Community Healthcare for Asthma Management and Prevention of Symptoms
Community Healthcare for Asthma Management and Prevention of Symptoms
The purpose of this study is to systematically investigate across health center study sites
 participating in this study the process of adopting, integrating, implementing, and diffusing
 a minimum set of evidence-based interventions for the management of childhood asthma.
 Investigators hypothesized that an intervention that is evidence- and consensus-based (i.e.,
 minimum elements to be integrated into existing practice, dosing of each element) would be
 implemented effectively, as measured by health center performance improvement on child health
 outcomes, health care utilization, and other measures (e.g., avoidable costs).
In this study, investigators combined childhood asthma counseling and environmental
 interventions proven effective in previous NIH-funded clinical trials, the National
 Cooperative Inner-City Asthma Study (NCICAS) and the Inner-City Asthma Study (ICAS), and a
 third study, Head-off Environmental Asthma in Louisiana (HEAL). These studies demonstrated
 that participant-tailored interventions reduce asthma morbidity. Through a process of
 consensus building, investigators adapted a hybrid of these interventions for use in primary
 care clinics located in medically underserved areas (FQHCs). Investigators recruited
 participants ages 5-12 years with poorly controlled, moderate-to-severe asthma to ensure
 comparability with previous studies. Unlike the earlier clinical trials, which limited
 eligibility to inner-city children in stable housing, CHAMPS enrolled participants regardless
 of housing situation (e.g., temporary/shared homes) and location (e.g., urban/rural).
 Investigators collaborated with 3 FQHCs in Arizona, Michigan, and Porto Rico to enroll
 children and implement the CHAMPS intervention but otherwise granted them discretion to make
 decisions about staffing, patient flow and other process determinations, while tracking what
 those entailed. Investigators also invited 3 additional FQHCs to recruit and enroll children
 in a comparison group that did not receive the intervention.

 The primary aim is to identify and understand barriers and solutions to the adaptation of an
 evidence-based asthma intervention at the system-level. The evaluation consists of
 determining how a system makes room for an intervention, identifying stakeholders to make it
 happen, documenting the process for replication, and monitoring processes and outcomes to
 ensure the integrity of the intervention remains intact. The process of implementation in the
 unique clinical settings presented by health centers will be described, including the
 facilitators and the barriers to the systematic adoption of an evidence-based childhood
 asthma intervention into routine practice. Of particular importance are those determinants
 related to in-home and community-based environmental risks, the limits of understanding on
 the part of parents and caretakers, and community-wide policies and practices that may create
 health risks.

 The secondary aim is to assess the effectiveness and cost-effectiveness of the evidence-based
 asthma intervention as implemented in health centers.

 The third and final aim is to develop a dissemination strategy and some tools for further
 take up of the intervention.
Inclusion Criteria:

 -  Diagnosis of asthma

 -  Currently receiving long-term asthma control therapy and either has symptoms
 consistent with persistent asthma or has evidence of uncontrolled disease or is not
 currently receiving long-term asthma control therapy and has symptoms consistent with
 persistent asthma and also has evidence of uncontrolled disease

 -  Caretaker speaks English or Spanish

 Exclusion Criteria:

 -  Younger or older children

 -  Mild, intermittent asthma