While great strides have been made to ensure children have access to proper asthma care in their home and community, linking those environments to the care that children receive while in school has been a challenge. In a new study, researchers from Children's Hospital of Philadelphia (CHOP) demonstrate that community health workers can play a critical role in integrating all environments where children encounter asthma triggers, and care coordination provided by these workers may be a cost-effective way to achieve that. The findings were recently published by JAMA Pediatrics .
There are persistent and concerning disparities in rates of asthma among American children. Black children, for example, have a hospitalization rate three times higher, and a death rate seven times higher, than their white counterparts. However, asthma symptoms can vary for children at different times of the day in different environments. While they may be able to control symptoms at home, children may encounter triggers at school like mice or dusty shelves that can exacerbate their symptoms.
Prior studies have confirmed the impact that community health workers – specially trained lay people who work with local hospital systems and community organizations in both rural and urban communities – can help improve asthma control to close gaps with evidence-based interventions. However, linking the care among different settings – homes, schools, primary care offices and surrounding communities – and coordinating appropriate care across those environments has been a major challenge. To garner a clearer picture of effectiveness, researchers implemented a randomized clinical trial design to properly assess the impact of community health workers.
"Children are in various environments during the day, and we have to think about a holistic and connected approach to reducing asthma across all environments a child may encounter," said Tyra Bryant-Stephens, MD , Medical Director of the Community Asthma Prevention Program (CAPP) and Chief Health Equity Officer of the Center for Health Equity at CHOP. "We want to make sure there is evidence-based asthma care, including increased adherence and availability of controller medication, wherever children may be and that everyone is taking steps to make every environment a healthier one."
This study was a hybrid effectiveness and implementation trial that randomized 36 total Philadelphia area schools with participant-level randomization into clinic-based community health worker intervention. The intervention took place in CHOP primary care offices, homes and 36 public and charter schools in West Philadelphia between May 2018 and June 2022. Children, aged 5 through 13, with uncontrolled asthma were recruited from local primary care practices and were followed for up to 12 months
Asthma management, trigger remediation, and care coordination took place in school, home and primary care settings. The Yes We Can Children's Asthma Program, Open Airways for Schools Plus and school-based asthma therapy were implemented.
In total, 626 study participants were analyzed, with 96% of them self-identifying as Black and 98% as non-Hispanic. All groups had statistically significant improvements in asthma control from baseline to 12 months. The study experienced interruptions during the pandemic. However, an analysis from the pre-pandemic interval demonstrated that children in the combined home-clinic-school intervention had a statistically significant improvement in asthma control scores compared with the control group.
"This study demonstrated the feasibility and effectiveness of community health workers connecting these environments to make care more accessible for kids, and future work will make sure that everyone has a seat at the table when making decisions concerning asthma prevention," Bryant-Stephens said.
This study was supported by grants U01HL138687 and K23HL136842 from the National Heart, Lung and Blood Institute.
Bryant-Stephens et al, "Community Health Workers Linking Clinics and Schools and Asthma Control: A Randomized Clinical Trial." JAMA Pediatr. Online October 21, 2024. DOI: 10.1001/jamapediatrics.2024.3967.
About Children's Hospital of Philadelphia:
A non-profit, charitable organization, Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and pioneering major research initiatives, the hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. The institution has a well-established history of providing advanced pediatric care close to home through its CHOP Care Network , which includes more than 50 primary care practices, specialty care and surgical centers, urgent care centers, and community hospital alliances throughout Pennsylvania and New Jersey, as well as the Middleman Family Pavilion
