title: Community Asthma Initiative to Improve Health Outcomes and Reduce Disparities Among Children with Asthma.
abstract: Black and Hispanic children are hospitalized with complications of asthma at much higher rates than white children. The Boston Children's Hospital Community Asthma Initiative (CAI) provides asthma case management and home visits for children from low-income neighborhoods in Boston, Massachusetts, to address racial/ethnic health disparities in pediatric asthma outcomes. CAI objectives were to evaluate 1) case management data by parent/guardian report for health outcomes and 2) hospital administrative data for comparison between intervention and comparison groups. Data from parent/guardian reports indicate that CAI decreased the number of children with any (one or more) asthma-related hospitalizations (decrease of 79% at 12 months) and any asthma-related emergency department visits (decrease of 56% at 12 months) among children served, most of whom were non-Hispanic black or Hispanic. Hospital administrative data also indicate that the number of asthma-related hospitalizations per child significantly decreased among CAI participants compared with a comparison group. The CAI model has been replicated in other cities and states with adaptations to local cultural and systems variations. Health outcome and cost data have been used to contribute to a business case to educate legislators and insurers about outcomes and costs for this enhanced approach to care. Strong partnerships with public health, community, and housing agencies have allowed CAI to leverage its outcomes to expand systemic changes locally and statewide to reduce asthma morbidity.
authors.affiliation: Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Woods
authors.forename: Urmi
authors.initials: U
authors.lastname: Bhaumik
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Sommer
authors.forename: Elaine
authors.initials: E
authors.lastname: Chan
authors.forename: Lindsay
authors.initials: L
authors.lastname: Tsopelas
authors.forename: Eric W
authors.initials: EW
authors.lastname: Fleegler
authors.forename: Margarita
authors.initials: M
authors.lastname: Lorenzi
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Klements
authors.forename: Deborah U
authors.initials: DU
authors.lastname: Dickerson
authors.forename: Shari
authors.initials: S
authors.lastname: Nethersole
authors.forename: Rick
authors.initials: R
authors.lastname: Dulin
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data; D001249:Asthma / Q000208:ethnology* / Q000517:prevention & control*; D002487:Centers for Disease Control and Prevention, U.S.; D002648:Child; D002675:Child, Preschool; D006293:Health Promotion; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008404:Massachusetts / Q000453:epidemiology; D015397:Program Evaluation; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology