Reducing Quality of Care Disparities in Childhood Asthma

La Red de Asma Infantil Intervention in San Juan, Puerto Rico

Combining two evidence-based interventions yielded a reduction in asthma symptoms and health care utilization.

Puerto Rican children have the highest asthma prevalence of all U.S. children. These researchers combined two previously tested asthma interventions into one to implement among children with moderate to severe asthma living in two low-income housing projects in Puerto Rico. The new intervention they called La Red Intervention.

From “Yes We Can” they retained a structural component of an interactive multidisciplinary team—physician-asthma champion, community nurse/coordinator, and community health worker to work with families during clinic visits.

From the “Inner-City Asthma Study” they adapted the remediation of allergens in the home—dust mite impermeable bed covers, vacuuming, and removal of cockroaches—delivered by a community health worker.

Researchers recruited children living with asthma in the housing projects. The most common allergies were to dust mites and cockroaches. The children received nine intervention encounters (three for clinic visits) over 12 months.

Asthma-related hospitalizations were reduced 60 percent; emergency department visits 50 percent. Preventive medication use doubled and rescue medication use decreased 75 percent. The average reduction in simulated total health care expenditures was $5,913, a 45 percent reduction.

At the end of the intervention, half of the caregivers reported having a child asthma action plan, compared to 4 percent at baseline.