An Asthma Collaboration to Reduce Childhood Asthma Disparities on the Navajo Nation

哮喘领域的合作旨在减少纳瓦霍族儿童哮喘的差异

基本信息

批准号：
10452568
负责人：
Bruce George Bender
金额：
$ 141.06万
依托单位：
NATIONAL JEWISH HEALTH
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-08-15 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10452568
关键词：
19 year old Address Admission activity Adoption Adrenal Cortex Hormones Advisory Committees African American Alaska Native American Indians Arizona Asthma Caring Child Child Health Childhood Asthma Cities Clinic Collaborations Collection Colorado Communities Data Databases Education Educational workshop Effectiveness Emergency department visit Environmental Exposure Environmental Pollutants Epidemiology Event Evidence based program Family Feedback Funding Future General Population Government Guidelines Health Health Care Costs Health Personnel Health Services Accessibility Healthcare Healthcare Systems Home Hospitalization Human Indian reservation Inpatients Intervention Interview Interviewer Intubation Leadership Low Income Population Maintenance Medical Methods Monitor Morbidity - disease rate Native Americans Navajo New Mexico Odds Ratio Oral Outcome Parents Perception Persons Pharmaceutical Preparations Phase Population Poverty Prevalence Primary Health Care Privatization Process Provider Quality of Care Quality of life Reach Effectiveness Adoption Implementation and Maintenance Recommendation Reporting Research Research Design Research Personnel Reservations Resources Rural School Nursing School Teachers Schools Severities Surveys Symptoms Testing Time Training Transportation Travel United States United States Indian Health Service United States National Institutes of Health Universities asthma exacerbation base care coordination caucasian American community planning cost design dissemination strategy effectiveness measure evidence base health disparity implementation evaluation implementation facilitation implementation process impression improved informant intervention program meetings member mortality primary outcome programs satisfaction secondary outcome success tribal member

项目摘要

PROJECT SUMMARY/ABSTRACT Asthma prevalence among children on the Navajo Nation, the largest tribal reservation in the United States, is 2-3 times that of the general population and fueled by health disparities that include devastating poverty, multiple environmental pollutants, and large travel distances to obtain healthcare. Delivery of evidence-based asthma care through the Indian Health Service (IHS), the only healthcare system on the reservation, is inconsistent. While schools and communities identify pediatric asthma as a strong concern, no comprehensive asthma care implementation plan has been previously introduced. Therefore, this proposed study will combine two previously tested programs, one focused on training providers and one on school-based education and monitoring, to build a comprehensive, integrated, team-based Asthma Care Implementation Program to address medical care, family, home, and community to improve the health of Navajo children with asthma. A one-year engagement phase has resulted in strong support from Navajo Nation organizations including the President and Vice President of the Navajo Nation, governmental organizations, healthcare centers, schools, and communities in the three participating agencies (Fort Defiance, Chinle, and Tuba City). Approval of the proposed study by the Navajo Nation Human Research Review Board has been obtained. Key recommendations from communities including use of existing resources such as the Navajo Epidemiology Center, Navajo Health Department, local media, lay health workers, and ongoing involvement of stakeholders are included in this plan. Using a stepped-wedge design, the intervention will be introduced sequentially into three agencies. A mixed-methods analysis strategy will be employed that includes annual examination of asthma exacerbations through the IHS database (primary outcome), interviews with 300 families with a child with asthma, and key informant interviews with healthcare providers and school teachers and nurses. During the sustainability phase, meetings will be held with multiple organizations including local chapter houses to share outcome data, gather feedback, and plan for future dissemination to other agencies and reservations. The RE-AIM framework will be employed to evaluate the implementation process and facilitate dissemination to other tribal populations.

项目概要/摘要纳瓦霍族保留地（美国最大的部落保留地）儿童哮喘患病率州，是一般人口的 2-3 倍，并且由于健康差距而加剧，其中包括毁灭性的贫困、多种环境污染物以及获取医疗服务的长途旅行。交付通过印度卫生服务 (IHS) 提供基于证据的哮喘护理，该服务是印度唯一的医疗保健系统预订，不一致。虽然学校和社区认为小儿哮喘是一个严重问题，但没有全面的哮喘护理实施计划此前已出台。因此，本建议研究将结合之前测试的两个项目，一个侧重于培训提供者，另一个侧重于学校教育和监测，建立全面、综合、基于团队的哮喘护理实施方案旨在解决医疗保健、家庭、家庭和社区问题的计划，以改善纳瓦霍儿童的健康哮喘。为期一年的参与阶段得到了纳瓦霍族组织的大力支持包括纳瓦霍族总统和副总统、政府组织、医疗保健三个参与机构（迪法恩斯堡、钦利和图巴市）的中心、学校和社区。拟议的研究已获得纳瓦霍族人类研究审查委员会的批准。钥匙来自社区的建议，包括使用现有资源，例如纳瓦霍流行病学中心、纳瓦霍卫生局、当地媒体、非专业卫生工作者以及利益相关者的持续参与都包含在这个计划中。使用阶梯式楔形设计，干预措施将依次引入三个机构。将采用混合方法分析策略，包括对通过 IHS 数据库了解哮喘恶化情况（主要结果），采访 300 个有孩子的家庭与哮喘，以及对医疗保健提供者和学校教师和护士的关键信息采访。期间在可持续发展阶段，将与包括地方分会在内的多个组织举行会议，以分享结果数据、收集反馈并计划未来向其他机构和保留地传播。 RE-AIM框架将用于评估实施过程并促进传播到其他部落人口。