Children with asthma from communities that experience health inequities frequently do not receive guideline-based asthma care, and as a result, account for a disproportionate percentage of asthma exacerbations, emergency department visits, and hospitalizations. Project ASTHMA (Aligning with Schools To Help Manage Asthma) tests the effectiveness of school-based health centers as a delivery model to improve health outcomes by providing children with guideline-based asthma assessments and preventive medication management, directly observed therapy of their preventive medication to support adherence, and self-management support. If successful, this multicomponent intervention will represent a cost effective and sustainable model to reduce asthma morbidity in historically marginalized communities, and has the potential to impact communities throughout the United States where over 2,500 school-based health centers operate.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
400
APPs will be trained to follow NIH guidelines for assessment and management of asthma, and to apply their knowledge to the care of the students. Students will also receive DOT of the morning dose of their controller medication.
University at Buffalo, Department of Pediatrics
Buffalo, New York, United States
RECRUITINGAsthma exacerbations
Number of asthma exacerbations requiring systemic steroids based on medical records
Time frame: from 1 month after enrollment to the end of the school year for 1 school year; to be assessed after the end of the school year.
Daytime asthma symptoms
Frequency of daytime asthma symptoms based on questionnaire minimum value: 0 days maximum value: 28 days Higher scores mean a worse outcome.
Time frame: to be assessed at baseline and 1-, 3-, 5- and 7-months after enrollment for 1 school year
Nighttime asthma symptoms
Frequency of nighttime asthma symptoms based on questionnaire minimum value: 0 nights maximum value: 28 nights Higher scores mean a worse outcome.
Time frame: to be assessed at baseline and 1-, 3-, 5- and 7-months after enrollment for 1 school year
Spirometry - FEV1
Forced Expiratory Volume in 1 second
Time frame: to be assessed at baseline and 1-, 3-, 5- and 7-months after enrollment for 1 school year
Spirometry - FEV1/FVC ratio
FEV1/Forced Vital Capacity ratio
Time frame: to be assessed at baseline and 1-, 3-, 5- and 7-months after enrollment for 1 school year
ED visits
Number of ED visits for asthma symptoms based on medical records
Time frame: from 1 month after enrollment to the end of the school year for 1 school year; to be assessed after the end of the school year.
Urgent care visits
Number of urgent care visits for asthma symptoms based on medical records
Time frame: from 1 month after enrollment to the end of the school year for 1 school year; to be assessed after the end of the school year.
Hospitalizations
Number of hospitalizations based on medical records
Time frame: from 1 month after enrollment to the end of the school year; to be assessed after the end of the school year.
Quality of Life - caregiver
Children's Health Survey for Asthma, American Academy of Pediatrics Higher scores mean a better outcome.
Time frame: to be assessed at baseline and at 7-month follow-up for 1 school year
Activity Limitation
Degree of activity limitation based on questionnaire Higher scores mean a worse outcome.
Time frame: to be assessed at baseline and 1-, 3-, 5- and 7-months after enrollment for 1 school year
school absenteeism
Number of missed school days based on school records
Time frame: from 1 month after enrollment to the end of the school year for 1 school year; to be assessed after the end of the school year.
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