For Children With Asthma, Community Health Workers May Improve Outcomes
AUTHOR:
Brittany Perry, DO
Nemours/Alfred I. duPont Hospital for Children
CITATION:
Perry B. For children with asthma, community health workers may improve outcomes. Consultant360. Published online April 20, 2021.
Shreeve K, Woods ER, Sommer SJ, et al. Community health workers in home visits and asthma outcomes. Pediatrics 2021;147(4):e2020011817. https://doi.org/10.1542/peds.2020-011817
Asthma is a common chronic condition that affects 7.5% of children in the United States.1 There are known health disparities in asthma among different socioeconomic and racial and ethnic groups. Shreeve and colleagues2 highlight the disparities in their paper, which examines the use of community health workers and asthma-related outcomes. The authors write that Black and Hispanic children from low-income families have higher rates of asthma, less access to preventive care and medications for asthma control, and more emergency department (ED) visits and hospitalizations related to asthma.
The Community Asthma Initiative (CAI) is a home-visiting program through Boston Children’s Hospital that seeks to address these disparities by providing case management, education, and environmental assessment for families in their communities. This initiative was previously structured as a home nurse visit model and transitioned to a community health worker model in 2013. Community health workers are trained public health care workers who serve as liaisons between the community and health care system.
The study assessed asthma-related health outcomes among patients with Medicaid who were supported under the previous home nurse visiting model compared with a nurse-supervised community health worker model. The home nurse visiting model included 2 nurse practitioners and 1 community health worker, whereas the community health worker model included 2 community health workers and 1 nurse practitioner. The authors measured the number of ED visits, hospital admissions, days of limited physical activity, missed school days, and missed workdays for each group at baseline, 6 months, and 12 months. For the new community health worker model, a quality-of-life questionnaire was also administered.
The authors found significant improvements in all outcomes for both the home nurse visiting model and community health worker model. Fewer hospital admissions and missed school or work days were reported at the 12-month follow-up for the community health worker group. Quality-of-life scores were also improved by the 6- and 12-month follow-up visits.
A limitation of the study was that the 2 groups were evaluated at different time periods, so seasonal factors, demographics, and asthma education were slightly different. However, this study supports that the community health worker model for asthma is effective compared with home nurse visiting model and may improve asthma outcomes.
References
1. Asthma. Centers for Disease Control and Prevention. Reviewed March 1, 2021. Accessed April 19, 2021. https://www.cdc.gov/nchs/fastats/asthma.htm
2. Shreeve K, Woods ER, Sommer SJ, et al. Community health workers in home visits and asthma outcomes. Pediatrics 2021;147(4):e2020011817. https://doi.org/10.1542/peds.2020-011817