title: Impact of asthma intervention in two elementary school-based health centers in the Bronx, New York City.
abstract: This study examines healthcare utilization over time in Bronx, New York schoolchildren with asthma who were previously identified via parent surveys in six elementary schools. Four of the schools have on-site school-based health centers (SBHCs), and two do not have on-site health services (control schools). At baseline, we reported an asthma prevalence of 20%, and high rates of emergency department (ED) use (46%) in the previous year. To determine if asthma morbidity (specifically, ED use, community provider use, and hospitalizations for asthma) could be reduced by incorporating an aggressive intervention at two schools with SBHCs, we prospectively followed children for up to 3 years. Parents were scheduled for interviews every 6 months, and were queried about their children's use of health services for asthma in the prior 6 months. In multivariate models, children in the two intervention SBHC schools were less likely to have visited a community provider for asthma (relative rate ratio, 0.52; 95% confidence interval (CI), 0.30-0.88) or an emergency department for asthma (odds ratio, 0.44; 95% CI, 0.14-1.38; P = 0.059) in the prior 6 months compared to children attending control schools. There was no difference in community provider use or emergency department use for asthma between children attending nonintervention SBHCs and control schools. However, school type did not affect asthma hospitalization rates, which declined in all groups. Our findings support the effectiveness of aggressive school-based asthma services provided by SBHCs to reduce asthma morbidity and complement community health services.
authors.affiliation: Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA. mwebber@montefiore.org
authors.forename: Mayris P
authors.initials: MP
authors.lastname: Webber
authors.forename: Anne-Marie E
authors.initials: AM
authors.lastname: Hoxie
authors.forename: Michelle
authors.initials: M
authors.lastname: Odlum
authors.forename: Tosan
authors.initials: T
authors.lastname: Oruwariye
authors.forename: Yungtai
authors.initials: Y
authors.lastname: Lo
authors.forename: David
authors.initials: D
authors.lastname: Appel
mesh_terms: D001249:Asthma / Q000453:epidemiology / Q000517:prevention & control*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D003153:Community Health Services / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009330:Nebulizers and Vaporizers / Q000706:statistics & numerical data; D009519:New York City / Q000453:epidemiology; D010290:Parents; D010353:Patient Education as Topic; D015995:Prevalence; D011446:Prospective Studies; D012572:School Health Services / Q000458:organization & administration*; D019037:Urban Health Services / Q000458:organization & administration; D014505:Urban Population
chemical_list: D001993:Bronchodilator Agents