Outcomes From a Cross-Site Evaluation of a Comprehensive Pediatric Asthma Initiative Incorporating Translation of Evidence-Based Interventions

Abstract

This article reports on an evaluation of the Merck Childhood Asthma Network, Inc. (MCAN) initiative using pooled cross-site data on patient-reported outcomes pre- and postintervention to quantify the changes experienced by children in five program sites supported by the network. The results show a consistent pattern of improvement across all measured outcomes, including symptoms, hospital and emergency department use, school absences, and caregiver confidence. Children who started with uncontrolled asthma experienced larger improvements than children with controlled asthma at baseline. However, even considering the significant gains made by children with uncontrolled asthma at baseline, after 12 months, most of the outcomes for these children were significantly worse than the 12-month outcomes for children with controlled asthma at baseline. The evaluation of the MCAN initiative offers a model that can be used in cases where resources must be balanced between evaluation and delivering services to children. The design process and results from the common survey instrument provide information for future initiatives seeking to translate evidence-based interventions in a community-based setting.

Building Bridges for Asthma Care Program: A School-Centered Program Connecting Schools, Families, and Community Health-Care Providers

“…Care coordination engages multiple stakeholders, can occur in a variety of settings, and can lead to reduced asthma symptoms, unscheduled health-care visits, activity limitations, and school absences (Clark et al, 2010;Kelly et al, 2015;Leroy et al, 2017;Szefler et al, 2018). BB Program activities support case management and care coordination among HCPs, school nurses, and students and families and include assessing asthma control and at-risk status, delivering asthma education, communicating with the clinical team, conducting follow-up visits with students and families, and referring families to medical and social services within their community (Garwick et al, 2015;Mansfield et al, 2011;Maughan & Schantz, 2014;NASN, 2016). The provision of standardized individualized letters to the student's physician and parents/guardians sent at the beginning, middle, and end of the school year makes the BB Program unique in its approach to engaging, communicating, and coordinating care.…”

Community-Based Care Coordination

“…Data were generated from descriptions of the site care coordination program features, a compilation of characteristics based on these descriptions, key process indicators supplied by each site, and cross-site data regarding asthma outcomes at baseline and follow-up. The cross-site data were derived from standardized baseline and follow-up instruments assessing critical management behaviors and asthma outcomes (Mansfield et al, 2011). The cross-site data were prepared by the project evaluation team at RTI International using Stata 11.0.…”

“…Table 2 includes data only for children with 12-month follow-up using the most recent version of the MCAN initiative follow-up questionnaire. The pre- and postintervention comparison of outcomes (baseline to follow-up) was assessed using the t test for differences in proportions, with a .01 significance level (see Mansfield et al, 2011 for a pooled cross-site analysis of individual-level data).…”

The Influence of Setting on Care Coordination for Childhood Asthma

“…Care coordination engages multiple stakeholders, such as family members, health care providers, social services, schools, and community organizations ( Bodenheimer, 2008 ). Care coordination has been shown to reduce asthma symptoms, unscheduled health care use, activity limitations, and school absences, among other positive outcomes ( Clark et al, 2010 ; Clark et al, 2013 ; Coughey et al, 2010 ; Mansfield et al, 2011 ; Thyne, Rising, Legion, & Love, 2006 ).…”

“…In Phase 1, five sites implemented evidence-based interventions (EBIs) to improve outcomes and explore the factors that led to successful adoption of EBIs in urban settings ( Viswanathan et al, 2011 ). These interventions yielded improvements in symptoms, hospital and ED use, school absences, and caregiver confidence ( Banda et al, 2013 ; Lara et al, 2011 ; Lara et al, 2013 ; Mansfield et al, 2011 ; Turyk et al, 2013 ). Whereas not all work in Phase 1 focused on care coordination, in a second phase, the four sites selected to continue emphasized care coordination activities.…”