Helen Margellos-Anast

The Pediatric Asthma Intervention: A Comprehensive Cost-Effective Approach to Asthma Management in a Disadvantaged Inner-City Community

Objective. To compare three pediatric asthma interventions for their impact on improving the health status of inner-city asthmatic children and in achieving cost savings. Study Design. A total of 212 children 1 to 16 years of age were randomized into three groups: group 1 (n = 74) received one individualized asthma education session; group 2 (n = 68) received reinforced asthma education; group 3 (n = 70) received reinforced asthma education plus case management. Asthma-related health resource utilization and cost were primary outcomes. The cost-benefit analysis sought to estimate the expected cost savings to the Illinois Department of Healthcare and Family Services (Medicaid administrator) associated with the intervention. Results. Participants in all three groups used significantly fewer emergency health care services in the follow-up year. Averaged across all three groups, the magnitudes of declines were substantial: 81% for hospitalizations, 69% for hospital days, 64% for emergency department visits, and 58% for clinic visits. Although there were no statistically significant differences between study groups for three of the four main outcome measures, group 3 participants consistently improved to the greatest degree. All three interventions were associated with considerable cost savings ranging from

The effects of cocaine and heroin use on intubation rates and hospital utilization in patients with acute asthma exacerbations.

4,021/child/year for group 1 to

Improving asthma management among African-American children via a community health worker model: findings from a Chicago-based pilot intervention.

4,503/child/year for group 3. Conclusion. Asthma education with or without case management services enhances the health of children with asthma thereby reducing associated costs.

Prevalence of Obesity Among Children in Six Chicago Communities: Findings from a Health Survey

BACKGROUND The use of both heroin and cocaine has been associated with asthma exacerbations. However, the magnitude of this effect has not been adequately described. The purpose of this study was to examine the association between cocaine or heroin use and asthma severity. METHODS We conducted a retrospective chart review of adult patients who had been admitted to an inner-city hospital and who subsequently had received a hospital discharge diagnosis of acute asthma exacerbation. Patients were classified as cocaine users if they had admitted to using cocaine within 24 h of symptom onset, or if a positive drug screen result was obtained. A similar classification was employed for heroin. The severity of asthma exacerbations among cocaine and heroin users was compared to severity among nonusers (ie, individuals without evidence of having used either drug within the 24 h preceding symptom onset). RESULTS One hundred sixty-six unique patient encounters were identified, and 152 patient records were analyzed. Of these, 27.6% (42 of 152 patients) used cocaine with or without heroin and were classified as cocaine users, while 30.9% (47 of 152 patients) used heroin with or without cocaine and were classified as heroin users. Cocaine users had longer mean lengths of hospital stay than nonusers (3.4 days vs 2.5 days; p < 0.049). Intubation and ICU admission were more common among cocaine users than nonusers (21.4% vs 2.3%, respectively [p = 0.0006]; 31.0% vs 11.5%, respectively [p = 0.0068]). Heroin users were also intubated more frequently than nonusers (17.0% vs 2.3%, respectively; p = 0.0036). Neither the length of hospital stay nor the percentage of ICU admissions was significantly different between heroin users and nonusers. CONCLUSION Heroin and cocaine use are common among adult asthmatic patients admitted to an inner-city hospital. Both cocaine and heroin are significantly associated with the need for intubation. Based on these findings, it may be prudent to screen adults with asthma presenting to an urban emergency department for cocaine and heroin use.

Engaging stakeholders to design a comparative effectiveness trial in children with uncontrolled asthma

Objectives. Asthma affects 25–30% of children living in certain disadvantaged Chicago neighborhoods, a rate twice the national prevalence (13%). Children living in poor, minority communities tend to rely heavily on the emergency department (ED) for asthma care and are unlikely to be properly medicated or educated on asthma self-management. A pilot project implemented and evaluated a community health worker (CHW) model for its effectiveness in reducing asthma morbidity and improving the quality of life among African-American children living in disadvantaged Chicago neighborhoods. Methods. Trained CHWs from targeted communities provided individualized asthma education during three to four home visits over 6 months. The CHWs also served as liaisons between families and the medical system. Seventy children were enrolled into the pilot phase between 15 November 2004 and 15 July 2005, of which 96% were insured by Medicaid and 54% lived with a smoker. Prior to starting, the study was approved by an institutional review board. Data on 50 children (71.4%) who completed the entire 12-month evaluation phase were analyzed using a before and after study design. Results. Findings indicate improved asthma control. Specifically, symptom frequency was reduced by 35% and urgent health resource utilization by 75% between the pre- and post-intervention periods. Parental quality of life also improved by a level that was both clinically and statistically significant. Other important outcomes included improved asthma-related knowledge, decreased exposure to asthma triggers, and improved medical management. The intervention was also shown to be cost-effective, resulting in an estimated

Care transition interventions for children with asthma in the emergency department

5.58 saved per dollar spent on the intervention. Conclusions. Findings suggest that individualized asthma education provided by a trained, culturally competent CHW is effective in improving asthma management among poorly controlled, inner-city children. Further studies are needed to affirm the findings and assess the model’s generalizability.

Utilizing the Community Health Worker Model to communicate strategies for asthma self-management and self-advocacy among public housing residents

Objectives. We analyzed data from a community health survey to assess levels of obesity and overweight among children in some Chicago communities compared with national U.S. estimates. Methods. Data came from the Sinai Improving Community Health Survey, which was conducted via face-to-face interviews with people living in six racially and ethnically diverse Chicago communities during 2002 and 2003. A stratified, three-stage probability study design was employed to obtain a representative sample from each community. Height and weight data reported by the primary caretakers of 501 randomly selected children aged 2–12 years were used to determine age- and gender-specific body mass index (BMI), which was then used to classify weight status (obese ≥95th percentile for age and gender). Results. Compared with 16.8% for the U.S., the prevalence of obesity was 11.8% in a non-Hispanic white community on Chicagos north side, 34.0% in a Mexican American community on the west side, and 56.4% in a non-Hispanic black community on the south side. Conclusions. Surveillance of the childhood obesity epidemic at the local level is limited. Findings describe the extent of disparities in childhood overweight and obesity within one city and how local-level data can shape new initiatives for improved health, one community at a time.

Design of a pragmatic trial in minority children presenting to the emergency department with uncontrolled asthma: The CHICAGO Plan

AIM To present the methods and outcomes of stakeholder engagement in the development of interventions for children presenting to the emergency department (ED) for uncontrolled asthma. METHODS We engaged stakeholders (caregivers, physicians, nurses, administrators) from six EDs in a three-phase process to: define design requirements; prototype and refine; and evaluate. RESULTS Interviews among 28 stakeholders yielded themes regarding in-home asthma management practices and ED discharge experiences. Quantitative and qualitative evaluation showed strong preference for the new discharge tool over current tools. CONCLUSION Engaging end-users in contextual inquiry resulted in CAPE (CHICAGO Action Plan after ED discharge), a new stakeholder-balanced discharge tool, which is being tested in a multicenter comparative effectiveness trial.

Engaging end-users in intervention research study design

The emergency department (ED) is a critical point of identification and treatment for some of the most high-risk children with asthma. This review summarizes the evidence regarding care transition interventions originating in the ED for children with uncontrolled asthma, with a focus on care coordination and self-management education. Although many interventions on care transition for pediatric asthma have been tested, only a few were actually conducted in the ED setting. Most of these targeted both care coordination and self-management education but ultimately did not improve attendance at follow-up appointments with primary care providers, improve asthma control, or reduce health care utilization. Conducting any ED-based intervention in the current environment is challenging because of the many demands on ED providers and staff, poor communication within and outside of the medical sector, and caregiver/patient burden. The evidence to date suggests that ED care transition interventions should consider expanding beyond the ED to bridge the multiple sectors children with asthma navigate, including health care settings, homes, schools, and community spaces. Patient-centered approaches may also be important to ensure adequate intervention design, enrollment, retention, and evaluation of outcomes important to children and their families.

Translating a Proven Pediatric Healthy Homes Asthma Intervention to Adults

Abstract Non-Hispanic Black children in the US experience a higher prevalence of asthma and are more likely to have severe and poorly controlled asthma than their non-Hispanic White counterparts. These disparities are particularly pronounced among those living in public housing compared to the general population. To combat these disparities, health care researchers collaborated with public housing management to deliver a year-long community health worker (CHW) asthma and healthy homes intervention to children with asthma in six public housing developments. CHWs, hired from the targeted housing developments, educated families to better manage asthma medically and address asthma triggers in the home, and served as a bridge to medical, social, and public housing services. This is the first time such a full spectrum asthma intervention has been implemented by CHWs in public housing. Fifty-nine children completed the intervention, 95% of whom were African American. Daytime asthma symptoms in the previous two weeks were significantly reduced between baseline (4.1) and 1-year follow-up (0.8). The percent of children making two or more urgent health resource utilization visits decreased significantly between baseline (42%) and 1-year follow-up (15%). Quality of life scores for caregivers of children increased significantly (by 0.7 points). The implementation of the CHW model in a public housing setting not only meets children where they live, but effectively bridges the gap between them and the health care system, reducing the disproportionate burden of asthma in these communities and improving overall quality of life.