, et al
Community interventions for childhood asthma ED visits and hospitalizations: a systematic review
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Investigators from the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, and Case Western Reserve University School of Medicine, Cleveland, OH, conducted a systematic review to evaluate the effectiveness of community interventions for childhood asthma. The investigators used a standardized search process to identify studies that assessed the impact of community interventions in reducing ED visits and hospitalizations for children with asthma. Studies included in the systematic review focused on community interventions that were place-based (eg, neighbor-hoods, zip codes); led by community health workers (CHWs), local leaders, or community partners; or sociodemographic-based (eg, low-income or minority populations) that assessed the effect on ED visits and hospitalizations for asthma among children in the defined community. Data abstracted from the identified studies included study participants, geographic location, type of community intervention, and results.

A total of 26 studies met criteria for inclusion in the systematic review. One of the included studies was based in Canada and 1 in Australia. The remaining studies were conducted in the US, including Puerto Rico. Community interventions in these studies were grouped into four categories: (1) community care coordination, (2) policy and environmental changes affecting communities, (3) home-based interventions in communities, and (4) community-based health services. Sources of outcome data in these studies were electronic health records, medical claims, and caregiver reports. Among the 8 studies that assessed community care coordination, a reduction in both ED visits and hospitalizations was reported in 7. Five studies evaluated interventions by the Merck Childhood Asthma Network (MCAN) that employed asthma care coordinators to connect families with health and social services and facilitate communication between families, physicians and schools. Eight studies assessed the impact of policy or environmental change. In 2 of these studies, interventions designed to improve substandard housing in low-income communities were associated with significant reductions in ED visits and hospitalizations for children with asthma in the community. There were mixed results from studies evaluating the effects of smoke-free laws and air pollution reduction strategies such as closing of a local steel industry and traffic reduction strategies. In 6 studies, the impact of home-based interventions in predominantly Black and Hispanic communities in which CHWs and others visited homes and identified asthma triggers and arranged for remediation were assessed. There were reductions in ED visits and hospitalizations found in 3 of these studies. Among 4 studies on community-based health services, 2 focused on the impact of mobile asthma clinics, with 1 showing significant reduction in ED visits and hospitalizations. There were 2 studies comparing in-home asthma interventions with the same intervention provided in a clinical setting in which there was little evidence of improved effectiveness with the in-home services.

The authors conclude that there is evidence that many community interventions...

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