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
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
Social-Medical Model of Care
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
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
Program Components
• Community asthma coalitions
• Asthma treatment services
™ Outpatient clinic-based services
• Community intervention services
™ Asthma coordinator services
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AC Services Provided
• 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
Outcome Measures
Evaluation (cont.)
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• Possession of a written asthma
management plan
• Hospitalizations
• Emergency room visits
• Childcare/preschool days, work days
missed
• Asthma symptoms
• Quality of Life
p e rc e n t
Outcome measures include:
ER
• 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
Entry interview
Care Coordination
Last interview
Why does it work?
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
• 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
• Consistent written asthma action plan
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