title: Improving asthma management among African-American children via a community health worker model: findings from a Chicago-based pilot intervention.
abstract: OBJECTIVE
  Asthma affects 25-30% of children living in certain disadvantaged Chicago neighborhoods, a rate twice the national prevalence (13%). Children living in poor, minority communities tend to rely heavily on the emergency department (ED) for asthma care and are unlikely to be properly medicated or educated on asthma self-management. A pilot project implemented and evaluated a community health worker (CHW) model for its effectiveness in reducing asthma morbidity and improving the quality of life among African-American children living in disadvantaged Chicago neighborhoods.
  
  
  METHODS
  Trained CHWs from targeted communities provided individualized asthma education during three to four home visits over 6 months. The CHWs also served as liaisons between families and the medical system. Seventy children were enrolled into the pilot phase between 15 November 2004 and 15 July 2005, of which 96% were insured by Medicaid and 54% lived with a smoker. Prior to starting, the study was approved by an institutional review board. Data on 50 children (71.4%) who completed the entire 12-month evaluation phase were analyzed using a before and after study design.
  
  
  RESULTS
  Findings indicate improved asthma control. Specifically, symptom frequency was reduced by 35% and urgent health resource utilization by 75% between the pre- and post-intervention periods. Parental quality of life also improved by a level that was both clinically and statistically significant. Other important outcomes included improved asthma-related knowledge, decreased exposure to asthma triggers, and improved medical management. The intervention was also shown to be cost-effective, resulting in an estimated $5.58 saved per dollar spent on the intervention.
  
  
  CONCLUSIONS
  Findings suggest that individualized asthma education provided by a trained, culturally competent CHW is effective in improving asthma management among poorly controlled, inner-city children. Further studies are needed to affirm the findings and assess the model's generalizability.
authors.affiliation: Sinai Urban Health Institute, Sinai Health System, Chicago, IL 60608, USA. helen.margellos@sinai.org
authors.forename: Helen
authors.initials: H
authors.lastname: Margellos-Anast
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Gutierrez
authors.forename: Steven
authors.initials: S
authors.lastname: Whitman
mesh_terms: D000293:Adolescent; D001741:Black or African American; D001249:Asthma / Q000208:ethnology / Q000523:psychology / Q000628:therapy*; D017028:Caregivers / Q000523:psychology; D002641:Chicago; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services / Q000379:methods; D003150:Community Health Workers / Q000458:organization & administration*; D003362:Cost-Benefit Analysis; D019468:Disease Management; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D036501:Metered Dose Inhalers; D010353:Patient Education as Topic / Q000191:economics / Q000458:organization & administration*; D010865:Pilot Projects; D011203:Poverty; D011788:Quality of Life; D012648:Self Care; D020377:Self Efficacy; D012907:Smoking / Q000208:ethnology; D014481:United States; D014505:Urban Population