Childhood Asthma Program in NYC Health Department Clinics
Condition: Asthma; Lung Diseases
MeSH terms: Asthma; Lung Diseases
Study type: Observational

Summary: 
      To demonstrate that the New York City Department of Health Child Health Clinics could improve
      the health status of Black and Hispanic children with asthma by providing them with a
      comprehensive system of continuity of care that included pharmacologic treatment, family
      health education and community outreach.

      Recent studies have shown that lack of continuing primary care for asthma is associated with
      increased levels of morbidity in low-income minority children. Although effective preventive
      therapy is available, many African-American and Latino children receive episodic treatment
      for asthma that does not follow current guidelines for care. To see if access, continuity,
      and quality of care could be improved in pediatric clinics serving low-income children in New
      York City, we trained staff in New York City Bureau of Child Health clinics to provide
      continuing, preventive care for asthma.
    

Detailed description: 
      BACKGROUND:

      The study was part of a demonstration and education initiative "Interventions for Control of
      Asthma Among Black and Hispanic Children" which was released by the NHLBI in June 1989.

      DESIGN NARRATIVE:

      To develop this comprehensive care system, the investigators provided training for Health
      Department physicians and nurses in up-to-date methods of diagnosing asthma, and providing
      clinical care and health education to patients and families as part of a series of regular 20
      minute patient visits. Nurses and public health assistants were also trained to supplement
      this by teaching the Open Airways self-management program to groups of families. A 24-hour
      telephone advice service for families of asthma patients was staffed by trained Health
      Department physicians.

      The intervention was based on social cognitive theory, especially self-regulation. In Phase
      I, the Health Department medical and nursing staffs were taught by Columbia University
      faculty with reinforcement by Health Department physician and nurse supervisors.
      Self-regulation was fostered in physicians by use of an Asthma Visit Record and in families
      by use of an Asthma Diary. Seven pairs of matched clinics were randomized to be controls or
      receive the intervention. The following hypotheses were tested: that a comprehensive system
      of continuity of care, including medical care, family health education and community outreach
      would (1) increase staff confidence to diagnose and treat childhood asthma; (2) attract and
      retain families who had children with asthma in continuing care relationships in the Health
      Department clinics; and (3) improve the health status of patients and the quality of life of
      their families. Phase II tested whether this comprehensive system could be made
      self-sustaining within the Health Department by having physician and nurse super-visors who
      took part in Phase I teach the program to staff from a second set of matched clinics. This
      program had the potential to reach more than 5000 minority children with asthma. If
      successful it could be generalized to other health departments in the country.
    

Intervention name(s): Continuing, preventative care
Intervention type(s): Behavioral
Intervention description(s): Training for intervention clinic staff was based on National Asthma Education and Prevention Program guidelines for the diagnosis and management of asthma, and included screening to identify new cases and health education to improve family management.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Children with asthma in New York City