PROJECT SUMMARY/ABSTRACT
Multicomponent interventions delivered in school-based health centers (SBHCs) have the potential to
decrease asthma morbidity in children from communities that experience health inequities. Asthma is the most
common chronic disease in children. Black and Hispanic children from low-socioeconomic communities
account for a disproportionate percentage of asthma exacerbations, emergency department (ED) visits, and
hospitalizations. These children often do not receive guideline-based asthma care, and adherence to daily
preventive asthma medication is poor. Traditional health service delivery models where care is received in
physicians’ offices have limited success in improving asthma outcomes in vulnerable populations. This is
attributable to multiple social determinants of health that interrupt consistent comprehensive care, including
limited availability of health services, lack of transportation, and caregiver employment demands. As a result,
these children often receive crisis-driven care rather than prevention-driven care. SBHCs can serve as a safety
net for children living in poor communities and improve health outcomes. SBHCs are staffed by advanced
practice providers (APPs) who can assess and manage diseases. There are therefore minimal costs to
integrating an asthma management program within this existing health care delivery model.
Project ASTHMA (Aligning with Schools To Help Manage Asthma) is a prospective, stepped wedge cluster
randomized trial based on a successful pilot study, that aims to assess the effectiveness of SBHCs as a cost
effective health care delivery model to reduce asthma symptoms, exacerbations, ED visits, and hospitalizations
in children with uncontrolled asthma who live in communities with health inequities. The intervention will take
place in SBHCs located in 10 Buffalo Public Schools. The APPs at the SBHCs randomized to Project ASTHMA
that year will be trained and supported to deliver guideline-based chronic asthma care. Students enrolled in
Project ASTHMA will receive asthma assessments and preventive medication management from the APPs,
directly observed therapy of their preventive asthma medication from school nurses to support adherence, and
self-management support to improve adherence to home doses of asthma medication. Students enrolled at the
SBHCs randomized to the control that year will be in an enhanced usual care group who will receive an
asthma assessment by the research team and then be referred to their primary care provider for assessment
and medication management. SBHCs are a financially and clinically sustainable health care delivery model,
and have the potential to substantially decrease inequities in asthma morbidity. If disseminated, Project
ASTHMA has the potential to improve the health of children in high-poverty schools throughout the country.
These improvements are likely to be cost-effective for state and county health departments because over
2,500 SBHCs already exist in hundreds of communities in the United States. Evidence generated through our
findings can assist public health policymakers in determining priorities and allocating resources to SBHCs.
