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Overview

The major goal of this study is to test the effect of the CHESS Web-based asthma education site coupled with nurse case management for parents of children (ages 4-12) with moderate to severe asthma. Primary outcome measures include children’s adherence to daily asthma control medication, utilization of urgent and emergency asthma-related health care services, and rescue medication prescription fills.

The Need

Asthma impacts six million children under the age of eighteen and is the leading chronic illness among children in the US (CDC, 2006). It is estimated to contribute to three million lost workdays per year and more than 14 million lost school days (Diette et al., 2000).

Details

This study will evaluate the effects of combining a monthly educational call from an asthma nurse case manager with CHESS (the Comprehensive Health Enhancement Support System – a web-based asthma educational program). Specifically, this randomized control study will test whether and how CHESS integrated with a monthly educational phone call from an asthma case manager (CHESS+CM) can improve asthma control and adherence to asthma controller medications in children with moderate to severe asthma.

  • Primarily, we hypothesize CHESS+CM will:
  1. Increase adherence to prescribed asthma controller medications
  2. Increase the number of asthma-free days
  3. Reduce asthma related health services utilization (ER, hospital, acute/urgent)
  • Secondarily, we will test a mediational model to explain the mechanisms of how CHESS+CM affects the above outcomes, including:
  1. Self-efficacy
  2. Information competence
  3. Adherence Model Factors (Gustafson, 2001b – Merck-funded medication adherence research)

We will recruit 400 parents of children, age 4-12, with moderate to severe asthma. Due to lower numbers than anticipated from the four Dane County area HMOs, recruitment for the CHESS Pediatric Asthma study has been expanded to include identifying eligible participants in the seven counties surrounding Dane County, as well as, Milwaukee County. This expansion includes Dane, Dodge, Sauk, Rock, Green, Columbia, Jefferson, Iowa, and Milwaukee counties.

We are targeting families (30% Medicaid), whose child has evidence of poor asthma control and poor adherence to asthma controller medications (as identified by pharmacy and health services utilization claims data).

Principal Investigators:
David Gustafson Sr., Ph.D