Childhood Asthma Program in NYC Health Department Clinics

NCT ID: NCT00005713

Last Updated: 2015-12-23

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

1000 participants

Study Classification

OBSERVATIONAL

Study Start Date

1990-08-31

Study Completion Date

1997-02-28

Brief Summary

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To demonstrate that the New York City Department of Health Child Health Clinics could improve the health status of Black and Hispanic children with asthma by providing them with a comprehensive system of continuity of care that included pharmacologic treatment, family health education and community outreach.

Recent studies have shown that lack of continuing primary care for asthma is associated with increased levels of morbidity in low-income minority children. Although effective preventive therapy is available, many African-American and Latino children receive episodic treatment for asthma that does not follow current guidelines for care. To see if access, continuity, and quality of care could be improved in pediatric clinics serving low-income children in New York City, we trained staff in New York City Bureau of Child Health clinics to provide continuing, preventive care for asthma.

Detailed Description

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BACKGROUND:

The study was part of a demonstration and education initiative "Interventions for Control of Asthma Among Black and Hispanic Children" which was released by the NHLBI in June 1989.

DESIGN NARRATIVE:

To develop this comprehensive care system, the investigators provided training for Health Department physicians and nurses in up-to-date methods of diagnosing asthma, and providing clinical care and health education to patients and families as part of a series of regular 20 minute patient visits. Nurses and public health assistants were also trained to supplement this by teaching the Open Airways self-management program to groups of families. A 24-hour telephone advice service for families of asthma patients was staffed by trained Health Department physicians.

The intervention was based on social cognitive theory, especially self-regulation. In Phase I, the Health Department medical and nursing staffs were taught by Columbia University faculty with reinforcement by Health Department physician and nurse supervisors. Self-regulation was fostered in physicians by use of an Asthma Visit Record and in families by use of an Asthma Diary. Seven pairs of matched clinics were randomized to be controls or receive the intervention. The following hypotheses were tested: that a comprehensive system of continuity of care, including medical care, family health education and community outreach would (1) increase staff confidence to diagnose and treat childhood asthma; (2) attract and retain families who had children with asthma in continuing care relationships in the Health Department clinics; and (3) improve the health status of patients and the quality of life of their families. Phase II tested whether this comprehensive system could be made self-sustaining within the Health Department by having physician and nurse super-visors who took part in Phase I teach the program to staff from a second set of matched clinics. This program had the potential to reach more than 5000 minority children with asthma. If successful it could be generalized to other health departments in the country.

Conditions

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Asthma Lung Diseases

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Continuing, preventative care for asthma

Low-income children with asthma will receive continuing, preventive care for asthma with trained staff in New York City Bureau of Child Health clinics

Continuing, preventative care

Intervention Type BEHAVIORAL

Training for intervention clinic staff was based on National Asthma Education and Prevention Program guidelines for the diagnosis and management of asthma, and included screening to identify new cases and health education to improve family management.

Interventions

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Continuing, preventative care

Training for intervention clinic staff was based on National Asthma Education and Prevention Program guidelines for the diagnosis and management of asthma, and included screening to identify new cases and health education to improve family management.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

1. Diagnosed with asthma
2. Attending pediatric clinics serving low-income children in New York City

Exclusion Criteria

1\. Unable to return to clinics for follow up and treatment
Minimum Eligible Age

1 Month

Maximum Eligible Age

21 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Heart, Lung, and Blood Institute (NHLBI)

NIH

Sponsor Role collaborator

Columbia University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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David Evans, MD

Role: PRINCIPAL_INVESTIGATOR

Professor of Emeritus of Clinical Sociomedical Sciences In Pedi, Dept of Sociomedical Sciences

Locations

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Columbia University

New York, New York, United States

Site Status

Countries

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United States

References

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Evans D, Mellins R, Lobach K, Ramos-Bonoan C, Pinkett-Heller M, Wiesemann S, Klein I, Donahue C, Burke D, Levison M, Levin B, Zimmerman B, Clark N. Improving care for minority children with asthma: professional education in public health clinics. Pediatrics. 1997 Feb;99(2):157-64. doi: 10.1542/peds.99.2.157.

Reference Type BACKGROUND
PMID: 9024439 (View on PubMed)

Other Identifiers

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R01HL045304

Identifier Type: NIH

Identifier Source: secondary_id

View Link

CUMC ID unknown (4922)

Identifier Type: -

Identifier Source: org_study_id