Reducing Barriers to Care for Vulnerable Children with Asthma
Project Number: R40 MC 08044 (01214-04) Project Date: 09/01/2003 Grantee: Cincinnati Children's Hospital and Medical Center Department/Center: Division of Pulmonary Medicine & Center for Health Care Quality
Michael Seid Ph.D., Director, Health Outcomes & Quality of Care Research, Cincinnati Children's Hospital and Medical Center Division of Pulmonary Medicine & Center for Health Care Quality, Division of Pulmonary Medicine MLC 2021; 3333 Burnet Avenue Cincinnati, OH 45229 Michael.Seid@cchmc.org
Abstract
The long term goal of this research is to improve quality of care and health outcomes for vulnerable children with asthma. The main objective of the proposed 4-year research project is to develop and test culturally and linguistically appropriate brief interventions to reduce barriers to health care for vulnerable children with persistent asthma. The specific aims of the proposed research are to 1) adapt and 2) test, within a randomized controlled clinical trial, a tailored Problem Solving Therapy intervention to address barriers to care. Children ages 5-12 years with persistent asthma and their families (n = 366) will be randomized to a) Care Coordination (CC), b) a combination of Care Coordination and tailored Problem Solving Therapy - a targeted form of Problem Solving Therapy specifically tailored to the key barriers to care identified by the family (tPST), or c) a wait-list control that will be offered the combination intervention after the trial (WL). We will measure the impact of the interventions on processes of care, health-related quality of life (HRQL), symptoms, and utilization at the end of the three-month intervention and at six months after intervention. We hypothesize that CC alone and tPST with CC will both be superior to WL at 3 months, but that the combination of tPST and CC will be superior to both CC along and WL at 6 months follow up. Successful accomplishment of the specific aims could have substantial impact on the clinical management of children with asthma throughout the United States. Evidence for the efficacy of tPST and the availability of culturally and linguistically appropriate treatment manuals should spur diffusion of this innovation to other practitioners and programs seeking evidence-based optimal clinical management strategies. The proposed research responds to MCHB's Research Program (CFDA #93.110RS) in that it is "applied research relating to maternal and child health services (that shows) promise of substantial contribution to the advancement of such services." It is further consistent with MCHB's "special emphasis on improving service delivery to women, children, and youth from communities with limited access to comprehensive care" by focusing on racial/ethnic minority children and families with limited English language ability. The proposed research is responsive to MCHB Priority Research Issue I in that it studies "alternatives for delivery of comprehensive continuous health care services for special health needs children."
Publications
Listed is descending order by year published.
Michael Seid. Barriers to Care and Primary Care for Vulnerable Children with Asthma. Pediatrics 2008; 122; 994-1002. Online version of this article found at: http://www.pediatrics.org/cgi/content/full/122/5/994.
Keywords
Access to Health Care, Asthma, Case Management, Children with Special Health Care Needs, Home Visiting Services, MCH Research, Parent Education, Primary Care
