Asthma Care Quality, Language, and Ethnicity in a Multi-State Network of Low-income Children

John Heintzman, MD, MPH; Jorge Kaufmann, ND, MS; Jennifer Lucas, PhD; Shakira Suglia, PhD; Arvin Garg, MD; Jon Puro, MS; Sophia Giebultowicz, MA; David Ezekiel-Herrera, MS; Andrew Bazemore, MD; Miguel Marino, PhD


J Am Board Fam Med. 2020;33(5):707-715. 

In This Article


Our analysis was in a low-income population seen in CHCs and may not be generalizable to other populations. Our dataset did not include prescription-fill information or the quality of asthma education or risk factor assessment, which are important additional factors to consider in asthma care. We also did not have Hispanic subgroup information in this analysis, which some literature suggests may affect asthma course.[33,34] However, the literature on Hispanic subgroup focuses mostly on asthma prevalence, and our analysis of care quality measures focuses on those already diagnosed making specific subgroup differences in prevalence less relevant here. Applying this analysis to subgroups could represent a direction for further research. Provider language or quality of interpreters were also not assessed in this analysis—we did not have access to provider language ability, although all CHCs are required to have language-appropriate services,[35] so ideal standards are equivalent across our study clinics. Future analyses can also study how quickly children receive follow-up care for asthma after diagnosis. We did not analyze non-Hispanic black children, as disparities in Latino children potentially encompass distinct issues from those faced in African American communities: geographic differences, immigration barriers, possible insurance differences, language barriers, and possible cultural factors, among others. Therefore, a specific examination of possible disparities in Latino children, compared with a single dominant culture majority, would seem warranted to focus on this population and its unique set of health care experiences. A proper analysis of black children was simply outside the scope of this article. Lastly, it is possible that children in this study received care outside of ADVANCE national CHC network; however, in previous work we have shown that patients are unlikely to leave the network.[36] Finally, we were unable to tell if oral steroids were prescribed in direct response to an asthma exacerbation or if they were given to have on hand for children with more severe disease or frequent exacerbations. Future work can explore this specific scenario further.