title: A randomized controlled trial of parental asthma coaching to improve outcomes among urban minority children.
abstract: OBJECTIVE
  To investigate whether asthma coaching decreases emergency department (ED) visits and hospitalizations and increases outpatient asthma monitoring visits.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Urban tertiary care children's hospital.
  
  
  METHODS
  Primary caregivers (hereafter referred to as parents) of children aged 2 to 10 years with asthma who have Medicaid insurance coverage and are urban residents who were attending the ED for acute asthma care.
  
  
  METHODS
  Eighteen months of participating in usual care (control group) vs receiving coaching focused on asthma home management, completion of periodic outpatient asthma monitoring visits, and development of a collaborative relationship with a primary care provider (intervention group).
  
  
  METHODS
  The primary outcome was ED visits. Secondary outcomes were hospitalizations and asthma monitoring visits (nonacute visits focused on asthma care). Outcomes were measured during the year before and 2 years after enrollment.
  
  
  RESULTS
  We included 120 intervention parents and 121 control parents. More children of coached parents had at least 1 asthma monitoring visit after enrollment (relative risk [RR], 1.21; 95% confidence interval [CI], 1.04-1.41), but proportions with at least 4 asthma monitoring visits during 2 years were low (20.0% in the intervention group vs 9.9% in the control group). Similar proportions of children in both study groups had at least 1 ED visit (59.2% in the intervention group vs 62.8% in the control group; RR, 0.94; 95% CI, 0.77-1.15) and at least 1 hospitalization (24.2% in the intervention group vs 26.4% in the control group; 0.91; 0.59-1.41) after enrollment. An ED visit after enrollment was more likely if an ED visit had occurred before enrollment (RR, 1.46; 95% CI, 1.16-1.86; adjusted for study group), but risk was similar in both study groups when adjusted for previous ED visits (1.02; 0.82-1.27).
  
  
  CONCLUSIONS
  This parental asthma coaching intervention increased outpatient asthma monitoring visits (although infrequent) but did not decrease ED visits.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00149500.
authors.affiliation: Pediatric Emergency Medicine, The Children's Hospital of Boston, Harvard Medical School, Boston, MA 02115, USA. kyle.nelson@childrens.harvard.edu
authors.forename: Kyle A
authors.initials: KA
authors.lastname: Nelson
authors.forename: Gabriele R
authors.initials: GR
authors.lastname: Highstein
authors.forename: Jane
authors.initials: J
authors.lastname: Garbutt
authors.forename: Kathryn
authors.initials: K
authors.lastname: Trinkaus
authors.forename: Edwin B
authors.initials: EB
authors.lastname: Fisher
authors.forename: Sharon R
authors.initials: SR
authors.lastname: Smith
authors.forename: Robert C
authors.initials: RC
authors.lastname: Strunk
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education / Q000379:methods*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D008913:Minority Groups / Q000193:education; D008991:Monitoring, Physiologic / Q000379:methods; D017063:Outcome Assessment, Health Care; D010290:Parents / Q000193:education*; D012016:Reference Values; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014505:Urban Population
chemical_list: D018927:Anti-Asthmatic Agents