MCAN, a U.S.-based, nonprofit 501(c)(3) organization, was established in 2005 as the only private foundation focused solely on addressing the complex and growing problem of childhood asthma in the United States.
Funded by our company’s Foundation, MCAN’s mission was to enhance the quality of life for children with asthma and their families, and to reduce the burden of the disease on them and society.
Led by Floyd Malveaux, M.D., Ph.D., a nationally recognized expert in asthma and allergic diseases, dean emeritus of the College of Medicine, and professor of microbiology and medicine at Howard University, MCAN funded the implementation of projects in varied settings to improve high quality asthma care for children. During its tenure, MCAN granted more than $20 million to programs set in some of the nation’s most impoverished, at-risk communities to study the impact of evidence-based interventions on symptoms and the emergent/urgent care use of children living with asthma.
The Foundation committed $41.1 million to support MCAN over 11 years (2005–2015). The investment in MCAN was $2.8 million in 2014 and $2 million in 2015.
- Fostered major advances in understanding the characteristics and challenges of effective community-level care and best practices for implementation
- Helped bring together leading organizations with a strong interest in childhood asthma
- Identified and successfully advocated for major public policy changes that were needed for improved asthma care
MCAN concluded operations in 2015, but leaves a legacy of experience that can be adapted and implemented by others providing services to at-risk populations. Its success in identifying barriers and facilitators in implementing effective asthma programs has valuable implications for the potential management of other chronic diseases. The MCAN 10-Year Impact Report, Translating Evidence into Practice, shares the work and outcomes of its programs and initiatives and the key impact highlights of MCAN’s work from 2005 to 2015. In addition, MCAN resources, implementation guides, publications and other tools are available in the MCAN library.
Through the Care Coordination grant portfolio, MCAN studied the feasibility and effectiveness of implementing and sustaining care-coordination models developed during MCAN Phase I in communities with significant childhood-asthma morbidity and/or disparities in outcomes.
Care Coordination program sites participated in a cross-site evaluation to assess outcome and process measures focused on care coordination and clinical outcomes. Preliminary findings from the evaluation indicate that the percentage of participants with “not well controlled” asthma decreased from 49 percent at baseline to 18 percent at 12-month follow-up. Final results were presented at the 2015 American Thoracic Society International Conference in May 2015.
MCAN Care Coordination Program Sites (2010–2014)
Los Angeles Unified School District, “YES WE CAN Children’s Asthma Program”
This program used a care-coordination and education model that extends beyond the immediate school clinic to foster systemic changes among health, educational and community settings. The program triaged students and families into appropriate levels of intervention, aimed to improve the coordination of care among schools, clinics and community providers, and focused on measuring symptom reductions and school days missed. The program was successful in reducing days of school missed due to asthma from approximately 13 days to five days a year.
University of Illinois at Chicago School of Public Health, “Addressing Asthma in Englewood”
This program centered on a community-educator model, linking children with asthma to appropriate services, community groups and local agencies. A home-visit case-management program was also provided to enhance asthma education and to identify and mitigate asthma triggers. Among the participants who completed the case-management program, emergency room visits for asthma decreased from 40 percent to 27 percent over 12 months.
RAND Corporation and University of Puerto Rico, “La Red de Asma Infantil de MSD de Puerto Rico”
This program carried out evidence-based interventions as part of an asthma care coordination program across home, health care and community settings. Implemented in a federally qualified health center (FQHC) in San Juan, Puerto Rico, “La Red” aimed to promote asthma-friendly communities throughout the island of Puerto Rico and improve access to quality asthma health care for this highly vulnerable and underserved community. After participating in La Red, the percentage of families who reported an asthma-related emergency department visit in the past 12 months decreased from 67.1 percent to 39.1 percent.
Children’s Hospital of Philadelphia, “Asthma Healthcare Navigator Program”
This program deployed asthma health care navigators in four primary care centers operated by the hospital to work with primary care providers as integral members of the families’ asthma care teams. They helped families identify and reduce asthma triggers in the home, as well as providing self-management education and other resources for families of high-risk children with asthma. Over 12 months, caregivers reported a significant reduction in the number of days their child with asthma used rescue medications over a two-week period (from 5.87 days at baseline to 2.74 days at follow-up).
Community Healthcare for Asthma Management and the Prevention of Symptoms (CHAMPS)
CHAMPS is an innovative translational research- and community-based clinical partnership funded by MCAN and led by the Milken Institute School of Public Health at the George Washington University. Additional partners include Rho, Inc., and the RCHN Community Health Foundation. The project is designed to demonstrate how tailored, evidence-based asthma management programs that have been proven efficacious in randomized, controlled trials can be implemented in FQHCs, where many low-income children and families receive care. Community health centers participating in the CHAMPS program include El Rio Community Health Center (Tucson, Arizona), Cherry Street Health Services (Grand Rapids, Michigan), and Costa Salud Community Health Center (Rincón, Puerto Rico).
CHAMPS has concluded final data collection and is presenting results of the study at the 2016 American Academy of Asthma Allergy & Immunology Annual Meeting. In addition, a comprehensive, interactive implementation guide for the CHAMPS intervention is available on EPA’s website for community-based asthma management programs.
Head-off Environmental Asthma in Louisiana (HEAL), Phase II
With support from MCAN, HEAL, Phase II, built upon the lessons learned from the Head-off Environmental Asthma in Louisiana (HEAL) project, a post-Katrina research initiative that studied the effects of mold and other indoor allergens on children with moderate-to-severe asthma. HEAL identified the challenges and effectiveness of implementing a multifaceted intervention in asthma case management and of environmental mitigation designed to help improve the health outcomes of children with asthma.
In HEAL, Phase II, the Xavier University of Louisiana Center for Minority Health & Health Disparities Research and Education, the Daughters of Charity Services of New Orleans, and the Children’s Health Fund worked together to disseminate and implement a multifaceted intervention in existing health care systems. They provided individualized counseling by certified asthma educators and community health workers who made home visits to families of children with poorly controlled asthma. The asthma educators provided tailored counseling for children with asthma ages 2–18 and their families to improve asthma management, avoid exposure to asthma triggers and reduce the occurrence of symptoms. Preliminary results from HEAL, Phase II, indicate that, among the affected children, those with uncontrolled asthma decreased from 71 percent at baseline to 38 percent at the 12-month follow-up.
National Ambulatory Medical Care Survey (NAMCS)
The National Ambulatory Medical Care Survey (NAMCS) is a national survey of physicians designed to increase understanding of how care is being delivered in providers’ offices. MCAN, the National Institutes of Health (NHLBI, NICHD, NIEHS, NIAID), the Centers for Disease Control and Prevention (NCEH, NIOSH, NCHS), the U.S. Environmental Protection Agency (EPA), and the Agency for Healthcare Research and Quality provided support and expertise to help develop specific questions for the 2012 NAMCS, that focused on the NAEPP asthma guidelines and their use.
The 2012 survey, whose findings are still being analyzed, will evaluate the implementation of the NAEPP guidelines from the health care providers’ perspective and help in identifying barriers to the uptake of critical elements of guideline-based management of asthma. These findings can inform ongoing strategies to increase effective implementation of the NIH guidelines.
MCAN partnered with the Milken Institute School of Public Health at the George Washington University and First Focus to establish the Childhood Asthma Leadership Coalition (CALC), the only national multi-sector coalition dedicated to improving policymaking that addresses childhood asthma.
Since its inception in June 2012, CALC has grown to more than 20 leading organizations representing a range of expertise in childhood asthma, public health, environmental health, poverty, housing, health care, and health care economics.
Under the guidance of its members, CALC has focused on advancing Medicaid policies that directly impact access to care for low-income children with asthma; educating stakeholders on opportunities available under the Patient Protection and Affordable Care Act (ACA); protecting federal funding for childhood-asthma-related programs; and examining current gaps in asthma research and opportunities to foster translational research that brings effective interventions from the research bench to the bedside the community.
Among the most important CALC successes is its advocacy in support of two Medicaid policy changes: withdrawal of the “free care” rule and reimbursement for preventive services provided by practitioners other than licensed providers. Although MCAN funding has concluded, CALC is continuing federal and state-based advocacy activities on behalf of children with asthma in 2016 and beyond.
|Demographics of Participants Enrolled in MCAN’s Translational Research Projects|
|Care Coordination||HEAL, Phase II||CHAMPS|
|Patients enrolled through 2014||805||222||314|
|Age (mean years)||7.1||9.0||7.8|
(Asian, Native American, Hispanic, Mixed)
|1 Hispanic: Not a mutually exclusive category|
|Preliminary Clinical Characteristics of MCAN Project Participants at Baseline and 12 months|
|Characteristic/ Variable||Care Coordination: Baseline1 [N=805]||Care Coordination: 12-Month Follow-Up1 [N=805]||HEAL, Phase II: Baseline [N=222]||HEAL, Phase II: 12-Month Follow-Up [N=187]||CHAMPS: Baseline [N=314]||CHAMPS: 12-Month Follow-Up [N=301]|
|Missed school days, past year (mean)2,3||11.3||4.06||1.4||0.5||1.5||0.6|
|Limited activities, past month (mean)||6.27||1.92||-||-||4.7||1.6|
|Nighttime awakenings, past month (mean)||6.55||2.02||-||-||4.7||1.1|
|Emergency room visits, past year4,5||2.86||1.09||41%||22%||5.9||0.6|
|Hospitalizations, past year6,7||1.11||0.36||10%||5%||0.3||0.03|
|Daytime symptoms within the past 2 weeks||7.38||3.13||7.9||5.0||8.7||2.7|
|Use of rescue medication within the past 2 weeks8,9||5.73||2.01||55%||45%||8.2||2.0|
|1 Care Coordination data are for individuals who had baseline and follow-up outcomes.|
2 The HEAL, Phase II, figure is for the past three months.
3 The CHAMPS figure is for the past month.
4 The Care Coordination and CHAMPS figures are mean numbers of visits.
5 The HEAL, Phase II, figure is the percentage of participants who reported that they had an ER visit within past year.
6 The Care Coordination and CHAMPS figures are mean numbers of hospitalizations.
7 The HEAL, Phase II, figure is the percentage of participants who reported that they had a hospitalization within the past year.
8 The Care Coordination and CHAMPS figures are mean number of days using rescue medication within the past two weeks.
9 The HEAL, Phase II, figure is the percentage of participants who reported that they used their rescue medication within the past two weeks.