Multisystemic therapy to reduce health disparities in adolescents with asthma

多系统治疗可减少青少年哮喘患者的健康差异

基本信息

批准号：
7383419
负责人：
SYLVIE NAAR
金额：
$ 74.88万
依托单位：
WAYNE STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-09-01 至 2013-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7383419
关键词：
Accident and Emergency department Accounting Address Adherence Admission activity Adolescent Affect African African American Age American Asthma Attention Caregivers Caring Censuses Centers for Disease Control and Prevention (U.S.)Cessation of life Characteristics Child Childhood Childhood Asthma Chronic Chronically Ill Cities Communities Community Health Condition County Data Data Collection Disadvantaged Disease Educational Intervention Effectiveness of Interventions Experimental Designs Family Family psychotherapy Fibrinogen Gender Goals Grant HIV Infections Health Health Care Costs Healthy People 2000 Home environment Hospitalization Individual Infection Innovative Therapy Inpatients Insulin-Dependent Diabetes Mellitus Intervention Joints Knowledge Mediator of activation protein Medical Medical center Mental Health Michigan Minority Modeling Morbidity - disease rate Nature Numbers Outcome Parents Participant Play Population Prevalence Provider Psychotherapy Purpose Randomized Randomized Clinical Trials Randomized Controlled Trials Rate Recruitment Activity Reporting Research Personnel Risk Role Sampling Schools Secondary to Social support Specific qualifier value Standards of Weights and Measures Symptoms Teenagers Testing Therapeutic Intervention Thinking Treatment Protocols United States United States Public Health Service Universities Urban Population Variant Visit Vulnerable Populations Wolves Youth base cost cost effectiveness day design follow-up health care service utilization health disparity improved inner city innovation medical specialties mortality multidisciplinary response severe behavior problem skills social success treatment effect

项目摘要

DESCRIPTION (provided by applicant): Asthma is the most common cause of hospitalization in children other than infections. The Health People 2000 initiative to reduce asthma hospitalizations was NOT met. Minority, inner city children, particularly adolescents, appear to be most at risk for high morbidity and mortality. Poor illness management is thought to be a primary driver of asthma morbidity and mortality. Yet, there are very few randomized controlled trials with inner city adolescents with asthma. Because of the complexity of asthma management and the associated barriers, intensive, multi-component interventions are needed to improve outcomes among those at highest risk. The investigators have adapted Multisystemic Therapy (MST), an innovative home- and community-based psychotherapy, to successfully improve treatment adherence and outcomes in urban pediatric medical populations. The objective of the present study is to utilize MST to improve asthma management and to reduce health care utilization (emergency department visits and hospitalizations) among high risk African American adolescents (ages 12-16) with moderate to severe persistent asthma. High risk is defined as having >=2 emergency department visits or >= 1 hospitalizations in 12 months). Additional aims are to determine the stability of MST's effects over a 12 month interval and to determine cost-effectiveness of the intervention. Families will be recruited from the only university-affiliated medical center in Detroit, Michigan. Detroit has the highest percentage of African Americans of any major city in the United States. The experimental design for the proposed study is a randomized controlled trial with 170 high risk African American adolescents with moderate to severe persistent asthma, 85 of whom will receive standard multidisciplinary specialty care (control condition) and 85 of whom will receive this care plus MST. Families will complete an initial data collection session (baseline), a 7-month post-test designed to coincide with treatment completion, and a subsequent post-test at 12 months after baseline. If successful, this intervention will provide immediate assistance to a vulnerable population disproportionately affected by asthma and may reduce costs of care for this high risk population. While asthma is the second most common cause of hospitalization in children, minority, inner city teens are at increased risk for complications from the disease. We are testing the effectiveness of an intervention for inner city African American teens with asthma using Multisystemic Therapy an intensive, home- and community-based psychotherapy. If successful, this intervention will improve asthma management and overall health, as well as reduce healthcare costs for this vulnerable population disproportionately affected by asthma.

描述（由申请人提供）：哮喘是感染以外的其他儿童住院的最常见原因。尚未达到2000年卫生人士旨在减少哮喘住院治疗的倡议。少数群体，城市内部儿童，尤其是青少年，似乎处于发病率和死亡率高的风险中。疾病管理不佳被认为是哮喘发病率和死亡率的主要驱动力。然而，与内部城市青少年患有哮喘的随机对照试验很少。由于哮喘管理的复杂性和相关的障碍，需要进行密集的多组分干预措施，以改善风险最高的结果。研究人员已经改编了一种创新的家庭和社区心理治疗多系统治疗（MST），以成功改善城市儿科医疗人群的治疗依从性和结果。本研究的目的是利用MST来改善哮喘管理，并减少高风险的非裔美国青少年（12-16岁）的医疗保健利用（急诊就诊和住院），并具有中等至严重的持久性哮喘。高风险被定义为> = 2个急诊室就诊或> = 1个在12个月内的住院）。其他目的是确定在12个月间隔内MST效应的稳定性，并确定干预措施的成本效益。家庭将从密歇根州底特律的唯一大学附属医学中心招募。底特律拥有美国任何主要城市的非裔美国人比例最高。拟议研究的实验设计是一项随机对照试验，有170名高风险的非裔美国青少年，中度至严重的持续性哮喘，其中85名将获得标准的多学科专科护理（控制条件），其中85名将获得此护理以及MST。家庭将完成初始数据收集课程（基线），这是一项为期7个月的测试，旨在与治疗的完成相吻合，以及基线后12个月后的后续测试。如果成功的话，这种干预将为哮喘影响不成比例的脆弱人群提供立即的援助，并可能降低对这种高风险人群的护理成本。虽然哮喘是儿童住院的第二大最常见原因，但少数群体，内城青少年却有疾病并发症的风险增加。我们正在使用多系统疗法进行哮喘内城市非洲裔美国青少年进行干预措施的有效性。如果成功的话，这种干预将改善哮喘管理和整体健康，并降低这种脆弱人群的医疗保健成本不成比例地受到哮喘的影响。