Improving Childhood Asthma Outcomes in the United States

Improving Childhood Asthma Outcomes in the United States: A Blueprint for Policy Action

Marielena Lara
Will Nicholas
Sally Morton
Mary E. Vaiana
Barbara Genovese
Gary Rachelefsky
Stephen Redd
Kevin Weiss
Copyright Date: 2001
Edition: 1
Published by: RAND Corporation
Pages: 124
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  • Book Info
    Improving Childhood Asthma Outcomes in the United States
    Book Description:

    One-liner: A set of policy recommendations to promote the development and maintenance of communities in which children with asthma can be swiftly diagnosed, effectively treated, and protected from exposure to harmful environmental factors. An estimated 5 million U.S. children have asthma. Too many of these children are unnecessarily impaired. Much of the money spent on asthma is for high-cost health care services to treat acute periods of illness. Many asthma attacks could be avoided--and much suffering prevented and many medical costs saved--if more children received good-quality, ongoing asthma care and if the 11 policy recommendations presented in this report were implemented in a oordinated fashion. A national call to action, the policy recommendations span public and private interests and compel integration of public health activities across local, state, and federal levels. This report summarizes the findings of an effort funded by the Robert Wood Johnson Foundation as part of the Pediatric Asthma Initiative, whose purpose is to address current gaps in national childhood asthma care. It is the first national initiative that simultaneously addresses treatment, policy, and financing issues for children with asthma at the patient, provider, and institutional levels. The purpose of RAND's effort was to:--identify a range of policy actions in both the public and private sectors that could improve childhood asthma outcomes nationwide--select a subset of policies to create a blueprint for national policy in this area--outline alternatives to implement these policies that build on prior efforts.The effort developed a comprehensive policy framework that maps the identified strategies to one overall policy objective: to promote the development and maintenance of asthma-friendly communities--communities in which children with asthma are swiftly diagnosed, receive appropriate and ongoing treatment, and are not exposed to environmental factors that exacerbate their condition. This report is intended as a working guide for coordinating the activities of both public and private organizations at the federal, state, and local community levels.

    eISBN: 978-0-8330-3242-3
    Subjects: Political Science, Sociology, Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-ii)
    (pp. iii-iv)
    (pp. v-vi)
    (pp. vii-x)
  5. Table of Contents
    (pp. xi-xiv)
    (pp. xv-xxx)
    (pp. xxxi-xxxii)
    Marielena Lara
    (pp. xxxiii-xxxiv)
  9. Chapter One INTRODUCTION
    (pp. 1-4)

    This project was inspired by the story of one of our own patients:

    Fabiola is a bright, active teenager: a good student, a cheerleader, and a member of the school choir. She is also one of an estimated 5 million American children under age 15 with asthma. Although asthma is a treatable and manageable disease, for Fabiola it was almost fatal.

    Fabiola was diagnosed with asthma when she was 5. At age 10, she was referred to the county asthma clinic, where she was put on a regular program of preventive medication. Her symptoms improved dramatically for a while.


  10. Chapter Two POLICY CONTEXT
    (pp. 5-14)

    Almost everyone knows a child with asthma. Although asthma is a treatable disease, too many children with asthma suffer unnecessarily. Some even die. Yet children whose asthma is properly controlled can lead a fully active life with minimal symptoms.

    Childhood asthma is a national public health problem that challenges not only the entire health system but also school systems and the many public and private organizations that track the effects of this illness, provide education and other community-based programs, and fund research into the causes of asthma. To combat this problem, improved coordination of ongoing national efforts and a significant...

  11. Chapter Three OVERVIEW OF METHODS
    (pp. 15-18)

    Because many factors affect asthma and its management, a multistrategy policy approach is needed to improve childhood asthma outcomes. To develop specific recommendations, we used both a structured panel meeting and policy formulation methods. The paucity of evidence on the potential impact of policies in key areas meant that interdisciplinary expert judgment had to be substituted in some instances.

    We used a nominal group method to structure the expert judgment process. This method is described in detail elsewhere38and has been used previously in policy exercises.39In general, this method entailed

    Selecting and convening an interdisciplinary group of asthma and...

  12. Chapter Four POLICY FRAMEWORK
    (pp. 19-24)

    The expert process described above led to the conclusion that a successful national childhood asthma policy agenda should have national, state, and community components and be comprehensive.

    Communities are the ultimate focus for asthma-related policy efforts, because it is at the community level that children with asthma and their caregivers interact with and obtain services from the health care system, schools, and other important social institutions. Community-based and community-centered efforts thus are the essential cornerstone of a public health approach to the problem. Consequently, all national policies (both public and private) should be considered with an eye toward the promotion...

    (pp. 25-64)

    The 11 policy recommendations fall into two major categories—“Improving Health Care Delivery and Financing” and “Strengthening the Public Health Infrastructure.” Each category and its related subcategories are described before the corresponding policy recommendations are presented.

    The six recommendations in this category are designed to improve the quality of asthma-related health care services and to increase access to these services through expansions in insurance coverage and improvements in the benefit structures of public and private insurance. Directed at health care providers, purchasers, and regulators, the recommendations fall into two subcategories: “Promoting Quality of Care for Key Childhood Asthma Care Services”...

  14. Chapter Six CONCLUSION
    (pp. 65-68)

    If fully implemented, the recommendations described in this report would lead to major improvements in childhood asthma outcomes in the United States and would increase the number ofasthma-friendlycommunities. These recommendations, which focus on prevention, treatment, and management of asthma and on the integration of community asthma prevention activities, are strongly related. At the same time, as with many public policy recommendations, they could be adopted in stages and over time.

    The timing of this report in tandem with the passage of the “Asthma Services for Children” title of the Children’s Health Act of 2000 is quite fortunate. The...

    (pp. 69-78)
    (pp. 79-90)