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{
    "pk": 65603,
    "title": "Closing the Asthma Care Gap: Lessons for the San Joaquin Valley",
    "subtitle": null,
    "abstract": "<p>Asthma remains a major driver of preventable morbidity and emergency department (ED) utilization in the United States, with a disproportionate burden in underserved communities. This review examines why preventable asthma exacerbations and ED reliance persist despite established management guidelines, and it interprets the evidence through a regional lens focused on California’s San Joaquin Valley (SJV), where structural barriers to preventive care and elevated pediatric acute care use have been documented. I frame ED reliance as the downstream consequence of cumulative failures across the asthma care cascade, in which gaps in diagnosis and risk assessment, controller initiation, inhaler technique, medication adherence, trigger mitigation, written action planning, and timely follow-up allow unstable disease to progress to exacerbation and emergency care. In underserved settings, these cascade failures are amplified by access constraints, affordability pressures, housing and environmental exposures, competing school and family demands, and weak transitions from ED care back to longitudinal management, which together reinforce a cycle of episodic rescue care. Across the literature, the strongest evidence favors multicomponent approaches that improve self management support, extend care beyond the clinic into homes and schools, and strengthen follow-up after acute events. Applying these findings to the SJV, I argue that reducing ED reliance is most likely to come from improving the reliability and coordination of guideline-based care delivery rather than from novel pharmacologic advances. Future research should prioritize implementation-focused, place-sensitive evaluation of scalable models in semi-rural underserved communities.</p>",
    "language": "eng",
    "license": {
        "name": "Creative Commons Attribution-NonCommercial  4.0",
        "short_name": "CC BY-NC 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNonCommercial — You may not use the material for commercial purposes.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by-nc/4.0"
    },
    "keywords": [],
    "section": "Articles",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/3hw5t0gt",
    "frozenauthors": [
        {
            "first_name": "Avinav",
            "middle_name": "",
            "last_name": "Biswas",
            "name_suffix": "",
            "institution": "",
            "department": ""
        }
    ],
    "date_submitted": null,
    "date_accepted": null,
    "date_published": "2026-05-07T12:00:00-07:00",
    "render_galley": null,
    "galleys": [
        {
            "label": "PDF",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/ucm_mwp_ucmurj/article/65603/galley/50232/download/"
        }
    ]
}