Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan
Year: 2023
Type: article
Abstract: 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.
Authors: Jerry A. Krishnan, Helen Margellos-Anast, Rajesh Kumar, Joel J. Africk, Michael Berbaum, Nina Bracken, Yi-Fan Chen, Julie DeLisa, Kim Erwin, Stacy Ignoffo, Sai Dheeraj Illendula, Hajwa Kim, Cortland Lohff, Tom MacTavish, Molly A. Martin, Giselle S. Mosnaim, Hannah Nguyen, Sarah Norell, Sharmilee M. Nyenhuis, S. Margaret Paik, Zachary Pittsenbarger, Valerie G. Press, Jennifer Sculley, Trevonne M. Thompson, Leslie Zun, Lynn B. Gerald, Michael McDermott, 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, Francine Ducharme, Sheri Hurdle, Xue Li, Sande Okelo
Institutions: University of Illinois Chicago, Sinai Health System, Northwestern University, Lurie Children's Hospital, Respiratory Health Association, Chicago Department of Public Health, Illinois Institute of Technology, Endeavor Health, University of Chicago, Comer Children's Hospital, University of Chicago Medical Center, Cook County Health and Hospitals System, Rosalind Franklin University of Medicine and Science
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,000
Funders: American Thoracic Society, GlaxoSmithKline, Sanofi, Patient-Centered Outcomes Research Institute, Teva Pharmaceutical Industries, Respiratory Health Association, Center for Clinical and Translational Science, University of Illinois at Chicago, Rush University, National Institutes of Health, Centers for Disease Control and Prevention, Agency for Healthcare Research and Quality, Genentech, University of Illinois at Urbana-Champaign, University of Illinois at Chicago, University of Chicago Medicine, National Heart, Lung, and Blood Institute, National Center for Advancing Translational Sciences
OpenAlex ID: W2562477346