Clinic navigation and home visits to improve guideline-based care and outcomes in low income minority adults with asthma

诊所导航和家访可改善低收入少数民族哮喘成人患者的基于指南的护理和结果

• 批准号: 10170404
• 负责人: ANDREA J. APTER
• 金额: $ 78.61万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10170404
• 关键词: Address; Adherence; Adult; Advocate; Affect; African American; Appointment; Asthma; Attention; Behavior Therapy; Caring; Cessation of life; Child; Chronic; Chronic Disease; Clinic; Clinic Visits; Clinical; Communication; Community Health; Community Health Aides; Data; Diabetes Mellitus; Diagnosis; Disease; Economics; Education; Effectiveness; Elderly; Elements; Emergency department visit; Ensure; Evaluation; Failure; Feedback; Guidelines; Health; Health Services Accessibility; Hearing; Home; Home environment; Home visitation; Hospitalization; Housing; Huntingtin-Associated protein 1; Hypertension; Improve Access; Infrastructure; Inhalation; Intervention; Interview; Low income; Minority; Monitor; Neighborhoods; Office Visits; Outcome; Patients; Pharmaceutical Preparations; Poverty; Prednisone; Primary Health Care; Protocols documentation; Provider; Quality of life; Randomized; Recommendation; Reporting; Risk; Savings; Steroids; Structure; Testing; Time; Transportation; Visit; Voice; asthmatic; asthmatic patient; base; care coordination; care outcomes; clinical practice; comorbidity; cost; design; evidence base; health care service utilization; health disparity; household environmental exposure; improved; improved outcome; intervention cost; literacy; medical specialties; obese patients; older patient; patient-clinician communication; program costs; recruit; social; socioeconomics; young adult

PROJECT SUMMARY/ ABSTRACT Asthma-related deaths, hospitalizations, and ED visits are more numerous among low-income and minority patients, including African Americans and among older adults who tend to suffer from other chronic diseases. Guidelines for asthma management have not met the unique needs of this older group with their socioeconomic burdens and frequent comorbidities. We recently demonstrated the feasibility, acceptability, and evidence of effectiveness of two separate interventions to improve access to care, patient-provider communication, and asthma outcomes: 1) CI: clinic intervention using a patient advocate to prepare for, attend, and confirm understanding of an office visit, and 2) HV: home visits for care coordination and informing clinicians of home barriers to managing asthma. This project explores whether these interventions can be combined for greater effectiveness and better delivery of guideline-based asthma care and outcomes in low-income minority patients. In addition, we explore whether giving clinicians real-time feedback on the patient’s health and home status structured in the framework of adherence to asthma guidelines is associated with subsequent improvement in asthma outcomes. In a randomized controlled factorial trial, 400 adults with uncontrolled asthma living in low-income urban neighborhoods will be offered 18-months participation: 12 months of clinical intervention and 6 months of evaluation to monitor sustainability of interventions and outcomes. Patients will be randomized to (1) patient advocate alone, (2) patient advocate with home visits, (3) patient advocate with real-time feedback to asthma provider (clinician) at each clinic visit of guidelines-relevant elements of a patient’s current care, and (4) both (2) and (3). The interventions will be delivered by a lay Community Health Navigator (CHN). The study will estimate: Specific Aim 1: improvement over time of within-group (before-after in four groups) asthma outcomes (asthma control, quality of life, ED visits, hospitalizations, prednisone bursts) Specific Aim 2: across group differences in improvement over time in asthma outcomes; Specific Aim 3: the costs associated with each of the interventions, and we will conduct a cost-offset analysis to determine which intervention costs are offset by savings attributable to reductions in ED, hospitalization or other visits for asthma control and other outcomes. Exploratory Aim: changes in behavior from the interventions using interviews of clinicians and patients. Hypothesis and Impact: We hypothesize improved outcomes in asthma patients through enhanced communication of patient and clinician, clinician attention to home environmental exposure, and clinician consideration of the guidelines, at a program cost offset by lower patient health care utilization.

项目摘要/摘要 在低收入和少数群体中，与哮喘有关的死亡，住院和ED访问量更多 包括非裔美国人在内的患者以及往往患有其他慢性疾病的老年人。 哮喘管理指南尚未满足这个较旧小组的独特需求 社会经济伯恩斯和经常合并症。我们最近证明了可行性，可接受性 以及两种单独干预措施的有效性以改善患者提供护理的机会 沟通和哮喘结果：1）CI：使用患者倡导者准备的诊所干预， 参加并确认对办公室访问的理解，以及2）HV：家庭访问以进行护理协调和 告知临床医生家庭障碍管理哮喘。该项目探讨了这些干预措施是否 可以合并以提高有效性，并更好地提供基于准则的哮喘护理和结果 低收入少数族裔患者。此外，我们探索是否会给临床医生是否实时反馈 患者的健康和家庭状况在遵守哮喘指南的框架内结构 随后改善哮喘结局。 在一项随机对照阶乘试验中，有400名居住在低收入城市中的不受控制的哮喘的成年人 社区将提供18个月的参与：12个月的临床干预和6个月的 评估以监控干预措施和结果的可持续性。患者将随机分为（1）患者 单独倡导，（2）患者倡导家庭访问，（3）具有实时反馈哮喘的患者倡导者 提供者（临床医生）在每次诊所访问患者当前护理与指南相关的元素和（4） （2）和（3）。干预措施将由外行社区健康导航员（CHN）提供。研究将 估计： 特定目标1：随着集体内（四组）哮喘结局（哮喘）的改善（四组） 控制，生活质量，急诊就诊，住院，泼尼松爆发） 具体目标2：跨越随时间的群体差异在哮喘结局中的差异； 特定目标3：与每种干预措施相关的成本，我们将进行成本偏移分析 确定归因于ED的减少，住院或 其他访问哮喘控制和其他结果。 探索目的：使用临床医生和患者访谈的干预措施的行为变化。 假设和影响：我们通过增强来假设哮喘患者的预后改善 患者和临床的沟通，临床关注家庭环境暴露以及临床 考虑指南的考虑，以较低的患者医疗保健利用来抵消计划的费用。