Registry and Screening Tool to Identify Children With Asthma Likely to Benefit From Home Assessment and Remediation
CREST
Utilizing a Clinical Registry and Environmental Screening Tool to Identify Children With Asthma Most Likely to Benefit From Home Assessment and Remediation
1 other identifier
interventional
21
1 country
1
Brief Summary
Recognizing a decline in pediatric primary care visits and immunizations rates, an increase in utilization of the emergency room and stagnating academic achievement, leaders of MetroHealth Medical Center and the Cleveland Metropolitan School District understood that an innovative delivery option would be required to meet the needs of their pediatric urban population. In the fall of 2013, with support from local and regional funders, they collaborated to open the first School Based Health Center in Cleveland. During its first year, the MetroHealth School Health Program provided primary care services to children in 98 clinical care visits. Through an emphasis on population health and care coordination, the School Health Program has grew dramatically, completing over 2,400 visits in the 2017-2018 school year at clinical sites in over 13 schools. The School Health Program has been successful in developing a care management model to improve the percentage of students who complete recommended preventive services including immunization and preventive visits. The investigators intend to apply and expand upon lessons learned to develop an effective multi component asthma care management model that includes (1) registry utilization (2) evidence based clinical care protocols (3) implementation of an Environmental Screening Tool (4) effective utilization of a Medical Legal Partnership (5) effective partnership with an environmental health justice community organization, Environmental Health Watch, for home assessment and remediation (6) utilization of a unique data sharing partnership between a large health system and school district to document health and educational outcomes.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at below P25 for not_applicable asthma
Started Dec 2019
Typical duration for not_applicable asthma
1 active site
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
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Study Timeline
Key milestones and dates
First Submitted
Initial submission to the registry
April 11, 2019
CompletedFirst Posted
Study publicly available on registry
April 16, 2019
CompletedStudy Start
First participant enrolled
December 1, 2019
CompletedPrimary Completion
Last participant's last visit for primary outcome
January 1, 2023
CompletedStudy Completion
Last participant's last visit for all outcomes
June 1, 2023
CompletedOctober 19, 2023
October 1, 2023
3.1 years
April 11, 2019
October 17, 2023
Conditions
Keywords
Outcome Measures
Primary Outcomes (1)
Change in Asthma Control Test Score
Score on: Asthma Control Test (for children 12 and over) or Child Asthma Control Test (for children under 12) The Asthma Control Test is used to identify asthma control with scores ranging from a minimum of 5 (poor control) to a maximum of 25 (complete control) A score of over 19 indicated well controlled asthma.
baseline and 3 and 6 months after intervention
Secondary Outcomes (4)
Change in number of Asthma Related Emergency Department Visits
baseline and 3 and 6 months after intervention
Change in number of Asthma Related Hospitalizations
baseline and 3 and 6 months after intervention
Change in number of Asthma related Express Care or Urgent Care visits
baseline and 3 and 6 months after intervention
Educational Outcome: attendance
in past 3 months
Study Arms (7)
CONTROL
NO INTERVENTIONControl group
GROUP A no referral
EXPERIMENTALScreener does not document need for home visit or medical legal partnership referral.
GROUP B1 home assessment only
EXPERIMENTALScreener documents need for home assessment. Home assessment does not document need for home remediation. Screener does not document need for medical legal partnership.
GROUP B2 home assessment only
EXPERIMENTALScreener documents need for home assessment. Home assessment does not document need for home remediation. Screener documents need for medical legal partnership.
GROUP C1 home assessment and remediation
EXPERIMENTALScreener documents need for home assessment. Home assessment documents need for home remediation. Screener does not document need for medical legal partnership.
GROUP C2 home assessment and remediation
EXPERIMENTALScreener documents need for home assessment. Home assessment documents need for home remediation. Screener documents need for medical legal partnership.
D medical legal partnership only
EXPERIMENTALScreener does not document need for home assessment. Screener does not document need for medical legal partnership.
Interventions
Home assessment for environmental hazards according to protocol established by Environmental Health Watch (Healthy Home Audit https://www.ehw.org/healthy-home-audit/)
Low level home remediation according to previously established protocol (Kercsmar CM, Dearborn DG, Schluchter M, et al. Reduction in asthma morbidity in children as a result of home remediation aimed at moisture sources. Environ Health Perspect. 2006;114(10):1574-80)
Medical Legal Partnership referral as described by the National Center for Medical Legal partnerships and others (Beck AF, Identifying and treating a substandard housing cluster using a medical-legal partnership. Pediatrics. 2012;130(5):831-838)
Regular care in the School Health Program
Eligibility Criteria
You may qualify if:
- Enrolled in the MetroHealth School Health Program (signed parental consent on file in Epic electronic health record)
- Has diagnosis of asthma on active problem list OR was seen in Emergency Department or Express Care in past 12 months for asthma related diagnosis, OR has asthma related rescue or controller inhaled medication on current medication list.
Contact the study team to confirm eligibility.
Sponsors & Collaborators
- MetroHealth Medical Centerlead
- Cleveland Metropolitan School Districtcollaborator
- Environmental Health Watchcollaborator
- Legal Aid Society of Clevelandcollaborator
Study Sites (1)
MetroHealth medical Center
Cleveland, Ohio, 44109, United States
MeSH Terms
Conditions
Condition Hierarchy (Ancestors)
Study Officials
- PRINCIPAL INVESTIGATOR
Vanessa Maier, MD, MPH
MetroHealth Medical Center
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Allocation
- RANDOMIZED
- Masking
- NONE
- Purpose
- TREATMENT
- Intervention Model
- PARALLEL
- Sponsor Type
- OTHER
- Responsible Party
- PRINCIPAL INVESTIGATOR
- PI Title
- Assistant Professor & Medical Director, School Health
Study Record Dates
First Submitted
April 11, 2019
First Posted
April 16, 2019
Study Start
December 1, 2019
Primary Completion
January 1, 2023
Study Completion
June 1, 2023
Last Updated
October 19, 2023
Record last verified: 2023-10
Data Sharing
- IPD Sharing
- Will not share