Improving asthma outcomes for children: Many paths to progress
Background: Asthma continues to be a significant public health issue for children. The extent to which tailored evidence-based interventions address the needs of children at varied levels of risk in the community is unclear.
Objective: Using data from five impoverished communities with high levels of pediatric asthma morbidity, this study assessed morbidity outcomes associated with tailored evidence-based interventions after stratifying children for risk based on two variables that reflect control, severity, and behavior: hospitalizations and daily use of a controller medication.
Methods: A pre/post evaluation (n=721) was used to categorize and analyze change in outcomes for four groups of patients: patients with one or more hospitalizations in the past 12 months with or without a baseline controller medication use, and no hospitalizations in the past 12 months with or without baseline controller medication use.
Results: Patients with one or more hospitalizations in the past 12 months and no baseline controller use made the biggest gains in several areas, including the largest percent increase in daily controller medication usage and asthma action plans, and the largest decrease in days and nights of symptoms. However, other groups made larger gains in reducing school days missed and emergency department visits and increasing parent confidence, consistent with the notion that community-based interventions can help a diverse set of patients make progress.
Conclusion: Practitioners in low-income communities where there are varying levels of resources and disease severity can tailor interventions to each child's needs and make substantial gains in outcomes across a range of risk profiles.