Community Healthcare for Asthma Management and Prevention of Symptoms
Condition: Asthma
MeSH terms: Asthma
Study type: Interventional

Summary: 
      The purpose of this study is to systematically investigate across health center study sites
      participating in this study the process of adopting, integrating, implementing, and diffusing
      a minimum set of evidence-based interventions for the management of childhood asthma.
      Investigators hypothesized that an intervention that is evidence- and consensus-based (i.e.,
      minimum elements to be integrated into existing practice, dosing of each element) would be
      implemented effectively, as measured by health center performance improvement on child health
      outcomes, health care utilization, and other measures (e.g., avoidable costs).
    

Detailed description: 
      In this study, investigators combined childhood asthma counseling and environmental
      interventions proven effective in previous NIH-funded clinical trials, the National
      Cooperative Inner-City Asthma Study (NCICAS) and the Inner-City Asthma Study (ICAS), and a
      third study, Head-off Environmental Asthma in Louisiana (HEAL). These studies demonstrated
      that participant-tailored interventions reduce asthma morbidity. Through a process of
      consensus building, investigators adapted a hybrid of these interventions for use in primary
      care clinics located in medically underserved areas (FQHCs). Investigators recruited
      participants ages 5-12 years with poorly controlled, moderate-to-severe asthma to ensure
      comparability with previous studies. Unlike the earlier clinical trials, which limited
      eligibility to inner-city children in stable housing, CHAMPS enrolled participants regardless
      of housing situation (e.g., temporary/shared homes) and location (e.g., urban/rural).
      Investigators collaborated with 3 FQHCs in Arizona, Michigan, and Porto Rico to enroll
      children and implement the CHAMPS intervention but otherwise granted them discretion to make
      decisions about staffing, patient flow and other process determinations, while tracking what
      those entailed. Investigators also invited 3 additional FQHCs to recruit and enroll children
      in a comparison group that did not receive the intervention.

      The primary aim is to identify and understand barriers and solutions to the adaptation of an
      evidence-based asthma intervention at the system-level. The evaluation consists of
      determining how a system makes room for an intervention, identifying stakeholders to make it
      happen, documenting the process for replication, and monitoring processes and outcomes to
      ensure the integrity of the intervention remains intact. The process of implementation in the
      unique clinical settings presented by health centers will be described, including the
      facilitators and the barriers to the systematic adoption of an evidence-based childhood
      asthma intervention into routine practice. Of particular importance are those determinants
      related to in-home and community-based environmental risks, the limits of understanding on
      the part of parents and caretakers, and community-wide policies and practices that may create
      health risks.

      The secondary aim is to assess the effectiveness and cost-effectiveness of the evidence-based
      asthma intervention as implemented in health centers.

      The third and final aim is to develop a dissemination strategy and some tools for further
      take up of the intervention.
    

Intervention name(s): CHAMPS
Intervention type(s): Behavioral
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Evidence-based intervention; Implementation; Underserved communities