Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan
Background: Evidence-based strategies to improve outcomes in minority children with uncontrolled asthma discharged from the emergency department (ED) are needed. Objectives: This multicenter pragmatic clinical trial was designed to compare an ED-only intervention (decision support tool), an ED-only...
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-08-01
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| Series: | Journal of Allergy and Clinical Immunology: Global |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772829323000255 |
| _version_ | 1797745991914356736 |
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| author | Jerry A. Krishnan, MD, PhD Helen Margellos-Anast, MPH Rajesh Kumar, MD Joel J. Africk, JD Michael Berbaum, PhD Nina Bracken, MSN, NP Yi-Fan Chen, PhD Julie DeLisa, MA Kim Erwin, MDes Stacy Ignoffo, MSW Sai Dheeraj Illendula, MS Hajwa Kim, MS Cortland Lohff, MD, MPH Tom MacTavish, MLIS Molly A. Martin, MD, MAPP Giselle S. Mosnaim, MD, MS Hannah Nguyen, MPH Sarah Norell, MDes, MFA Sharmilee M. Nyenhuis, MD S. Margaret Paik, MD Zachary Pittsenbarger, MD Valerie G. Press, MD, MPH Jennifer Sculley, MDes Trevonne M. Thompson, MD Leslie Zun, MD, MBA Lynn B. Gerald, PhD, MSPH Michael McDermott, MD Sana Ali Janet Flores Shahina Gantiwala Carmen Goralski Rajesh Kumar Jacqueline Ortega Zachary Pittsenbarger Isabelle Wilson Cortland Lohff Michael McDermott Kim Erwin Thomas MacTavish Sarah Norell Maureen Damitz David Massaquoi Kenneth Soyemi Thomas Senko Trevonne Thompson Kate McMahon Joel Africk Amy O’Rourke Christopher Codispoti Jane Kramer Rabia Malik Pamela Manning Giselle Mosnaim Jeanette Avila Helen Margellos-Anast Fatima Padron Jessica Ramsay Nazia Saiyed Tala Schwindt Gloria Seals Leslie Zun Susannah Butters Ashley Hull John Kim S. Margaret Paik Valerie Press Crystal Stevenson Nicole Twu Nicole Woodrick Michael Berbaum Nina Bracken Jennifer Buenrostro Lauren Castro Yi-Fan Chen Julie DeLisa David De La Torre-Dorado Dameka Edwards Alexander Frye Maciej Grabarek Sai Dheeraj Illendula Hajwa Kim Jerry Krishnan Molly Martin Melissa Morales- Perez Hannah Nguyen Sharmilee Nyenhuis Jennifer Sculley Bruce Bender, PhD Francine Ducharme, MD Sheri Hurdle Xue Li, PhD Sande Okelo, MD, PhD |
| author_facet | Jerry A. Krishnan, MD, PhD Helen Margellos-Anast, MPH Rajesh Kumar, MD Joel J. Africk, JD Michael Berbaum, PhD Nina Bracken, MSN, NP Yi-Fan Chen, PhD Julie DeLisa, MA Kim Erwin, MDes Stacy Ignoffo, MSW Sai Dheeraj Illendula, MS Hajwa Kim, MS Cortland Lohff, MD, MPH Tom MacTavish, MLIS Molly A. Martin, MD, MAPP Giselle S. Mosnaim, MD, MS Hannah Nguyen, MPH Sarah Norell, MDes, MFA Sharmilee M. Nyenhuis, MD S. Margaret Paik, MD Zachary Pittsenbarger, MD Valerie G. Press, MD, MPH Jennifer Sculley, MDes Trevonne M. Thompson, MD Leslie Zun, MD, MBA Lynn B. Gerald, PhD, MSPH Michael McDermott, MD Sana Ali Janet Flores Shahina Gantiwala Carmen Goralski Rajesh Kumar Jacqueline Ortega Zachary Pittsenbarger Isabelle Wilson Cortland Lohff Michael McDermott Kim Erwin Thomas MacTavish Sarah Norell Maureen Damitz David Massaquoi Kenneth Soyemi Thomas Senko Trevonne Thompson Kate McMahon Joel Africk Amy O’Rourke Christopher Codispoti Jane Kramer Rabia Malik Pamela Manning Giselle Mosnaim Jeanette Avila Helen Margellos-Anast Fatima Padron Jessica Ramsay Nazia Saiyed Tala Schwindt Gloria Seals Leslie Zun Susannah Butters Ashley Hull John Kim S. Margaret Paik Valerie Press Crystal Stevenson Nicole Twu Nicole Woodrick Michael Berbaum Nina Bracken Jennifer Buenrostro Lauren Castro Yi-Fan Chen Julie DeLisa David De La Torre-Dorado Dameka Edwards Alexander Frye Maciej Grabarek Sai Dheeraj Illendula Hajwa Kim Jerry Krishnan Molly Martin Melissa Morales- Perez Hannah Nguyen Sharmilee Nyenhuis Jennifer Sculley Bruce Bender, PhD Francine Ducharme, MD Sheri Hurdle Xue Li, PhD Sande Okelo, MD, PhD |
| author_sort | Jerry A. Krishnan, MD, PhD |
| collection | DOAJ |
| description | Background: Evidence-based strategies to improve outcomes in minority children with uncontrolled asthma discharged from the emergency department (ED) are needed. Objectives: This multicenter pragmatic clinical trial was designed to compare an ED-only intervention (decision support tool), an ED-only intervention and home visits by community health workers for 6 months (ED-plus-home), and enhanced usual care (UC). Methods: Children aged 5 to 11 years with uncontrolled asthma were enrolled. The change over 6 months in the Patient-Reported Outcomes Measurement Information System Asthma Impact Scale score in children and Satisfaction with Participation in Social Roles score in caregivers were the primary outcomes. The secondary outcomes included guideline-recommended ED discharge care and self-management. Results: Recruitment was significantly lower than expected (373 vs 640 expected). Of the 373 children (64% Black and 31% Latino children), only 63% completed the 6-month follow-up visit. In multivariable analyses that accounted for missing data, the adjusted odds ratios and 98% CIs for differences in Asthma Impact Scores or caregivers’ Satisfaction with Participation in Social Roles scores were not significant. However, guideline-recommended ED discharge care was significantly improved in the intervention groups versus in the UC group, and self-management behaviors were significantly improved in the ED-plus-home group versus in the ED-only and UC groups. Conclusions: The ED-based interventions did not significantly improve the primary clinical outcomes, although the study was likely underpowered. Although guideline-recommended ED discharge care and self-management did improve, their effect on clinical outcomes needs further study. |
| first_indexed | 2024-03-12T15:30:43Z |
| format | Article |
| id | doaj.art-a2e31eeee44c43ab803ff0dfe0ba529e |
| institution | Directory Open Access Journal |
| issn | 2772-8293 |
| language | English |
| last_indexed | 2024-03-12T15:30:43Z |
| publishDate | 2023-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Allergy and Clinical Immunology: Global |
| spelling | doaj.art-a2e31eeee44c43ab803ff0dfe0ba529e2023-08-10T04:35:07ZengElsevierJournal of Allergy and Clinical Immunology: Global2772-82932023-08-0123100100Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) planJerry A. Krishnan, MD, PhD0Helen Margellos-Anast, MPH1Rajesh Kumar, MD2Joel J. Africk, JD3Michael Berbaum, PhD4Nina Bracken, MSN, NP5Yi-Fan Chen, PhD6Julie DeLisa, MA7Kim Erwin, MDes8Stacy Ignoffo, MSW9Sai Dheeraj Illendula, MS10Hajwa Kim, MS11Cortland Lohff, MD, MPH12Tom MacTavish, MLIS13Molly A. Martin, MD, MAPP14Giselle S. Mosnaim, MD, MS15Hannah Nguyen, MPH16Sarah Norell, MDes, MFA17Sharmilee M. Nyenhuis, MD18S. Margaret Paik, MD19Zachary Pittsenbarger, MD20Valerie G. Press, MD, MPH21Jennifer Sculley, MDes22Trevonne M. Thompson, MD23Leslie Zun, MD, MBA24Lynn B. Gerald, PhD, MSPH25Michael McDermott, MD26Sana AliJanet FloresShahina GantiwalaCarmen GoralskiRajesh KumarJacqueline OrtegaZachary PittsenbargerIsabelle WilsonCortland LohffMichael McDermottKim ErwinThomas MacTavishSarah NorellMaureen DamitzDavid MassaquoiKenneth SoyemiThomas SenkoTrevonne ThompsonKate McMahonJoel AfrickAmy O’RourkeChristopher CodispotiJane KramerRabia MalikPamela ManningGiselle MosnaimJeanette AvilaHelen Margellos-AnastFatima PadronJessica RamsayNazia SaiyedTala SchwindtGloria SealsLeslie ZunSusannah ButtersAshley HullJohn KimS. Margaret PaikValerie PressCrystal StevensonNicole TwuNicole WoodrickMichael BerbaumNina BrackenJennifer BuenrostroLauren CastroYi-Fan ChenJulie DeLisaDavid De La Torre-DoradoDameka EdwardsAlexander FryeMaciej GrabarekSai Dheeraj IllendulaHajwa KimJerry KrishnanMolly MartinMelissa Morales- PerezHannah NguyenSharmilee NyenhuisJennifer SculleyBruce Bender, PhDFrancine Ducharme, MDSheri HurdleXue Li, PhDSande Okelo, MD, PhDOffice of the Vice Chancellor for Health Affairs, University of Illinois Chicago, Chicago, Ill; Department of Medicine, University of Illinois Chicago, Chicago, IllSinai Urban Health Institute, Sinai Health System, Chicago, IllDepartment of Pediatrics, Northwestern University and Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IllRespiratory Health Association, Chicago, IllCenter for Clinical and Translational Science, University of Illinois Chicago, Chicago, IllDepartment of Medicine, University of Illinois Chicago, Chicago, IllCenter for Clinical and Translational Science, University of Illinois Chicago, Chicago, IllDepartment of Medicine, University of Illinois Chicago, Chicago, IllOffice of the Vice Chancellor for Health Affairs, University of Illinois Chicago, Chicago, IllSinai Urban Health Institute, Sinai Health System, Chicago, IllDepartment of Medicine, University of Illinois Chicago, Chicago, IllCenter for Clinical and Translational Science, University of Illinois Chicago, Chicago, IllChicago Department of Public Health, Chicago, IllInstitute of Design, Illinois Institute of Technology, Chicago, IllDepartment of Pediatrics, University of Illinois Chicago, Chicago, IllDepartment of Medicine, NorthShore University Health System, Chicago, IllDepartment of Medicine, University of Illinois Chicago, Chicago, IllOffice of the Vice Chancellor for Health Affairs, University of Illinois Chicago, Chicago, IllDepartment of Pediatrics, University of Chicago Medicine Comer Children's Hospital, Chicago, IllDepartment of Pediatrics, University of Chicago Medicine Comer Children's Hospital, Chicago, IllDepartment of Pediatrics, Northwestern University and Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IllDepartment of Pediatrics, University of Chicago Medicine Comer Children's Hospital, Chicago, Ill; Department of Medicine, University of Chicago Medicine, Chicago, IllOffice of the Vice Chancellor for Health Affairs, University of Illinois Chicago, Chicago, IllDepartment of Emergency Medicine, Cook County Health and Hospitals System, Chicago, Ill; Department of Emergency Medicine, University of Illinois Chicago, Chicago, IllDepartment of Emergency Medicine and Psychiatry, Rosalind Franklin University of Medicine and Science, Chicago Medical School, Chicago, IllOffice of the Vice Chancellor for Health Affairs, University of Illinois Chicago, Chicago, Ill; Department of Medicine, University of Illinois Chicago, Chicago, Ill; Corresponding author: Lynn B. Gerald, PhD, MSPH, University of Illinois Chicago,1220 S Wood Street, Chicago, IL 60608.Illinois Emergency Department Asthma Surveillance Project, Chicago, IllBackground: Evidence-based strategies to improve outcomes in minority children with uncontrolled asthma discharged from the emergency department (ED) are needed. Objectives: This multicenter pragmatic clinical trial was designed to compare an ED-only intervention (decision support tool), an ED-only intervention and home visits by community health workers for 6 months (ED-plus-home), and enhanced usual care (UC). Methods: Children aged 5 to 11 years with uncontrolled asthma were enrolled. The change over 6 months in the Patient-Reported Outcomes Measurement Information System Asthma Impact Scale score in children and Satisfaction with Participation in Social Roles score in caregivers were the primary outcomes. The secondary outcomes included guideline-recommended ED discharge care and self-management. Results: Recruitment was significantly lower than expected (373 vs 640 expected). Of the 373 children (64% Black and 31% Latino children), only 63% completed the 6-month follow-up visit. In multivariable analyses that accounted for missing data, the adjusted odds ratios and 98% CIs for differences in Asthma Impact Scores or caregivers’ Satisfaction with Participation in Social Roles scores were not significant. However, guideline-recommended ED discharge care was significantly improved in the intervention groups versus in the UC group, and self-management behaviors were significantly improved in the ED-plus-home group versus in the ED-only and UC groups. Conclusions: The ED-based interventions did not significantly improve the primary clinical outcomes, although the study was likely underpowered. Although guideline-recommended ED discharge care and self-management did improve, their effect on clinical outcomes needs further study.http://www.sciencedirect.com/science/article/pii/S2772829323000255Pragmatic clinical trialasthmacommunity health workeremergency department |
| spellingShingle | Jerry A. Krishnan, MD, PhD Helen Margellos-Anast, MPH Rajesh Kumar, MD Joel J. Africk, JD Michael Berbaum, PhD Nina Bracken, MSN, NP Yi-Fan Chen, PhD Julie DeLisa, MA Kim Erwin, MDes Stacy Ignoffo, MSW Sai Dheeraj Illendula, MS Hajwa Kim, MS Cortland Lohff, MD, MPH Tom MacTavish, MLIS Molly A. Martin, MD, MAPP Giselle S. Mosnaim, MD, MS Hannah Nguyen, MPH Sarah Norell, MDes, MFA Sharmilee M. Nyenhuis, MD S. Margaret Paik, MD Zachary Pittsenbarger, MD Valerie G. Press, MD, MPH Jennifer Sculley, MDes Trevonne M. Thompson, MD Leslie Zun, MD, MBA Lynn B. Gerald, PhD, MSPH Michael McDermott, MD Sana Ali Janet Flores Shahina Gantiwala Carmen Goralski Rajesh Kumar Jacqueline Ortega Zachary Pittsenbarger Isabelle Wilson Cortland Lohff Michael McDermott Kim Erwin Thomas MacTavish Sarah Norell Maureen Damitz David Massaquoi Kenneth Soyemi Thomas Senko Trevonne Thompson Kate McMahon Joel Africk Amy O’Rourke Christopher Codispoti Jane Kramer Rabia Malik Pamela Manning Giselle Mosnaim Jeanette Avila Helen Margellos-Anast Fatima Padron Jessica Ramsay Nazia Saiyed Tala Schwindt Gloria Seals Leslie Zun Susannah Butters Ashley Hull John Kim S. Margaret Paik Valerie Press Crystal Stevenson Nicole Twu Nicole Woodrick Michael Berbaum Nina Bracken Jennifer Buenrostro Lauren Castro Yi-Fan Chen Julie DeLisa David De La Torre-Dorado Dameka Edwards Alexander Frye Maciej Grabarek Sai Dheeraj Illendula Hajwa Kim Jerry Krishnan Molly Martin Melissa Morales- Perez Hannah Nguyen Sharmilee Nyenhuis Jennifer Sculley Bruce Bender, PhD Francine Ducharme, MD Sheri Hurdle Xue Li, PhD Sande Okelo, MD, PhD Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan Journal of Allergy and Clinical Immunology: Global Pragmatic clinical trial asthma community health worker emergency department |
| title | Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan |
| title_full | Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan |
| title_fullStr | Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan |
| title_full_unstemmed | Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan |
| title_short | Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan |
| title_sort | coordinated health care interventions for childhood asthma gaps in outcomes chicago plan |
| topic | Pragmatic clinical trial asthma community health worker emergency department |
| url | http://www.sciencedirect.com/science/article/pii/S2772829323000255 |
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