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Childhood Asthma Foundation Invests Millions

Childhood Asthma Foundation Invests Millions to Implement Best Practices

Childhood asthma foundation invests millions to implement best practices to manage the disease
November 10th, 2010

The Merck Childhood Asthma Network, Inc. (MCAN), today announced it is targeting four high risk cities with nearly $4 million for programs that will combine evidence-based science, case management and asthma trigger removal plans to manage a disease that requires more than the right medical care. Programs in Chicago, Los Angeles, Philadelphia and San Juan, Puerto Rico – all cities with high rates of childhood asthma – will enroll children and families in the most comprehensive asthma management research program ever designed for the community level.

MCAN’s funding, an investment that will cover a four-year period of enrollment, education, implementation and evaluation, follows previous investments in each of the cities that resulted in positive health outcomes. While still being analyzed, results include decreasing the number of missed school days in half, a decrease in symptom days and an increase in the number of families whose children have asthma action plans.

“When it comes to overcoming the enormous cost, health and personal burdens of childhood asthma, we knew it required more than dusting off the clinical research and parachuting it into different parts of the country. We needed to be there, to see how the research translated on the ground,” said Dr. Floyd Malveaux Executive Director of MCAN and former Dean of the College of Medicine at Howard University. “Our continued community partnerships will reveal the best ways to manage a disease with roots that are both biological and environmental.”

The evidence-based programs allow the different communities to both adhere to rigorous asthma management fundamentals and tailor the approach to meet their particular needs. To evaluate the effectiveness of this approach, researchers at the Center for Managing Chronic Disease at the University of Michigan will lead a cross-site program evaluation and help disseminate findings that could impact public health practices and policies surrounding the management of childhood asthma.

The Addressing Asthma in Englewood Project is based on the Southside of Chicago and is a collaborative effort of the University of Illinois, School of Public Health and the Respiratory Health Association of Metropolitan Chicago. The program centers around a community educator model and links children with asthma to appropriate services, education programs in schools, community groups, and local agencies; and a home visit case management program to enhance asthma education, identification and mitigation of asthma triggers.

In Los Angeles, MCAN is partnering with the LA Unified School District for the “Yes We Can” Children’s Asthma Program in the nation’s second largest school district. The program involves a care coordination and education model that will extend beyond the immediate school clinic to include system changes between health, educational and community settings. The program will triage students and families into the appropriate level of intervention, improve the coordination of care between schools, clinics and community providers, and will focus on measuring symptom reduction and school days missed.

In Philadelphia, the Children’s Hospital of Philadelphia’s You Can Control Asthma Care Coordination Program will utilize asthma health care navigators located within four primary care centers operated by the hospital. Navigators will work with primary care providers as an integral member of the family’s asthma care team assisting families in the identification and reduction of asthma triggers in the home, providing self-management education, and other support and resources for families of high risk children with asthma.

The La Red de Asma Infantil de Merck de Puerto Rico program involves evidence-based interventions as part of an asthma care coordination program across home, health care and community settings. The program will be implemented in the Nemesio Canales Housing Project in San Juan, Puerto Rico by the University of Puerto Rico and RAND Health. “La Red” aims to promote asthma-friendly communities throughout the island of Puerto Rico and to enhance access to quality asthma healthcare for this highly vulnerable and underserved community.

According to Dr. Malveaux, one of the keys to moving forward and making broad, systemic change, will be to demonstrate the results, disseminate the approaches and sustain the important work MCAN’s partners are achieving in their communities.

“While the health improvements we have seen to date in individual communities have been overwhelmingly positive, the real potential lies in the ability to make the lessons learned applied as broadly as possible, to help as many children with asthma as possible,” Dr. Malveaux said. “Long term and wide spread change is the goal of our next phase of work.”

Provided by The Merck Childhood Asthma Network, Inc.

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Childhood Asthma Foundation invests Millions to implement Best Practices

NIH asthma outcome measures aim to maximize research investments, reduce disparities
New measures may hold key to reducing disparities in children with asthma

Newly proposed asthma outcome measures will help standardize and improve results from the hundreds of millions of dollars the National Institutes of Health (NIH) spends annually to study asthma, according to the Merck Childhood Asthma Network, Inc. (MCAN), the nation’s only organization focused solely on childhood asthma. Even though years of research have led to groundbreaking improvements in better understanding and managing asthma, MCAN noted that the inability to compare results across many studies has hindered the nation’s efforts to find long-term solutions and reduce childhood asthma disparities.

This set of proposed outcome measures, published as a supplement to the March issue of the Journal of Allergy and Clinical Immunology, will be officially released at the annual meeting of the American Academy of Allergy Asthma & Immunology (AAAAI) in Orlando on March 3. NIH and other agencies will consider these outcomes in future clinical research initiatives later this year, which according to MCAN will permit the comparison of results across many large federally supported studies.

“For years, researchers, clinicians and others have worked to close the wide gap between the treatment that is recommended for children with asthma and the treatment most of them receive. We’ve struggled with an inability to make ‘apples to apples’ comparisons with research outcomes that could lead to improvements in management,” said Dr. Floyd Malveaux, Executive Director of MCAN and former Dean of the College of Medicine at Howard University. “This move towards standardization is a huge step in the right direction. It paves a way to reducing disparities in asthma management and treatment, especially for the most vulnerable children among us.”

In 2010, several federal agencies, non-governmental organizations and industry representatives gathered in Bethesda, Md., to identify how the nation might overcome the lack of outcomes standards in asthma clinical research. The meeting was organized by several NIH institutes, including the National Institute of Allergy and Infectious Diseases; the National Heart, Lung, and Blood Institute; the Eunice Kennedy Shriver National Institute of Child Health and Human Development; and the National Institute of Environmental Health Sciences, as well as the Agency for Healthcare Research and Quality and MCAN. The report of the meeting recommended a standardization of outcome measures that these federal agencies will consider implementing in the coming months.

Dr. Malveaux also noted that there is great potential for increased ability to duplicate successful interventions in some of the country’s neediest communities, identify areas for cost reduction and, through data-sharing, reduce disparities in the communities hardest hit by asthma.

Although other endpoints may be proposed by researchers, the NIH has identified seven outcome categories that are important in clinical studies. These categories include:

Symptoms: Asthma symptoms are used to assess the impact of interventions on health outcomes. Although current tools have shortcomings, the report reviews key instruments and encourages further development of new ones.
Exacerbations: Future studies will report exacerbations or worsening of asthma requiring the use of systemic corticosteroids.
Biomarkers: The report identified ten biomarkers relevant to disease progression and response to treatment, with particular emphasis on reporting multi-allergen screening.
Lung Function: Lung function outcomes are of central importance for future asthma clinical research, and spirometry and bronchial reversibility measures are considered key in diagnosing and determining disease severity.
Quality of Life: Measures of asthma’s impact on a patient’s life as essential for characterizing patient populations and assessing the benefits or harms of specific asthma interventions; no core measures have been identified to date.
Asthma Control Questionnaire Results: Several questionnaire instruments, including the Asthma Control Questionnaire (ACQ) and Asthma Control Test (ACT), were identified.
Healthcare Utilization and Costs: Collecting and reporting information on healthcare utilization, intervention resources and indirect impact of asthma will be encouraged so that costs can be calculated and cost-effectiveness analyses can be conducted across several asthma studies.

The final outcomes standards report entitled “Asthma Outcomes in Clinical Research: Report of the Asthma Outcomes Workshop” is available online at www.jacionline.org. The press conference at the AAAAI annual meeting will be webcast live on Saturday, March 3 from 2 to 3 p.m. ET at www.facebook.com/MedPageToday (click on the LiveStream link on the left). MCAN provided financial support for the 2010 NIH Outcomes Workshop and follow-up activities.

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About Childhood Asthma

Asthma is the single most common chronic condition among children. In 2009, one in every 11 children – 7.1 million – had asthma, a number that has grown steadily over the 1997-2009 time period. It is also costly. The nation spends between $8 and $10 billion alone on treating childhood asthma, more than any other childhood condition. Additionally, indirect costs which include missed school days and lost wages for a parent or care giver who is caring for a child, approach $10 billion annually. While asthma affects children in every community across the country, low income and minority children bear the heaviest burden of the disease and its consequences, including death. Compared with white non-Hispanic children, data reported in 2009 indicate that asthma is nearly twice as high among Puerto Rican children and twice as high in African-American children.

About the Merck Childhood Asthma Network

The Merck Childhood Asthma Network, Inc. (MCAN) is a non-profit, 501(c)(3) organization established to address the complex and growing problem of pediatric asthma. Funded by the Merck Company Foundation, and led by Floyd Malveaux, MD, PhD, a nationally recognized expert in asthma and allergic diseases and former Dean of the Howard University College of Medicine, MCAN is specifically focused on enhancing access to quality asthma care and management for children in the United States. For more information, visit www.mcanonline.org.

Contact: Kimberly Wise
kwise@ccapr.com
202-609-6015
The Merck Childhood Asthma Network, Inc.

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