Pediatric Asthma Care Coordination in Underserved Communities: A Quasiexperimental Study

Am J Public Health. 2016 Nov;106(11):2012-2018. doi: 10.2105/AJPH.2016.303373. Epub 2016 Sep 15.

Abstract

Objectives: To assess the effect of care coordination on asthma outcomes among children in underserved urban communities.

Methods: 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.

Results: 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.

Conclusions: Care coordination may improve pediatric asthma symptom control and reduce emergency department visits.

Policy implications: Expanding third-party reimbursement for care coordination services may help reduce pediatric asthma disparities.

MeSH terms

  • Adolescent
  • African Americans
  • Asthma / ethnology
  • Asthma / therapy*
  • Child
  • Child, Preschool
  • Disease Management*
  • Female
  • Health Services / statistics & numerical data*
  • Hispanic Americans
  • House Calls
  • Humans
  • Male
  • Medically Underserved Area*
  • Patient Education as Topic
  • Urban Population*