system, and 11) establishing a national agenda for asthma prevention research, with an emphasis on epidemiologic and behavioral sciences, are also recommended.


CONCLUSIONS
Implementing these recommendations will require coordination of activities at the national, state, and local community level, and within and outside the health care delivery system. With a further commitment of national and local resources, implementation of these recommendations will likely lead to improved child and family asthma outcomes in the United States. childhood asthma, health care policy, health care services.
Lara
Marielena
M
University of California-Los Angeles/RAND Program on Latino Children with Asthma: RAND Health, Santa Monica, California 90407-2138, USA. lara@rand.org
Rosenbaum
Sara
S
Rachelefsky
Gary
G
Nicholas
Will
W
Morton
Sally C
SC
Emont
Seth
S
Branch
Marian
M
Genovese
Barbara
B
Vaiana
Mary E
ME
Smith
Vernon
V
Wheeler
Lani
L
Platts-Mills
Thomas
T
Clark
Noreen
N
Lurie
Nicole
N
Weiss
Kevin B
KB
D026683:Advisory Committees; D001249:Asthma / Q000628:therapy*; D002648:Child; D006291:Health Policy; D006801:Humans; D017063:Outcome Assessment, Health Care; D014481:United States