The Merck Childhood Asthma Network, Inc. (MCAN) has released a report, "Translating Evidence into Practice," that examines its impact on childhood asthma care over the past decade. As the only 501(c)(3) organization to focus solely on the burden and associated morbidity of childhood asthma, MCAN - funded by the Merck Foundation - worked with partners in local communities, as well as other nonprofit organizations, foundations and government agencies to respond to this pervasive public health problem. The report covers the nature and scope of MCAN's work.
From 2005-2015, MCAN funded the implementation of evidence-based interventions in impoverished and medically underserved communities. MCAN was created after decades of increasing disparities in asthma morbidity despite the existence of well-documented and proven management strategies. Even today, more than six million children in the United States have asthma. It is the third-leading cause of hospitalizations among children under 15 and is also the leading cause of school absenteeism due to a chronic condition, accounting for nearly 15 million lost days of school each year.
In response to this public health challenge, MCAN launched Phase I of its community-based model (2005-2009) by awarding grants to asthma management programs at five sites in the United States and Puerto Rico. The initial outcomes surpassed expectations. Emergency room visits among children at MCAN-funded sites dropped by 30 percent, and 80 percent of the children across all sites missed fewer days of school due to asthma. This success was largely attributed to innovative care coordination involving evidence-based interventions, use of local care coordinators, and creation of community-based partnerships with organizations on the ground, such as city health departments and school districts.
MCAN project teams ensured the care coordination programs were designed to fit each community's specific needs, a necessary contextual factor for implementation in real-world settings. "It takes more than dusting off the clinical research findings and parachuting one-size fits all models into different parts of the country," said Dr. Floyd Malveaux, executive director, Merck Childhood Asthma Network. "We need to understand how research translates in each community and adapt accordingly."
For example, in the aftermath of Hurricane Katrina when allergens from flooding and lack of adequate healthcare could have caused a spike in childhood asthma symptoms, MCAN and partners provided patient-tailored asthma counseling and mitigation of triggers of asthma symptoms to address this extraordinary challenge. Over 12 months, patients in New Orleans and surrounding parishes reported that the average number of maximum asthma symptom days plummeted by 45 percent.
Harnessing the experiences and findings from successful Phase I strategies, MCAN launched Phase II (2010-2015) by expanding its scope to new and more focused programs. The 805 children enrolled in its care coordination sites in the U.S. and Puerto Rico missed an average of 45 percent fewer days of school after the interventions had been in place for a year. As noted in earlier randomized controlled studies, tailored healthcare strategies embedded in evidence-based interventions played a crucial role in managing adverse childhood asthma outcomes, particularly in high-risk communities. "The Phase II outcomes were impressive and demonstrated the impact that care coordination strategies can have," said Cynthia Rand, National Advisory Board Chair, MCAN, and Professor of Medicine, Johns Hopkins University. "MCAN's tailored, evidence-based approach in individual communities can make a sustainable change in the quality of asthma care."
MCAN appreciated the need to address and impact public policy to ensure sustainability of systemic change through adequate reimbursement for services and the way in which guidelines-based asthma care is provided. "We realized early that in order to achieve sustainable change in healthcare settings, federal and state level policies for quality care were necessary," said Dr. Malveaux.
MCAN partnered with the Environmental Protection Agency (EPA) to build an online network for asthma programs, www.AsthmaCommunityNetwork.org, which will to continue to house the MCAN knowledge base beyond 2015. The organization consulted with the Centers for Disease Control and Prevention and Department of Housing and Urban Development to advance quality asthma care and to mitigate exposure to asthma triggers in the home and schools. MCAN and its partners played a significant role and served as a catalyst for the Centers for Medicare and Medicaid Services to provide Medicaid funding for asthma care in the school setting as well as expansion of Medicaid reimbursement by states for preventive health services provided by professionals other than licensed practitioners.
As MCAN's funded initiatives conclude later this year, its findings, experiences and recommendations are a key resource to build and advance the role of implementation science in reducing disparities in childhood asthma outcomes. MCAN's impact contributes to the ongoing effort to close the gap between what works in controlled settings and what is done in healthcare practice in the real world.