The trial, called the Coordinated Healthcare Interventions for Childhood Asthma Gaps in Outcomes Trial, or CHICAGO Trial, could help thousands of children living with asthma in Chicago. Rates of asthma in children are unusually high in Chicago, and the respiratory disorder disproportionately affects African-American children.
“Children with asthma are frequent visitors to emergency departments,” says Dr. Jerry Krishnan, associate vice president for population health sciences at UI Health and principal investigator on the contract. “There are gaps in our understanding about how best to implement asthma guidelines in the emergency department. The CHICAGO Trial was designed specifically to address gaps in the care of children.”
Researchers at UI Health, Sinai Health System, the Ann & Robert H. Lurie Children’s Hospital of Chicago, University of Chicago Medicine, Rush University Medical Center, John H. Stroger, Jr. Hospital of Cook County, NorthShore University Health System and Northwestern University will investigate the effectiveness of two interventions among 640 children ages 5 to 11 visiting their emergency departments with uncontrolled asthma.
The first intervention provides emergency physicians with decision-support tools to help them follow established guidelines for prescribing oral and inhaled corticosteroids and faster-acting “rescue” medications, and provides patients and their parents or guardians with guidance on how to self-manage asthma and arrange for follow-up with a primary care provider.
The second intervention will include visits to the home of the child by a community health worker to help the family reduce environmental triggers of asthma at home.
“Many homes contain asthma triggers that patients don’t know about, or don’t know how to avoid” Krishnan said. “Having a trained community health care worker come to the home, identify triggers, and help the family avoid these triggers can have a great impact on children’s asthma.” The community health workers will also provide individualized education to improve asthma self-management skills and work closely with the child’s outpatient asthma care provider.
The success of the interventions will be assessed through interviews with the children’s caregivers and will focus on outcomes meaningful to children — such as not missing school and being able to participate in sports — and on outcomes meaningful to caregivers and families, such as lowered anxiety and not having to miss work. The researchers will also examine self-management skills and adherence to prescribed medications, avoidance of asthma triggers, and acute-care use.
Partners in the trial are the Respiratory Health Association, Chicago Asthma Consortium, the City of Chicago Department of Public Health, the IIT Institute of Design, Illinois Emergency Department Asthma Surveillance Program and the NIH/NCATS Clinical and Translational Science Award Chicago Consortium.
The Patient-Centered Outcomes Research Institute conducts research to provide information about the best available evidence to help patients and their health care providers make more informed decisions. PCORI’s research is intended to give patients a better understanding of the prevention, treatment and care options available, and the science that supports those options.
Other investigators from UI Health in the CHICAGO Trial include Michael Berbaum, adjunct associate professor of epidemiology and biostatistics; Dr. Sharmilee Nyenhuis, assistant professor of pulmonary, critical care, sleep and alergy; Dr. Trevonne Thompson, assistant professor of emergency medicine and Dr. Harsha Kumar, assistant professor of clinical pediatrics.
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