Colorado school-based asthma program to improve health equity for children in low-income communities across the stateMar 30, 2021
The DECIPHeR Alliance is composed of seven research centers across the United States plus a research coordinating center. The Colorado DECIPHeR site is made up of team members from Children’s Hospital Colorado’s (Children’s Colorado) Breathing Institute, National Jewish Health, University of Colorado School of Medicine, Colorado Comprehensive School-Centered Asthma Program (AsthmaCOMP) and the Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS). The DECIPHeR Alliance supports research to identify the best strategies for ensuring successful integration of evidence-based interventions within clinical and public health settings. The goal of the Colorado site is to create broad and equitable reach through a flexible and customizable playbook to help each community reduce asthma symptoms and manage asthma attacks.
Stanley Szefler, MD, professor of pediatrics-pulmonary medicine in the School of Medicine and director of the Pediatric Asthma Research Program at Children's Hospital Colorado's Breathing Institute and Lisa Cicutto, PhD, RN, the director of Education, Training and Career Development program at the Colorado Clinical and Translational Sciences Institute (CCTSI), will serve as principal investigators on the project called “Reducing Asthma Attacks in Disadvantaged School Children with Asthma.” Szefler and Cicutto's team is the only one focused on respiratory disease within diverse school-based populations and is the only pediatric site in the DECIPHeR Alliance.
“Access to medical care is the number one factor that impacts a child's asthma control and that access varies by school districts,” said Dr. Szefler. This access refers both to having healthcare and health coverage resources, and how families utilize those resources. It also refers to the varied school-based nursing resources available within each district to communicate with families and the child's primary care home.
About 8.4% of Colorado's children have asthma, yet prevalence among African American children is higher (10.1%); prevalence among Latino children is lower (6.4%), yet grows with each subsequent generation going to school. Previous work of the team funded by Colorado Department of Public Health and Environment demonstrated that a school-based asthma program (AsthmaCOMP) successfully improves asthma management skills and behaviors, resulting in an approximately 80% decrease in asthma exacerbations, emergency department visits and hospitalizations. Missed school days also decreased significantly among low-income and racial/ethnic minority students across six Colorado public school districts. A key piece of AsthmaCOMP is that it leverages partnerships between school nurses, clinical care and public health.
“This award will allow us to better scale and spread the evidence-based best practices we've developed in the Denver metropolitan area,” said Dr. Szefler. “We hope to replicate the improvements in asthma care found in our Denver-area programs. Yet distance to primary or specialty care, access to telephone and internet services and different environmental exposures may be factors that need to be addressed in different communities. Accordingly, we are working with state and regional community advisory boards to tailor the program to meet the priorities and needs.”
Meeting the priorities and needs of rural geographies and diverse socioeconomic populations across Colorado and the nation will require development of a scalable model that identifies local and regional social determinants of health. Social determinants of health (SDOH) include many factors that affect asthma care, including difficulty with transportation to health care visits and difficulty affording medications.
To ensure all children have access to best practices for managing and reducing asthma attacks, the team will expand the AsthmaCOMP program with a SDOH screening and culturally sensitive asthma coaches to support school-based nursing resources and families. The combination of AsthmaCOMP plus SDOH screening and referral is called the Stop Asthma Attacks (SAA) program.
Ultimately, this multi-institutional team will identify key lessons that will inform the development of a “playbook” for communities to use to plan how to implement SAA. Overall, the team expects this study will help diverse and disadvantaged communities nationally to implement SAA in a way that addresses local factors critical for success and sustainability.
Other key DECIPHeR investigators include Amy Huebschmann, MD, MSc, associate professor of Medicine; Melanie Gleason, PA-C, MS, associate director of AsthmaCOMP; Arthur McFarlane, evaluator for diversity, equity and inclusion for Children's Colorado's Breathing Institute; a number of investigators at ACCORDS and the Children’s Colorado’s Breathing Institute.
This research project is supported by the NHLBI under NIH Award Number UG3HL151297. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.