title: Effects of pediatric asthma care coordination in underserved communities on parent perceptions of care and asthma-management confidence.
abstract: OBJECTIVE
  Disparities by race and socioeconomic status persist in pediatric asthma morbidity, mortality, and treatment. Improving parent/provider communication and parents' asthma-management confidence may result in better asthma control in vulnerable populations. The Merck Childhood Asthma Network, Inc. funded an initiative to implement medical-social care coordination to improve asthma outcomes at sites in four low-income, urban communities (Los Angeles, CA; Philadelphia, PA; Chicago, IL; and San Juan, PR.) As part of a cross-site evaluation of this effort, pre- post-program changes in parents' reports of asthma care and management were assessed.
  
  
  METHODS
  Across sites, 805 parents or other caregivers responded to a baseline survey that was repeated one year later following their child's participation in care coordination. Parents' asthma-management confidence, as well as their perceptions of provider access, trust, and communication, were measured with Likert scales. Linear mixed models were used to assess improvement in these variables, across and within sites, adjusting for sociodemographics.
  
  
  RESULTS
  Pooled across sites, the adjusted mean estimate for all outcomes showed a significant improvement (p <.05) from baseline to follow-up. Knowledge and Between-Provider Communication improved significantly (p <.05) within all four sites; Access improved significantly in Chicago, Philadelphia, and Puerto Rico; Trust improved significantly in Chicago, Los Angeles, and Philadelphia; and Patient-Provider Communication improved significantly in Philadelphia only.
  
  
  CONCLUSIONS
  Pediatric asthma care coordination, as implemented variously in diverse settings, was associated with improvement in parents' perceptions of asthma care and self-reported asthma-management knowledge and confidence. This positive impact on parents may help sustain care coordination's impact on children.
authors.affiliation: a School of Public Health, University of Michigan , Ann Arbor , MI , USA.
authors.forename: Mary R
authors.initials: MR
authors.lastname: Janevic
authors.affiliation: b Division of Allergy and Clinical Immunology , University of Michigan Medical School , Ann Arbor , MI , USA.
authors.forename: Alan P
authors.initials: AP
authors.lastname: Baptist
authors.affiliation: c Children's Hospital of Philadelphia , Philadelphia , PA , USA.
authors.forename: Tyra
authors.initials: T
authors.lastname: Bryant-Stephens
authors.affiliation: d Children's Hospital of Los Angeles, University of Southern California , Los Angeles , CA , USA.|e RAND Corporation , Santa Monica , CA , USA.
authors.forename: Marielena
authors.initials: M
authors.lastname: Lara
authors.affiliation: f University of Illinois at Chicago School of Public Health , Chicago , IL , USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Persky
authors.affiliation: g School of Public Health, University of Puerto Rico , San Juan , Puerto Rico.
authors.forename: Gilberto
authors.initials: G
authors.lastname: Ramos-Valencia
authors.affiliation: h Los Angeles Unified School District , Los Angeles , CA , USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Uyeda
authors.affiliation: a School of Public Health, University of Michigan , Ann Arbor , MI , USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hazan
authors.affiliation: a School of Public Health, University of Michigan , Ann Arbor , MI , USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Garrity
authors.affiliation: i Merck Childhood Asthma Network, Inc. , Washington, DC , USA.
authors.forename: Floyd J
authors.initials: FJ
authors.lastname: Malveaux
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003142:Communication; D003266:Continuity of Patient Care / Q000458:organization & administration* / Q000592:standards; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D010290:Parents / Q000523:psychology*; D017060:Patient Satisfaction; D010465:Perception; D011203:Poverty; D011368:Professional-Family Relations; D020377:Self Efficacy; D035502:Trust; D014481:United States; D014505:Urban Population
keywords: Education; management/control; prevention