Medicaid Asthma Home Visit Project- Improving Health and Reducing Costs of Health

医疗补助哮喘家访项目 - 改善健康并降低健康成本

• 批准号: 8138317
• 负责人: JAMES W KRIEGER
• 金额: $ 44.99万
• 依托单位: SEATTLE-KING COUNTY PUBLIC HEALTH DEPT
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2013-08-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8138317
• 关键词: Medicaid; Asthma; Home; Visit; Project

DESCRIPTION (provided by applicant): Seattle-King County Healthy Homes is an evidence-based approach for controlling asthma among low-income children. The first aim of our proposal is to translate the research-based model into practice, assess the impact of translation on the asthma-related outcomes included in evaluation of the original model, and describe the translation process. Our second aim is to assess the cost-effectiveness and return on investment (ROI) of the translated model. We hope to demonstrate that Healthy Homes is a replicable and cost-effective model that can be provided to all children with uncontrolled asthma insured by Medicaid. Background: Asthma remains the most common chronic condition of childhood, affecting 9.1% of all American children. The rate of asthma has doubled since 1980 and remains at historically high levels. Asthma education is effective in reducing asthma morbidity and urgent health services utilization. The National Institutes of Health has identified it as a core asthma control strategy. However, many children with asthma and their caretakers do not participate in asthma education because of access barriers. Offering education in the home may increase participation. Recent research shows that providing asthma education through home visits results in reductions in asthma symptoms and urgent health care utilization. The CDC Guide to Community Preventive Services recently recommended home visits as an effective intervention. A major barrier to wider implementation of the home visit approach is lack of reimbursement for this service by health care payers, who need evidence of the ROI of this intervention. Intervention: A community health workers (CHW) will visit 200 Medicaid-insured children with uncontrolled asthma in their homes over a year. A CHW is a peer educator who provides tailored, culturally-appropriate asthma education. She will assess current asthma control status, self-management practices and the presence of asthma triggers in the home and help children and their caretakers use medications more effectively, prevent and manage exacerbations, facilitate access health services and communication with providers, and reduce exposure to asthma triggers. They will provide participants with tools to reduce exposure to triggers (e.g. a vacuum). Another important role will be provision of instrumental, informational and emotional support. Evaluation: We will use the RE-AIM framework and community-based participatory research methods to assess the translation process. We will complete a quasi-experimental study to assess the cost-effectiveness and ROI of the intervention using administrative claims and self-reported asthma control data. PUBLIC HEALTH RELEVANCE: Information on the cost-effectiveness of CHW home visits for asthma will enable policy makers to assess the health and economic benefits of providing this service to all children with uncontrolled asthma who are insured by Medicaid. Home visits have the potential not only to improve children's health but also to reduce Medicaid expenditures.

描述（由申请人提供）：西雅图 - 金县健康家庭是一种基于证据的方法来控制低收入儿童的哮喘。我们建议的第一个目的是将基于研究的模型转化为实践，评估翻译对原始模型评估中与哮喘相关结果的影响，并描述翻译过程。我们的第二个目标是评估翻译模型的成本效益和投资回报率（ROI）。我们希望证明健康的房屋是一种可复制且具有成本效益的模型，可以向所有医疗补助提供的哮喘患者提供的儿童提供。背景：哮喘仍然是最常见的童年慢性疾病，影响了所有美国儿童的9.1％。自1980年以来，哮喘的发生率翻了一番，并且在历史上保持较高。哮喘教育可有效降低哮喘发病率和紧急卫生服务利用。美国国立卫生研究院已将其确定为核心哮喘控制策略。但是，许多患有哮喘及其看护人的儿童由于访问障碍而没有参加哮喘教育。在家中提供教育可能会增加参与。最近的研究表明，通过家庭访问提供哮喘教育会导致哮喘症状和紧急医疗保健利用的减少。 CDC社区预防服务指南最近建议进行家庭访问作为有效的干预措施。更广泛实施家庭访问方法的主要障碍是医疗保健付款人缺乏为这项服务的报销，他们需要这种干预措施的投资回报率的证据。干预：一年多年来，社区卫生工作者（CHW）将在其家中拜访200名受医疗补助保险的儿童，患有哮喘。 CHW是一名同伴教育者，他提供量身定制的，适合文化的运动教育。她将评估当前的哮喘控制状况，自我管理实践以及在家中的哮喘触发者的存在，并帮助儿童及其看护人更有效地使用药物，预防和管理加重，促进访问卫生服务并与提供者进行沟通，并减少哮喘触发因素的暴露。他们将为参与者提供减少触发因素暴露（例如真空）的工具。另一个重要的作用将是提供工具，信息性和情感支持。评估：我们将使用RE-AIM框架和基于社区的参与研究方法来评估翻译过程。我们将完成一项准实验研究，以使用行政索赔和自我报告的哮喘控制数据来评估干预的成本效益和ROI。 公共卫生相关性：有关哮喘的CHW家庭就诊成本效益的信息将使政策制定者能够评估为所有受Medicaid保险的不受控制的哮喘儿童提供此服务的健康和经济利益。家庭访问不仅有可能改善儿童的健康，还可以减少医疗补助支出。