Registry and Screening Tool to Identify Children With Asthma Likely to Benefit From Home Assessment and Remediation
Condition: Asthma; Pediatric ALL; School Health Services; Registries; Medical Informatics; Home Visits; Housing Problems; Social Determinants of Health; Healthcare Disparity; Health Status Disparity
MeSH terms: Asthma
Study type: Interventional

Summary: 
      Recognizing a decline in pediatric primary care visits and immunizations rates, an increase
      in utilization of the emergency room and stagnating academic achievement, leaders of
      MetroHealth Medical Center and the Cleveland Metropolitan School District understood that an
      innovative delivery option would be required to meet the needs of their pediatric urban
      population. In the fall of 2013, with support from local and regional funders, they
      collaborated to open the first School Based Health Center in Cleveland. During its first
      year, the MetroHealth School Health Program provided primary care services to children in 98
      clinical care visits. Through an emphasis on population health and care coordination, the
      School Health Program has grew dramatically, completing over 2,400 visits in the 2017-2018
      school year at clinical sites in over 13 schools. The School Health Program has been
      successful in developing a care management model to improve the percentage of students who
      complete recommended preventive services including immunization and preventive visits. The
      investigators intend to apply and expand upon lessons learned to develop an effective multi
      component asthma care management model that includes (1) registry utilization (2) evidence
      based clinical care protocols (3) implementation of an Environmental Screening Tool (4)
      effective utilization of a Medical Legal Partnership (5) effective partnership with an
      environmental health justice community organization, Environmental Health Watch, for home
      assessment and remediation (6) utilization of a unique data sharing partnership between a
      large health system and school district to document health and educational outcomes.
    

Detailed description: 
      Students enrolled in the MetroHealth School Health Program (signed parental consent on file
      in electronic health record) and have a diagnosis of asthma on active problem list, or were
      seen in Emergency Department or Express Care in past 12 months for asthma related diagnosis,
      or have a rescue or controller inhaled medication on current medication list, will be
      considered for inclusion. Research staff will call families who meet inclusion criteria to
      discuss the study, determine interest in inclusion and obtain consent. Once enrolled baseline
      measures will be obtained, including level of asthma control and responses on the
      Environmental Screening Tool (EST) and the Community Advocacy Program Home Asthma Screening
      Tool (CAPHAST) (see CREST phone screening tool). Participants will then be randomized into
      two groups. The first group will receive regular care. The second group will receive the
      Asthma Home Assessment Intervention. Based on results of the screening tool and home
      assessments, participants will be placed into one of four groups (see CREST study design):
      GROUP A (no referral) GROUP B (home assessment only) GROUP C (home assessment and
      remediation) and GROUP D (medical legal partnership referral only) Participants randomized to
      regular care will be assessed for outcome measures at 3 and 6 months after randomization.
      Those randomized to the intervention arm will be assessed at 3 and 6 months after completion
      of intervention.
    

Intervention name(s): Home assessment; Home remediation; Referral to Medical Legal Partnership; Regular School Based Health Asthma Care
Intervention type(s): Other; Other; Other; Other
Intervention description(s): Home assessment for environmental hazards according to protocol established by Environmental Health Watch (Healthy Home Audit https://www.ehw.org/healthy-home-audit/); Low level home remediation according to previously established protocol (Kercsmar CM, Dearborn DG, Schluchter M, et al. Reduction in asthma morbidity in children as a result of home remediation aimed at moisture sources. Environ Health Perspect. 2006;114(10):1574-80); Medical Legal Partnership referral as described by the National Center for Medical Legal partnerships and others (Beck AF, Identifying and treating a substandard housing cluster using a medical-legal partnership. Pediatrics. 2012;130(5):831-838); Regular care in the School Health Program
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Students enrolled in the School Health Program with a diagnosis of asthma will be randomized into two groups. The first group will receive regular School Health asthma care. The second group will receive the Asthma Home Assessment Intervention. Based on results of the screening tool and home assessments, participants will be placed into one of four groups: GROUP A (no referral) GROUP B (home assessment only) GROUP C (home assessment and remediation) and GROUP D (medical legal partnership referral only) Home assessment and remediation follows Environmental Health Watch Healthy Homes model previously described. Medical Legal partnership referrals follow protocols consistent with medical legal partnerships previously prescribed.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: medical legal partnership; urban health services; urban health