Addressing Pediatric Asthma Disparities through RI-AIR's Community Approach: A Randomized Trial.

Rationale: Clustering of social and environmental risks in low-income neighborhoods is a key factor in racial and ethnic asthma disparities. Integrating school and in-home programs, with treatment tailored to disease risk, is a promising approach for children with high disease burden.

Objectives: We evaluated the Rhode Island-Asthma Integrated Response (RI-AIR) Program in improving asthma outcomes at the individual and community levels. RI-AIR leverages existing community collaborations and technological advances to identify children with asthma at highest risk for poor outcomes through a system of identification, screening, and intervention.

Methods: We conducted a stepped wedge cluster randomized hybrid type-II effectiveness-implementation study. School-based catchment areas (n=32) of high asthma burden were identified using geospatial mapping of asthma-related urgent healthcare use from 2010-2018. Families received only school-based interventions if the child's asthma was Not Well Controlled or school and home-based interventions if the child's asthma was Poorly Controlled. Community Health Workers facilitated communication between families, schools, and healthcare providers. Follow-ups occurred every 3 months to 1-year post-intervention.

Results: Individual level: At 3-months, asthma control (primary outcome) improved (d=0.47 [95% confidence interval = 0.33; 0.61]) and symptom-free days increased (d=0.37 [0.24; 0.51]); both were sustained at 12 months. Community level: Healthcare utilization remained the same or increased (RR = 1.16 [1.00; 1.36]); however, sensitivity analyses indicated utilization was slightly lower in areas with greater family participation (penetration; active=0.93 [0.87; 0.99]; post=0.91 [0.86; 0.97]).

Conclusions: Intensive, multi-component interventions and community engagement are needed to improve asthma outcomes in areas of high burden.