West Philadelphia Controls Asthma
Condition: Childhood Asthma; Community Health Workers
MeSH terms: Asthma
Study type: Interventional

Summary: 
      This project uses community health workers (CHW) or lay health educators to implement asthma
      interventions that have been proven to work in the primary care setting and in schools. The
      objective is to integrate the home, school, healthcare system, and community for 640
      school-aged asthmatic children in West Philadelphia through use of CHWs.

      The children enrolled in the study will be randomized to one of four groups including:
      primary care CHW, school CHW, primary care and school CHW or the control group (no CHW).
    

Detailed description: 
      The Community Asthma Prevention Program (CAPP) at the Children's Hospital of Philadelphia has
      a two-decade history of utilizing CHWs to improve asthma outcomes of children in
      Philadelphia. Building on this foundation, a network of stakeholders was established
      including, The West Philadelphia Asthma Care Collaborative (WEPACC), with representation from
      public housing, healthcare, community, and schools. As a result of assessment of local needs,
      resource mapping, and months of planning, Investigators designed an asthma care
      implementation program with the broad objective of integrating home, school, healthcare
      system, and community for school-aged asthmatic children in West Philadelphia. Investigators
      seek to accomplish this goal using CHWs to deliver sustainable patient-centered
      evidence-based interventions. The evidence-based interventions include (1) a primary
      care-based Yes We Can intervention with home visitation and (2) a comprehensive and
      rigorously evaluated school-based intervention, Open Airways for schools and School Based
      Asthma Therapy. CHWs will function as the hub of each interventions, serving either as
      primary care CHWs or school CHWs to provide a network of education, care coordination
      support, and to facilitate communication for families of children with asthma between the
      four sectors. This project seeks to integrate interventions in a comprehensive and
      sustainable manner to reduce asthma disparities in poor, minority children.

      Using a factorial design, Investigators will recruit and randomize 640 asthmatic children
      (ages 5-13 years) from up to five inner-city primary care clinics who attend one of 36 West
      Philadelphia schools to one of four study conditions: both interventions (both primary care
      and school CHWs intervention), primary care CHW or school-CHW alone, or control and follow
      for one year. As a part of this project the Investigators seek to accomplish the following
      objectives:

      Objective 1. Compare effectiveness of the primary care and school interventions to improve
      asthma control and reduce symptom days using main and simple effects from the factorial
      design.

      Objective 2. Explore moderators and mechanisms of effectiveness and sustainability of the
      interventions.

      Objective 3. Use mixed methods to explore implementation determinants and outcomes of school
      intervention that promote effectiveness, fidelity and sustainability

      Objective 4. Examine the costs, savings, and cost effectiveness associated with the
      intervention and implementation strategies to promote sustainability.
    

Intervention name(s): Yes We Can Children's Asthma Program; School-Based Asthma Therapy; Open Airways for School Plus
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): The Yes We Can Children's Asthma Program intervention is a medical-social model based on a chronic care approach, including risk stratification, clinical care management, social care coordination by a community health worker, and primary care physician asthma champions. This intervention includes asthma education, trigger reduction visits and care coordination. There will be five clinic visits and four home visits over 12 months implemented by the primary care CHW who is integrated into the primary care practice.; School-Based Asthma Therapy includes enhanced care coordination for prescribed daily controller medication. The school nurse will coordinate with teachers and the school CHW to schedule daily controller asthma medication administration. The school CHW will assist in obtaining a current asthma care plan and medication administration form from the primary care provider.; Open Airways for Schools Plus was designed to improve the asthma self-management skills in children and enhance control of asthma in the school. The school intervention includes:
Open Airways for Schools curriculum for all students with asthma. Classes will be conducted by the school CHW once each semester.
Environmental classroom assessments conducted by school CHWs for students enrolled in the study. These teachers will receive classroom supplies to create a more asthma-friendly classroom environment.
Asthma education for school staff/personnel at the start of each school year.
School facility walk-through assessments to detect potential environmental asthma triggers will be conducted by the School District of Philadelphia.
Other intervention name(s): Primary Care Intervention; Primary Care and School Intervention (Partner School); School Intervention (Partner School)
Allocation: Randomized
Intervention model: Factorial Assignment
Intervention model description: A factorial design has enhanced statistical power and can handle cluster randomization of schools. Statistical methods will be used to estimate variation in the effect across schools over time. Linear mixed effects models with random intercepts and slopes for school, and fixed effects for the school-level intervention, time, and time-by-intervention interaction will be applied. Second, marginal models using generalized estimating equations will produce robust estimates that adjust for clustering at the school level. Third, assumption-free, randomization-test-based methods do not rely on assumptions of parametric models. Investigators will use conventional levels of statistical significance (p=0.05) for all pre-specified comparisons for our objectives. Variability of the intervention effect across schools will reflect consistency of intervention effects and thus generalizability in new settings. Both mixed effects models and permutation-test methods will estimate variance components.
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: asthma disparities; community health worker; childhood asthma