The Childhood Asthma Initiative
The Impact of Chronic Care
Coordination on Young
Children (Age 0 to 5) with
Asthma
A Statewide Evaluation of the
California Community Asthma
Intervention
David Núñez, MD, MPH
Mina Lai, MPH
Toshi Hayashi, PhD
Pradeep Gidwani, MD, MPH
Asthma Statistics
• Asthma affects 9 million children in the U.S.
• Asthma accounts for 14.7 million missed school days
and 11.8 million missed work days annually
• In 2002, 4,261 deaths due to asthma; 187 children
under 18
• $14 billion in asthma-related healthcare each year
• 1.9 million asthma-related visits to hospital
emergency departments in 2002; 727,000 for
children under 18
• Children aged 0 to 4 years have the highest rates of
hospitalization and ED visits for asthma
Childhood Asthma Initiative
First Five California established the
Childhood Asthma Initiative in 2000
with Proposition 10 (tobacco tax):
• For children with asthma <5 years old
• In communities with greatest asthma
disparities
• Enrollees: 72% Latino, 14% African
American, 5% Caucasian, 4% Asian/PI,
5% other
Goals
• Improve quality of life for children and
their families
• Increase access to quality health care
• Decrease asthma morbidity and
mortality
• Decrease ER and hospitalization visits
Social-Medical Model of Care
Program Components
• Community asthma coalitions
• Asthma treatment services
 Outpatient clinic-based services
• Community intervention services
 Asthma coordinator services
AC Services Provided
• Basic asthma education
• Assess home environment & assist in
implementing environmental control
measures
• Instruct on proper use of medications/devices
• Reinforce asthma management plan
• Refer to community resources
• Refer to MediCal/Healthy Families/California
Kids
• Coordinate care with health care providers
• Coordinate care with child care providers
Evaluation
• Pre-interview and post-interview with
parents or caregivers
• 1,920 out of 2,460 total enrollees had 2
interviews or more
• Cochran-Mantel-Haenszel chi-square
test used for analysis
Evaluation (cont.)
Outcome measures include:
• Possession of a written asthma
management plan
• Hospitalizations
• Emergency room visits
• Childcare/preschool days, work days
missed
• Asthma symptoms
• Quality of Life
Entry interview
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Outcome Measures
70
60
50
40
30
20
10
0
Last interview
Care Coordination
In the Home:
• Use asthma coordinators
• Provide in-home environmental assessment
and environmental control supplies
In the Community:
• Collaborate with other community asthma
programs, policymakers, organizations
Linking the clinic, home and community:
• Consistent education
• Consistent communication
• Consistent written asthma action plan
Why does it work?
• Improves communication
• Addresses cultural competency
• Enables parents to be more active in
child’s care
• Provides social support for the family
and asthmatic child
• Streamlines delivery of health care
services