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PEDIATRICS Vol. 99 No. 2 February 1997, pp. 157-164
Received May 23, 1995; accepted February 2, 1996..
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From the * Department of Pediatrics, Columbia University College
of Physicians and Surgeons; New York, New York; Bureau of Child
Health, New York City Department of Health (now called Child Health
Clinics of New York City, a subdivision of the New York City Health and
Hospitals Corporation), New York, New York; § Department of Health
Sciences, Jersey City State College, Jersey City, New Jersey;
Medical and Health Research Association of New York City, Inc, New
York, New York; ¶ Division of Biostatistics, Columbia University School
of Public Health; New York, New York; # Department of Educational
Psychology, City University of New York Graduate Center; New York, New
York; and ** Department of Health Behavior and Health Education,
University of Michigan School of Public Health, Ann Arbor, Michigan.
Objective. Recent studies have shown that lack of continuing primary care for asthma is associated with increased levels of morbidity in low-income minority children. Although effective preventive therapy is available, many African-American and Latino children receive episodic treatment for asthma that does not follow current guidelines for care. To see if access, continuity, and quality of care could be improved in pediatric clinics serving low-income children in New York City, we trained staff in New York City Bureau of Child Health clinics to provide continuing, preventive care for asthma.
Methods. We evaluated the impact of the intervention over a 2-year period in a controlled study of 22 clinics. Training for intervention clinic staff was based on National Asthma Education and Prevention Program guidelines for the diagnosis and management of asthma, and included screening to identify new cases and health education to improve family management. The intervention included strong administrative support by the Bureau of Child Health to promote staff behavior change. We hypothesized that after the intervention, clinics that received the intervention would, compared with control clinics, have increased numbers of children with asthma receiving continuing care in the clinics and increased staff use of new pharmacologic and educational treatment methods.
Results. In both the first and second follow-up years, the
intervention clinics had greater positive changes than control clinics
on measures of access, continuity, and quality of care. For second year
follow-up data these include: for access, greater rate of new asthma
patients (40/1000 vs 16/1000; P < .01); for continuity, greater percentage of asthma patients returning for treatment 2 years in a row (42% vs 12%; P < .001)
and greater annual frequency of scheduled visits for asthma per patient
(1.85 vs .88; P < .001); and for quality, greater
percentage of patients receiving inhaled 
agonists (52% vs 15%;
P < .001) and inhaled antiinflammatory drugs (25% vs
2%; P < .001), and greater percentages of parents
who reported receiving patient education on 12 topics from Bureau of
Child Health physicians (71% vs 58%; P < .01) and nurses (61% vs 44%; P < .05).
Conclusion. We conclude that the intervention substantially increased the Bureau of Child Health staff's ability to identify children with asthma, involve them in continuing care, and provide them with state-of-the-art care for asthma.
Key words: asthma, children, minority populations, continuing medical education, patient education, public health, antiinflammatory therapy, spacer devices for inhaled therapy.
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