A systematic review of interventions in community environments found significant reductions in childhood asthma exacerbations leading to emergency department visits and hospitalizations. BACKGROUND AND OBJECTIVES Structural and social determinants of childhood asthma inequities manifest within geographic communities that are often segregated. Childhood asthma disproportionately affects Black, Hispanic, and low-income populations. Community interventions have the potential to improve inequities in emergency healthcare. This systematic review was conducted to assess the effectiveness of childhood asthma community interventions and provide a conceptual model to inform implementation of future community interventions. METHODS Publications from PubMed, ScienceDirect, CINAHL, Cochrane Library, Web of Science, and hand searched references were examined from 2010 to 2021. Community intervention studies among children with asthma were included. Main outcomes were emergency department visits and hospitalizations. Community interventions exclusively focusing on schools or hospitals were excluded. Two reviewers independently assessed eligibility for final inclusion. Emergency healthcare findings were extracted in addition to co-benefits (eg, fewer missed school days and caregiver workdays). RESULTS Out of 1856 records, 26 publications met the inclusion criteria. Community interventions were categorized by care coordination (n = 8), policy and environmental changes (eg, smoke-free legislature, traffic reduction models, and green housing) (n = 8), home-based (n = 6), and community-based health services (n = 4). Selected studies indicated that community interventions significantly reduced childhood asthma emergency department visits and hospitalizations through increased caregiver self-efficacy, home environmental trigger reduction, and increased access to healthcare. Because of heterogeneity among studies, we were unable to conduct a meta-analysis. CONCLUSIONS Findings show significant associations between community interventions and the reduction of emergency healthcare, suggesting a protective effect for severe cases of childhood asthma.

中文翻译：

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儿童哮喘急诊就诊和住院的社区干预：系统评价。

一项对社区环境干预措施的系统评价发现，导致急诊就诊和住院的儿童哮喘发作显着减少。背景和目标儿童哮喘不平等的结构和社会决定因素在经常被隔离的地理社区中表现出来。儿童哮喘不成比例地影响黑人、西班牙裔和低收入人群。社区干预有可能改善紧急医疗保健中的不公平现象。该系统评价旨在评估儿童哮喘社区干预措施的有效性，并提供一个概念模型来为未来社区干预措施的实施提供信息。方法 来自 PubMed、ScienceDirect、CINAHL、Cochrane 图书馆、Web of Science、并从 2010 年到 2021 年检查了手动搜索的参考文献。纳入了哮喘儿童的社区干预研究。主要结果是急诊科就诊和住院。专门针对学校或医院的社区干预被排除在外。两名评审员独立评估了最终纳入的资格。除了共同利益（例如，更少的缺课时间和看护者工作日）之外，还提取了紧急医疗保健结果。结果 在 1856 条记录中，有 26 篇出版物符合纳入标准。社区干预按护理协调（n = 8）、政策和环境变化（例如，无烟立法机构、交通减少模式和绿色住房）（n = 8）、以家庭为基础（n = 6）和社区进行分类基于卫生服务（n = 4）。选定的研究表明，社区干预通过提高护理人员的自我效能、减少家庭环境触发因素和增加获得医疗保健的机会，显着减少了儿童哮喘急诊就诊和住院治疗。由于研究之间的异质性，我们无法进行荟萃分析。结论 研究结果显示社区干预与减少紧急医疗保健之间存在显着关联，这表明对儿童哮喘的严重病例具有保护作用。