摘要：Objectives. We assessed changes in asthma-related health care use by low-income children in communities across the country where 6 Allies Against Asthma coalitions (Hampton Roads, VA; Washington, DC; Milwaukee, WI; King County/Seattle, WA; Long Beach, CA; and Philadelphia, PA) mobilized stakeholders to bring about policy changes conducive to asthma control. Methods. Allies intervention zip codes were matched with comparison communities by median household income, asthma prevalence, total population size, and race/ethnicity. Five years of data provided by the Center for Medicare and Medicaid Services on hospitalizations, emergency department (ED) use, and physician urgent care visits for children were analyzed. Intervention and comparison sites were compared with a stratified recurrent event analysis using a Cox proportional hazard model. Results. In most of the assessment years, children in Allies communities were significantly less likely ( P < .04) to have an asthma-related hospitalization, ED visit, or urgent care visit than children in comparison communities. During the entire period, children in Allies communities were significantly less likely ( P < .02) to have such health care use. Conclusions. Mobilizing a diverse group of stakeholders, and focusing on policy and system changes generated significant reductions in health care use for asthma in vulnerable communities. In a previous issue of the Journal , 1 we reported the sustainable asthma-care policy and system improvements for low-income children achieved by 7 community coalitions participating in the Allies Against Asthma initiative. Allies coalitions worked in areas of high-level asthma burden to lead community- and system-wide efforts to improve the quality of care and health status of children with the condition. Engagement of stakeholders and activities constituting the coalitions’ collaborative work, beginning in 2002, were described in detail elsewhere. 2 Collectively, the coalitions succeeded in implementing 93 institutional, organizational, and public policy changes addressing clinical practice, care coordination, environmental conditions, and asthma management by families. We also reported that their work resulted in significant decreases in asthma symptoms among children and increases in parents’ sense of control over the disease in families participating in Allies sponsored interventions versus a comparison group. 1 This article presents data assessing changes in health care use for asthma by children residing in neighborhoods with extensive Allies activities compared with those without this exposure. This health care utilization study acknowledged that emergency department (ED) use and hospitalizations create significant burden on families in low-income neighborhoods, especially in African American and Hispanic populations. 3,4 Furthermore, the costs of urgent care for childhood asthma are exceedingly high 5 and constitute a serious burden not only for families but for the health care system. An important marker of success of the initiative would be the decreased need of Allies children for urgent health services subsequent to the activities of the Allies coalitions compared with children living in non-Allies communities. The premise of the study presented was that the policy and system changes achieved by Allies coalitions would reach beyond the cohort of children followed to ascertain differences in symptoms and quality of life to affect much larger numbers of children with asthma residing in Allies neighborhoods. Furthermore, the assumption was that the impact of sustained policy and system changes engendered by Allies coalitions for these larger numbers of low-income children would be observable. Over time, there would be a community-wide decrease in the need for urgent asthma care services in the children with asthma. After a planning period, implementation of Allies activities began by 2002, and coalitions were fully operational through 2004. This effectiveness study examined health care use in low-income children with asthma in Allies communities measured against comparison neighborhoods from 2002 to 2006, including 2 follow-up years (2005 and 2006) to assess sustained coalition effects. Outcomes assessed were differences in ED visits, urgent care visits, and hospitalizations for asthma.
