title: Reducing quality-of-care disparities in childhood asthma: La Red de Asma Infantil intervention in San Juan, Puerto Rico.
abstract: OBJECTIVE
  Although children living in Puerto Rico have the highest asthma prevalence of all US children, little is known regarding the quality-of-care disparities they experience nor the adaptability of existing asthma evidence-based interventions to reduce these disparities. The objective of this study was to describe our experience in reducing quality-of-care disparities among Puerto Rican children with asthma by adapting 2 existing evidence-based asthma interventions.
  
  
  METHODS
  We describe our experience in adapting and implementing 2 previously tested asthma evidence-based interventions: the Yes We Can program and the Inner-City Asthma Study intervention. We assessed the feasibility of combining key components of the 2 interventions to reduce asthma symptoms and estimated the potential cost savings associated with reductions in asthma-related hospitalizations and emergency department visits. A total of 117 children with moderate and severe asthma participated in the 12-month intervention in 2 housing projects in San Juan, Puerto Rico. A community-academic team with the necessary technical and cultural competences adapted and implemented the intervention.
  
  
  RESULTS
  Our case study revealed the feasibility of implementing the combined intervention, henceforth referred to as La Red intervention, in the selected Puerto Rican communities experiencing a disproportionately high level of asthma burden. After 1-year follow-up, La Red intervention significantly reduced asthma symptoms and exceeded reductions of the original interventions. Asthma-related hospitalizations and emergency department use, and their associated high costs, were also significantly reduced.
  
  
  CONCLUSIONS
  Asthma evidence-based interventions can be adapted to improve quality of care for children with asthma in a different cultural community setting.
authors: RAND Corporation, 1776 Main St, PO Box 2138, Santa Monica, CA 90407-2138, USA. lara@rand.org
authors: Marielena
authors: M
authors: Lara
authors: Gilberto
authors: G
authors: Ramos-Valencia
authors: Jesús A
authors: JA
authors: González-Gavillán
authors: Fernando
authors: F
authors: López-Malpica
authors: Beatriz
authors: B
authors: Morales-Reyes
authors: Heriberto
authors: H
authors: Marín
authors: Mario H
authors: MH
authors: Rodríguez-Sánchez
authors: Herman
authors: H
authors: Mitchell
mesh_terms: D016902:Air Pollution, Indoor / Q000009:adverse effects / Q000517:prevention & control; D000485:Allergens / Q000009:adverse effects; D001249:Asthma / Q000453:epidemiology / Q000628:therapy*; D002662:Child Health Services / Q000458:organization & administration*; D002675:Child, Preschool; D017046:Cost Savings; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D004781:Environmental Exposure / Q000009:adverse effects / Q000517:prevention & control; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education; D005102:Health Expenditures; D054624:Health Status Disparities; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009010:Monte Carlo Method; D011203:Poverty; D011647:Puerto Rico / Q000453:epidemiology; D011787:Quality of Health Care; D012648:Self Care; D012720:Severity of Illness Index
chemical_list: D000485:Allergens