Building Bridges for Asthma Care: Reducing school absence for inner-city children with health disparities - 18/08/18

Doi : 10.1016/j.jaci.2018.05.041

Stanley J. Szefler, MD ^a,^⁎^{^{∗
These authors contribute equally to this work as co-lead authors.}} , Michelle M. Cloutier, MD ^b,^{^{∗
These authors contribute equally to this work as co-lead authors.}}, Miguel Villarreal, MS ^c, Jessica P. Hollenbach, PhD, AE-C ^d, Melanie Gleason, MS, PA-C, AE-C ^e, Christy Haas-Howard, RN, MPH, AE-C ^f, Carol Vinick, RN, APRN ^g, Agustin Calatroni, MA, MS ^c, Lisa Cicutto, RN, ACNP(cert), PhD, CAE ^h, Marty White, BSN, RN, AE-C ⁱ, Shann Williams, PMP ^c, Meghan McGinn ^c, Christine Langton, MSW, MPH ^g, Donna Shocks, MSN, RN, CNS ^j, Herman Mitchell, PhD ^c, David A. Stempel, MD ^k
^a Pediatric Asthma Research Program and the Breathing Institute, Children's Hospital Colorado, and the Section of Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colo
^b Pediatrics and Medicine, UCONN Health, and the Asthma Center, Connecticut Children's Medical Center, Hartford, Conn
^c Rho, Chapel Hill, NC
^d Department of Pediatrics, University of Connecticut School of Medicine, and the Asthma Center, Connecticut Children's Medical Center, Hartford, Conn
^e Building Bridges Asthma Program, Children's Hospital Colorado, and the Department of Pediatrics, Section of Pediatric Pulmonary Medicine, University of Colorado School of Medicine, Aurora, Colo
^f Denver Public Schools, Nursing and Student Health Services, and the Colorado Department of Education, Asthma Grant Program, Denver, Colo
^g Building Bridges Coordinator, Asthma Center, and the Connecticut Children's Medical Center, Hartford, Conn
^h Community Outreach and Research, National Jewish Health, and the Clinical Science Program, University of Colorado Denver AMC, Denver, Colo
ⁱ Children's Hospital Colorado/Denver Public Schools, Denver, Colo
^j Denver Public Schools, Nursing and Student Health Services, Denver, Colo
^k Propeller Health, San Francisco, Calif

^∗Corresponding author: Stanley J. Szefler, MD, Children's Hospital Colorado, Breathing Institute, and Department of Pediatrics, Section for Pediatric Pulmonary and Sleep Medicine, 13123 E 16th Ave, B395, Denver, CO 80045.Children's Hospital ColoradoBreathing Institute, and Department of PediatricsSection for Pediatric Pulmonary and Sleep Medicine13123 E 16th Ave, B395DenverCO80045

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Abstract

Background

Children with asthma are at increased risk for experiencing health and educational disparities because of increased school absence. School nurses are well positioned to support asthma management and improve school attendance.

Objective

We sought to implement and assess the effect of the Building Bridges for Asthma Care Program on improving school attendance and measures of asthma control.

Methods

Children with asthma (age, 5-14 years) in the Denver Public School System (n = 240) and the Hartford Public School System (n = 223) were enrolled in the Building Bridges Program during the 2013-2014 and 2014-2015 school years and followed until the end of the second school year. The primary outcome was school absence, with secondary outcomes, including asthma control, measured based on Childhood Asthma Control Test or the Asthma Control Test scores and rescue inhaler use.

Results

Participants experienced a 22% absolute decrease in school absenteeism, the number of children with an Asthma Control Test/Childhood Asthma Control Test score of less than the control threshold of 20 decreased from 42.7% to 28.8%, and bronchodilator use greater than 2 times per week decreased from 35.8% to 22.9% (all changes were significant, P < .01).

Conclusions

Children enrolled in the Building Bridges for Asthma Care Program experienced reduced school absence and improved asthma control.

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Key words : African American, asthma, case management, care coordination, children, disease management, Hispanic, partnerships, school

Abbreviations used : ACT, cACT, HCP

Plan

Methods

Program description

Program implementation

Statistical analysis

Results

Student population

Asthma morbidity, health care access, and environmental exposures

School absence

Clinical outcomes

Discussion

Supported by GlaxoSmithKline study no. FLV116794. S.J.S. is supported by the Colorado Department of Public Health and Environment grants 15 FLA 65765, 16 FHLA 76546 and 17FHLA87312; the Caring for Colorado Foundation; the McCormick Foundation; and GlaxoSmithKline grant FLV116794. S.J.S. is also supported by National Heart, Lung, and Blood Institute (NHLBI) AsthmaNet U10 HL098075 and supported in part by Colorado CTSA Grant UL1 RR025780 from the National Institutes of Health (NIH)/National Center for Research Resources and UL1 TR000154 from the NIH/National Center for Advancing Translational Sciences. M.M.C. is supported by the State of Connecticut Department of Public Health, Community Health Network of Connecticut, and NHLBI 1U34 HL130665-01 and by the University of Colorado School of Medicine funded through GlaxoSmithKline FLV116794. M.V. is supported by the University of Colorado School of Medicine funded through GlaxoSmithKline grant FLV116794. J.P.H. is supported by the State of Connecticut Department of Public Health, Community Health Network of Connecticut, NHLBI grant 1U34 HL130665-0, and the University of Colorado School of Medicine funded through GlaxoSmithKline grant FLV116794. M.G. is supported by the Colorado Department of Public Health and Environment grants 15 FLA 65765, 16 FHLA 76546, and 17FHLA87312; the Caring for Colorado Foundation; the McCormick Foundation; and GlaxoSmithKline grant FLV116794. C.H.-H. is supported by Colorado Department of Public Health and Environment grants 15 FLA 65765, 16 FHLA 76546, and 17FHLA87312 and Kaiser Permanente and the University of Colorado School of Medicine funded through GlaxoSmithKline grant FLV116794. C.V. is supported by NHLBI grant 1U34 HL130665-01 and supported the University of Colorado School of Medicine funded through GlaxoSmithKline grant FLV116794. A.C. is supported by the University of Colorado School of Medicine funded through GlaxoSmithKline grant FLV116794. L.C. is supported by the Colorado Department of Public Health and Environment, Colorado CTSA grant UL1 TR001082 from the NIH/NCRR, the Kaiser Permanente Foundation, the Jessie Ball Du Pont Fund, and the McCormick Foundation. M.W. is supported by Colorado Department of Public Health and Environment grants 15 FLA 65765, 16 FHLA 76546, and 17FHLA87312, the Caring for Colorado Foundation, the McCormick Foundation, and the University of Colorado School of Medicine funded through GlaxoSmithKline grant FLV116794. S.W. is supported by the University of Colorado School of Medicine funded through GlaxoSmithKline grant FLV116794. M.M. is supported by the University of Colorado School of Medicine funded through GlaxoSmithKline grant FLV116794. C.L. is supported by the State of Connecticut Department of Public Health, the Community Health Network of Connecticut, and NHLBI grant 1U34 HL130665-01 and by the University of Colorado School of Medicine funded through GlaxoSmithKline grant FLV116794. H.M. is supported by the University of Colorado School of Medicine funded through GlaxoSmithKline grant FLV116794.

Disclosure of potential conflict of interest: S. J. Szefler reports grants from GlaxoSmithKline during the conduct of the study and grants from Boehringer-Ingelheim, Genentech, GlaxoSmithKline, Aerocrine, Novartis, AstraZeneca, Daiichi Sankyo, Roche, and Teva outside the submitted work. M. M. Cloutier, M. Villarreal, J. P. Hollenbach, A. Calatroni, M. Gleason, C. Haas-Howard, C. Vinick, M. White, S. Williams M. McGinn, C. Langton, D. Shocks, and H. Mitchell received grant support to conduct this study from GlaxoSmithKline through the University of Colorado School of Medicine. L. Cicutto reports grants from Seasons to Share McCormick, the Colorado Department of Public Health and Environment, the Jesse Ball Du Pont Fund, the Environmental Protection Agency, the Colorado Clinical and Translational Sciences Institute, and the National Institutes of Health/National Center for Advancing Translational Sciences Clinical and Translational Sciences Award outside the submitted work. D. A. Stempel is a former employee of GlaxoSmithKline and a stockholder of GlaxoSmithKline.