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Cited by 160Asthma and respiratory diseasesPrimary Care and Health OutcomesClinical practice guidelines implementation

Improving care for minority children with asthma: professional education in public health clinics

Evans, David, Mellins, Robert, Lobach, Katherine, Ramos-Bonoan, Carmen, Pinkett-Heller, Marcia, Wiesemann, Sandra, Klein, Ilene, Donahue, Caroline +5 more·1997·Pediatrics
DOI 10.1542/peds.99.2.157
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Abstract

Objective. 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. Methods. We evaluated the impact of the intervention over a 2-year period in a controlled study of 22 clinics. 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. The intervention included strong administrative support by the Bureau of Child Health to promote staff behavior change. We hypothesized that after the intervention, clinics that received the intervention would, compared with control clinics, have increased numbers of children with asthma receiving continuing care in the clinics and increased staff use of new pharmacologic and educational treatment methods. Results. In both the first and second follow-up years, the intervention clinics had greater positive changes than control clinics on measures of access, continuity, and quality of care. For second year follow-up data these include: for access, greater rate of new asthma patients (40/1000 vs 16/1000; P < .01); for continuity, greater percentage of asthma patients returning for treatment 2 years in a row (42% vs 12%; P < .001) and greater annual frequency of scheduled visits for asthma per patient (1.85 vs .88; P < .001); and for quality, greater percentage of patients receiving inhaled β agonists (52% vs 15%;P < .001) and inhaled antiinflammatory drugs (25% vs 2%; P < .001), and greater percentages of parents who reported receiving patient education on 12 topics from Bureau of Child Health physicians (71% vs 58%; P < .01) and nurses (61% vs 44%; P < .05). Conclusion. We conclude that the intervention substantially increased the Bureau of Child Health staff's ability to identify children with asthma, involve them in continuing care, and provide them with state-of-the-art care for asthma.

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Authors
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.
Affiliations
  • Columbia University Irving Medical Center (US)
  • Bureau of Child Health, New York City Department of Health (now called Child Health Clinics of New York City, a subdivision of the New York City Health and Hospitals Corporation), New York, New York;
  • New York City Health and Hospitals Corporation (US)
  • Department of Health Sciences, Jersey City State College, Jersey City, New Jersey;
  • Medical and Health Research Association of New York City, Inc, New York, New York;
  • Columbia University (US)
  • The Graduate Center, CUNY (US)
  • University of Michigan (US)
ORCID
Venue
Pediatrics
Publisher
American Academy of Pediatrics (AAP)
Published
1997-02-01
Volume
99
Issue
2
Pages
157-164
ISSN
  • 0031-4005 (ISSN-L)
  • 1098-4275
DOI
10.1542/peds.99.2.157
OpenAlex
W2040879964
Semantic Scholar
7c73189236ae25cd6cb8960c6374047003b882cf
Cited by
159
References
18
Citations by year
2026: 1 · 2025: 1 · 2023: 3 · 2021: 2 · 2019: 1 · 2018: 1 · 2017: 3 · 2016: 2 · 2015: 3 · 2014: 4 · 2013: 3 · 2012: 3
FWCI
9.67
Type
journal article
Language
en
Open access
closed
Locations
  • PEDIATRICS (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Stony Wold-Herbert Fund
  • National Heart, Lung, and Blood Institute (R18 HL-45304)
Topics
  • Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Keywords
childhood asthma, minority children, African American children, Latino children, low-income children, asthma management, continuing care, preventive medicine, employee training, public health clinics, inhaled beta-agonists, asthma screening, health education, continuity of care, quality of care, health care access
MeSH terms
Workforce, Asthma, Black or African American, Child, Child Health Services, Community Health Centers, Continuity of Patient Care, Education, Continuing, Health Personnel, Hispanic or Latino, Humans, Minority Groups, New York City, Patient Education as Topic, Public Health, Quality of Health Care, Odds Ratio, Practice Guidelines as Topic

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