ImportanceChildhood asthma is characterized by pervasive disparities, including 3-fold higher hospitalization rates and 7-fold higher death rates for Black children compared with White children. To address asthma disparities, one must intervene in all lived environments.ObjectiveTo determine if a community health worker (CHW) intervention to connect the primary care, home, and school for low-income minoritized school-aged children with asthma and their caregivers improves asthma control.Design, Setting, and ParticipantsThis study was a hybrid effectiveness/implementation trial using a 2 × 2 factorial, cluster randomized clinical trial design of 36 schools crossed with participant-level randomization into a clinic-based CHW intervention. The study was conducted from May 2018 to June 2022. The intervention took place in primary care offices, homes, and 36 West Philadelphia, Pennsylvania, public and charter schools. Children aged 5 to 13 years with uncontrolled asthma were recruited from local primary care practices.InterventionsAsthma management, trigger remediation, and care coordination occurred in school, home, and primary care settings. Children were followed up for 12 months. The Yes We Can Children’s Asthma Program, Open Airways For Schools Plus, and school-based asthma therapy were implemented.Main Outcomes and MeasuresImprovement in asthma control, as measured by the Asthma Control Questionnaire, comparing the mean difference between groups 1 year after randomization with their baseline (difference in differences). Both primary care and school interventions were dramatically disrupted by the COVID-19 pandemic; therefore, stratified analyses were performed to assess per-protocol intervention efficacy before the pandemic disruptions.ResultsA total of 1875 participants were approached, 1248 were excluded, and 1 was withdrawn. The 626 analyzed study participants (mean [SD] age, 8.7 [2.4] years; 363 male [58%]) self-identified as Black race (96%) and non-Hispanic ethnicity (98%). Although all groups had statistically significant improvements in asthma control from baseline to 12 months (P− group: −0.46; 95% CI, −0.58 to −0.33; P+ group: −0.57; 95% CI, −0.74 to −0.44; S− group: −0.47; 95% CI, −0.58 to −0.35; S+ group: −0.59; 95% CI, −0.74 to −0.44), none of the difference-in-differences estimates from the primary prespecified models showed a clinically meaningful improvement in asthma control. Analysis from the prepandemic interval, however, demonstrated that children in the combined clinic-school intervention had a statistically significant improvement in asthma control scores compared with control (−0.79; 95% CI, −1.40 to −0.18).Conclusions and RelevanceThis randomized clinical trial provides preliminary evidence that connecting all lived environments for care of children can be accomplished through linkages with CHWs.

中文翻译：

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将诊所和学校与哮喘控制联系起来的社区卫生工作者


重要性儿童哮喘的特点是普遍存在差异，包括黑人儿童的住院率比白人儿童高 3 倍，死亡率高 7 倍。为了解决哮喘差异，必须对所有生活环境进行干预。目的确定社区卫生工作者 （CHW） 干预将低收入少数族裔学龄哮喘儿童及其照顾者与初级保健、家庭和学校联系起来是否能改善哮喘控制。设计、设置和参与者本研究是一项混合有效性/实施试验，使用 2 × 2 个析因、整群随机临床试验设计，将 36 所学校与参与者水平随机化交叉为基于临床的 CHW 干预。该研究于 2018 年 5 月至 2022 年 6 月进行。干预在初级保健办公室、家庭和宾夕法尼亚州西费城的 36 所公立和特许学校进行。从当地的初级保健实践中招募了 5 至 13 岁患有未控制的哮喘的儿童。干预措施哮喘管理、触发因素补救和护理协调发生在学校、家庭和初级保健环境中。儿童随访 12 个月。实施了 Yes We Can 儿童哮喘计划、Open Airways For Schools Plus 和以学校为基础的哮喘治疗。主要结局和措施哮喘控制的改善，通过哮喘控制问卷测量，比较随机分组后 1 年组间的平均差异与基线（差异差异）。初级保健和学校干预都受到 COVID-19 大流行的严重干扰;因此，进行了分层分析以评估大流行中断前按方案干预的有效性。结果共接触了 1875 名参与者，排除了 1248 名参与者，1 名退出了参与者。626 名分析的研究参与者 （平均 [SD] 年龄，8.7 [2.4] 岁;363 名男性 [58%]）自我认同为黑人 （96%） 和非西班牙裔 （98%）。尽管从基线到 12 个月，所有组的哮喘控制都有统计学意义改善（P 组：-0.46;95% CI，-0.58 至 -0.33;P+ 组：−0.57;95% CI，-0.74 至 -0.44;S− 组：−0.47;95% CI，-0.58 至 -0.35;S+ 组：−0.59;95% CI，-0.74 至 -0.44），来自主要预先指定模型的任何双重差分估计均未显示哮喘控制有临床意义的改善。然而，大流行前间隔的分析表明，与对照组相比，临床-学校联合干预中的儿童哮喘控制评分有统计学意义改善（-0.79;95% CI，-1.40 至 -0.18）。结论和相关性这项随机临床试验提供了初步证据，表明可以通过与 CHW 的联系来实现连接所有生活环境以照顾儿童。