Asthma coalition effects on vulnerable sub groups of children: the most frequent users of health care and the youngest

Abstract

Objective: To examine the impact of Allies Against Asthma, community-based coalitions working to improve asthma outcomes, on vulnerable children: those with the most urgent health care use and those of youngest age. Methods: Allies zip codes were matched with comparison communities on demographic factors. Five years of Medicaid data (n = 26,836) for significant health care events: hospitalizations, ED and urgent care facility visits, were analyzed. Longitudinal analyses using generalized estimating equations and proportional hazards models compared Allies and comparison group children. Results: In the two start-up years of Allies, odds of having a significant event were greater for Allies children than for comparison children (p < 0.05). During the third and fourth years when Allies activities were fully implemented, for frequent health care users at baseline, odds of an asthma event were the same for both Allies and comparison children, yet in the less frequent users, odds of an event were lower in Allies children (p < 0.0001). In the initial year of Allies efforts, among the youngest, the Allies children had greater odds than comparison children of an event (p < 0.01), but by the fourth year the Allies group had lower odds (p = 0.02) of an event. Hazard ratios over all years of the study for the youngest Allies children and most frequent baseline users of urgent care were lower than for comparison children (p = 0.01 and p = 0.0004). Conclusion: Mobilizing a coalition of diverse stakeholders focused on policy and system change generated community-wide reductions over the long-term in health care use for vulnerable children.

• Management/control
• morbidity and mortality
• pediatrics
• prevention
• quality of life

Acknowledgements

We gratefully acknowledge the guidance and contributions of Allies Advisory board members and consultants Michele Carrick, MSW, Elaine Cassidy, PhD, Mary desVignes-Kendrick, MD, MPH, Susan Downey, M.Ed., Rachel A. Gonzales-Hanson, Rob Fulwood, PhD, JA Grisso, MPH, MD, Barbara Israel, Ph.D., Talmadge King, MD, Floyd Malveaux, MD, PhD, Robert Mellins, MD, Steve Page, MPA, Guy Parcel, PhD, Stephen Redd, MD, Jeanne Taylor, PhD, Abe Wandersman, PhD, Sandra Wilson, PhD, Albert Yee, MD, Sarah Hearn, Ye Yang, and Charles Brinker. Additionally, we thank Christine Joseph, PhD and her team for matches of Allies zip codes. We also wish to thank the dedicated members of all the Allies coalitions. This work is dedicated to the memory of Dr. Noreen M. Clark, Director of the Center for Managing Chronic Disease, University of Michigan School of Public Health and to the memory of Dr. M. Beth Benedict, retired from the Centers for Medicare, Medicaid Services, Health & Human Services with gratitude for their vision and guidance.