A randomized controlled evaluation of the effect of community health workers on hospitalization for asthma: the asthma coach

Abstract

Objective: To test whether community health workers are able to reach low-income parents of African American children hospitalized for asthma and to reduce rehospitalization among them.

Design: A randomized controlled evaluation of usual care vs 2-year asthma coach intervention.

Setting: An urban children's hospital and the surrounding community.

Participants: A population-based sample of 306 children hospitalized for asthma met the inclusion criteria of being 2 to 8 years of age, of African American ethnicity, and having Medicaid coverage. Of these, 200 were contacted and 191 recruited with commitment to evaluation activities but, in order to assess reach, no commitment to participating in intervention.

Interventions: Coaches reinforced basic asthma education and encouraged key management behaviors through home visits and phone calls tailored to parent's readiness to adopt management practices and emphasizing a nondirective supportive style (cooperative and accepting of feelings and choices).

Outcome measures: The reach of intervention to parents, contacts with coaches, and rehospitalization over 2 years based on hospital records.

Results: Within 3 months of randomization to the asthma coach group, 89.6% of parents had at least 1 substantive contact with the coach, with an average of 21.1 contacts per parent over the 24-month intervention. The proportion of children rehospitalized was 35 of 96 (36.5%) in the asthma coach group and 55 of 93 (59.1%) in the usual care group (P < .01), controlling for parental education and child age, sex, and hospitalization in the year prior to the index hospitalization. In surveys, parents indicated the importance of the nondirective approach to support.

Conclusions: An asthma coach can reach low-income parents of African American children hospitalized for asthma and reduce rehospitalization among the children.