title: Pediatric Asthma Care Coordination in Underserved Communities: A Quasiexperimental Study.
abstract: To assess the effect of care coordination on asthma outcomes among children in underserved urban communities.
  
  
  
  We enrolled children, most of whom had very poorly or not well-controlled asthma, in medical-social care coordination programs in Los Angeles, California; Chicago, Illinois; Philadelphia, Pennsylvania; and San Juan, Puerto Rico in 2011 to 2014. Participants (n = 805; mean age = 7 years) were 60% male, 50% African American, and 42% Latino. We assessed asthma symptoms and health care utilization via parent interview at baseline and 12 months. To prevent overestimation of intervention effects, we constructed a comparison group using bootstrap resampling of matched control cases from previous pediatric asthma trials.
  
  
  
  At follow-up, intervention participants had 2.2 fewer symptom days per month (SD = 0.3; P < .01) and 1.9 fewer symptom nights per month (SD = 0.35; P < .01) than did the comparison group. The relative risk in the past year associated with the intervention was 0.63 (95% confidence interval [CI] = 0.45, 0.89) for an emergency department visit and 0.69 (95% CI = 0.47, 1.01) for hospitalization.
  
  
  
  Care coordination may improve pediatric asthma symptom control and reduce emergency department visits.
  
  
  
  Expanding third-party reimbursement for care coordination services may help reduce pediatric asthma disparities.
authors.affiliation: At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC.
authors.forename: Mary R
authors.initials: MR
authors.lastname: Janevic
authors.affiliation: At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC.
authors.forename: Shelley
authors.initials: S
authors.lastname: Stoll
authors.affiliation: At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC.
authors.forename: Margaret
authors.initials: M
authors.lastname: Wilkin
authors.affiliation: At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC.
authors.forename: Peter X K
authors.initials: PX
authors.lastname: Song
authors.affiliation: At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC.
authors.forename: Alan
authors.initials: A
authors.lastname: Baptist
authors.affiliation: At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC.
authors.forename: Marielena
authors.initials: M
authors.lastname: Lara
authors.affiliation: At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC.
authors.forename: Gilberto
authors.initials: G
authors.lastname: Ramos-Valencia
authors.affiliation: At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC.
authors.forename: Tyra
authors.initials: T
authors.lastname: Bryant-Stephens
authors.affiliation: At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC.
authors.forename: Victoria
authors.initials: V
authors.lastname: Persky
authors.affiliation: At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Uyeda
authors.affiliation: At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC.
authors.forename: Julie Kennedy
authors.initials: JK
authors.lastname: Lesch
authors.affiliation: At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC.
authors.forename: Wen
authors.initials: W
authors.lastname: Wang
authors.affiliation: At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC.
authors.forename: Floyd J
authors.initials: FJ
authors.lastname: Malveaux
mesh_terms: D000293:Adolescent; D001741:Black or African American; D001249:Asthma / Q000208:ethnology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006630:Hispanic or Latino; D006792:House Calls; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D010353:Patient Education as Topic; D014505:Urban Population