Groundbreaking Asthma Intervention Lessons Help Inner-City Children

Newswise — The Inner-City Asthma Intervention (ICAI), a four-year project at 25 health care institutions around the country funded by the Centers for Disease Control & Prevention (CDC), implemented findings from successful clinical trials to help inner-city children with chronic asthma and their families.

The purpose of the ICAI project " published this month in Annals of Allergy, Asthma & Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI) " was to determine whether the National Cooperative Inner-City Asthma Study (NCICAS) could be implemented in the community setting.

Editorial author Meyer Kattan, M.D., of Mount Sinai School of Medicine, New York, describes the project as an "important first step to determine barriers that must be overcome to translate a successful clinical trial into a successful community-based program." Dr. Kattan acknowledged that the experience gained in the ICAI identified these barriers and found some workable solutions.

Although only approximately half of the 4,174 children that were enrolled completed the core intervention activities, and a limited 1-site evaluation showed only small improvements, the ICAI served its purpose in providing a guide for implementation of an asthma program in poor, disadvantaged populations.

"Many asthma interventions such as NCICAS have been shown to be effective in the context of grant-funded clinical trials," said ACAAI Vice President Jay M. Portnoy, M.D., who participated in testing the model at Children's Mercy Hospitals and Clinics, Kansas City, Mo. "The real challenge is to implement them effectively in real-world situations where less than perfect adherence and follow-up occur."

"I would like to see more implementation projects of this type. If we don't follow-up our scientifically-based interventions with public dissemination, then research that is funded by our public dollars is unlikely to benefit our patients in the way that it should. Given the world-wide increase in asthma morbidity and mortality, we cannot afford to overlook this resource. We have a lot of work to do. The time to start is now," Dr. Portnoy said.

The ICAI underscores the NCICAS finding that a social worker is best suited to address risk factors involving living conditions, social welfare and mental health issues of the family, while also serving as an asthma educator. The counselor intervention can be implemented in a variety of settings, and was recognized by the families as a value to them.

Other findings identified by Dr. Kattan were that the program needed to be flexible to accommodate the inflexible work hours of the parents. Providing refreshments allowed the sessions to occur around mealtimes and increased the incentive and enjoyment of meeting attendance.

Editorial authors Seymour G. Williams, M.D., and Stephen C. Redd, M.D., of the CDC's National Center for Environmental Health in Atlanta, noted the following themes based on the ICAI reports:

-- Implementation of the protocol was feasible, although retention of participants was challenging and customization at each site was essential. -- Master's degree level social workers were well suited to partnering with health care professionals to address the many issues involved in caring for children with asthma and their families.

-- Collaboration between team members and community partners was critical to successful implementation.

-- Sustainability beyond external funding is attainable if local funding is sought and outcome measures that are considered important to the community are measured and reported.

The lessons learned by these 25 sites were used to develop the Alleviate Asthma! Cultivating a Successful Pediatric Asthma Initiative tool kit released by the Alliance of Community Health Plans (ACHP). The tool kit draws on the experience of implementation and provides strategies, options and considerations for health care organizations to use in tailoring project activities. It is available publicly online (www.achp.org) for use by sites that wish to improve outcomes for their most challenging asthma patients.

Patient information on allergic diseases including asthma is available by calling the ACAAI toll free number at (800) 842-7777 or visiting its Web site at http://www.acaai.org.

The American College of Allergy, Asthma and Immunology (ACAAI) is a professional medical organization headquartered in Arlington Heights, Ill., that promotes excellence in the practice of the subspecialty of allergy and immunology. The College, comprising more than 5,000 allergists-immunologists and related health care professionals, fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy and research.

Citation: Wood, PR, Warman KL, Spiegel J. Research to practice: implementation of the inner city asthma intervention in community settings. Ann Allergy Asthma Immunol 2006;97(Suppl 1):S1-S46

Annals of Allergy, Asthma & Immunology is online at http://www.annallergy.org.