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PEDIATRICS Vol. 109 No. 5 May 2002, pp. 919-930

SPECIAL ARTICLE

Improving Childhood Asthma Outcomes in the United States: A Blueprint for Policy Action

Marielena Lara, MD, MPH*,{ddagger}, Sara Rosenbaum, JD§, Gary Rachelefsky, MD{ddagger},||, Will Nicholas, MPH, PhD, Sally C. Morton, PhD*, Seth Emont, PhD#, Marian Branch, MA*, Barbara Genovese, MA*, Mary E. Vaiana, PhD*, Vernon Smith, PhD**, Lani Wheeler, MD{ddagger}{ddagger}, Thomas Platts-Mills, MD§§, Noreen Clark, PhD||||, Nicole Lurie, MSPH, MD* and Kevin B. Weiss, MD¶¶

* From the University of California-Los Angeles/RAND Program on Latino Children with Asthma: RAND Health, Santa Monica, California
{ddagger} Division of General Pediatrics, University of California-Los Angeles Department of Pediatrics, Los Angeles, California
§ Center for Health Services Research and Policy, George Washington University School of Public Health and Health Services, Washington, DC
|| Allergy Research Foundation, Los Angeles, California
Los Angeles County Children and Families First Commission, Los Angeles, California
# White Mountain Research Associates, LLC, Plainsboro, New Jersey
** Health Management Associates, Lansing, Michigan
{ddagger}{ddagger} Anne Arundel County Department of Health, Annapolis, Maryland
§§ Asthma and Allergic Diseases Center, University of Virginia
|||| University of Michigan School of Public Health, Ann Arbor, Michigan
¶¶ The Center for Healthcare Studies, and the Division of General Medicine, Department of Medicine, Northwestern University Medical School, Chicago, Illinois, and the Midwest Center for Health Services and Policy Research, Hines VA Medical Center, Hines, Illinois

Background/Objective. Asthma is increasingly being recognized as an important public health concern for children in the United States. Effective management of childhood asthma may require not only improving guideline-based therapeutic interventions, but also addressing social and physical environmental risk factors. The objective of this project was to create a blueprint for improvement of national policy in this area.

Design/Methods. A nominal group process with nationally recognized experts and leaders (referred to as "the committee") in childhood asthma.

Results. The committee identified 11 policy recommendations (numbered in order below) in 2 broad categories: Improving Health Care Delivery and Financing, and Strengthening the Public Health Infrastructure. Recommendations regarding Improving Health Care Delivery and Financing include the development and implementation of quality-of-care standards in 1) primary care, 2) self-management education, and 3) case-management interventions, and the expansion of insurance coverage and benefit design by 4) extending continuous health insurance coverage for all children, 5) developing model insurance benefits packages for essential childhood asthma services, and 6) educating health care purchasers in how to use them. Recommendations for Strengthening the Public Health Infrastructure include public funding of asthma services that fall outside the insurance system through establishing 7) public health grants to foster asthma-friendly communities and 8) school-based asthma initiatives. 9) Launching a national asthma public education campaign, 10) developing a national asthma surveillance system, and 11) establishing a national agenda for asthma prevention research, with an emphasis on epidemiologic and behavioral sciences, are also recommended.

Conclusions. Implementing these recommendations will require coordination of activities at the national, state, and local community level, and within and outside the health care delivery system. With a further commitment of national and local resources, implementation of these recommendations will likely lead to improved child and family asthma outcomes in the United States. childhood asthma, health care policy, health care services.

Abbreviations: NAEPP, National Asthma Education and Prevention Program • SCHIP, State Children’s Health Insurance Program

Received for publication Nov 9, 2001; Accepted Mar 5, 2002.




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