A Patient Advocate to improve real-world asthma management for inner city adults

患者倡导者改善内城成年人的现实世界哮喘管理

基本信息

批准号：
8414670
负责人：
ANDREA J. APTER
金额：
$ 69.36万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-08-01 至 2018-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8414670
关键词：
Accident and Emergency department Accounting Adherence Adult Advocate Affect Anxiety Appointment Asthma Authorization documentation Awareness Behavior Therapy Budgets Caring Chronic Chronic Care Chronic Disease Clinic Clinical Trials Design Communication Communities Comorbidity Death Rate Disease Education Effectiveness Effectiveness of Interventions Enrollment Ethnic Origin Federally Qualified Health Center Focus Groups Health Health Services Accessibility Hospitalization Household Income Individual Institute of Medicine (U.S.)Insurance Coverage Intervention Low income Measures Mediating Mediator of activation protein Medical Mental Depression Methods Minority Modeling Morbidity - disease rate Neighborhoods Outcome Participant Patient Preferences Patient-Focused Outcomes Patients Practice Guidelines Prednisone Preparation Primary Health Care Productivity Provider Puerto Rican Pulmonary Function Test/Forced Expiratory Volume 1 Quality of life Race Randomized Clinical Trials Randomized Controlled Trials Recruitment Activity Relative (related person)Reporting Research Schedule Self Efficacy Testing Time Visit Wit Work base career clinical practice college comparative effectiveness compare effectiveness cost cost effectiveness demographics empowered experience health literacy improved inner city innovation interest medical specialties psychosocial public health relevance response social treatment as usual trial comparing

项目摘要

DESCRIPTION (provided by applicant): Few interventions to improve asthma management have targeted low-income minority adults and even fewer have focused on the real-world practice where care is provided for these patients. We adapted a patient navigator, here called a Patient Advocate (PA), a term preferred by patients, as a means of facilitating and maintaining access to chronic care for adults with moderate or severe asthma and prevalent chronic morbidities recruited from clinics serving low-income urban neighborhoods. The intervention, informed by focus groups of patients and providers, activates and empowers both groups, integrating activities with proven efficacy. Its feasibility and acceptability were demonstrated in RC1 HL099612 this project, implemented in a variety of practices, tests its comparative effectiveness and cost effectiveness. Our PA coaches, models, and assists with preparations for a visit with the asthma doctor attends the visit with permission of participant and provider and confirms understanding. The PA facilitates scheduling, obtaining insurance coverage, overcoming patients' unique social and administrative barriers to carrying out medical advice, and transfer of information between providers and patients. PA activities are individualized, multimodal, take account of comorbidities, and are generalizable to other chronic diseases. The PAs, highly valued by patients in RC1HL099612, are recent college graduates interested in health-related or education careers, research experience, working with patients, and generally having the same race/ethnicity distribution as potential subjects. We will enroll 300 adults wit moderate-severe asthma into a randomized clinical trial testing whether the PA intervention, compared to usual care, is associated with better and sustained asthma control (Specific Aim 1) and other asthma outcomes (prednisone bursts, ED visits, hospitalizations, quality of life, FEV1) (Specific Aim 2) relative to baseline. Secondary aims will assess mediators and moderators of the PA-asthma outcome relationship. Specific Aim 3 evaluates the intervention's cost-effectiveness. We will explore intervention's impact on providers in post-study focus groups. This proposal is innovative and significant because it 1) compares the effectiveness of the PA to usual care, 2) focuses on inner-city low-income predominantly minority adults who experience high asthma morbidity, 3) uses a real-world behavioral intervention tested for sustainability in an RCT design, 4) tests a multi-faceted individualized intervention which considers comorbidities as it provides a model of chronic asthma management and is thus generalizable to patients with other chronic diseases and comorbidities, 5) examines patient-provider communication, 6) uses a unique PA, 7) considers both English- and Spanish-speaking patients, and 8) assesses the cost-effectiveness of the intervention relative to UC.

描述（由申请人提供）：很少有改善哮喘管理的干预措施针对低收入的少数族裔成年人，甚至更少专注于为这些患者提供护理的现实世界实践。我们改编了一名患者导航器，这里称为患者倡导者（PA），这是患者偏爱的术语，是一种促进和维持与中度或严重哮喘和普遍存在的慢性病且普遍存在的慢性病的慢性护理的手段，并从为低收入城市社区服务的诊所招募。该干预措施由焦点组和提供者组成的焦点组成，激活并赋予了两个小组，将活动与可靠的功效相结合。它的可行性和可接受性已在 RC1 HL099612该项目在各种实践中实施，测试了其比较效率和成本效益。我们的PA教练，模特和协助准备哮喘医生的准备工作，并在参与者和提供者的允许下参加了访问，并确认了理解。 PA促进日程安排，获得保险范围，克服患者的独特社会和行政障碍，以执行医疗建议，以及提供者和患者之间的信息转移。 PA活动是个性化的，多模式的，考虑合并症，并且可以推广到其他慢性疾病。 RC1HL099612患者高度重视的PA是最近对与健康有关或教育职业感兴趣的大学毕业生，研究经验，与患者合作以及通常具有与潜在受试者相同的种族/种族分布。我们将在中度重度哮喘中招募300名成年人进行随机临床试验测试，该试验与通常的护理相比，PA干预是否与更好，持续的哮喘控制（特定目标1）和其他哮喘结局相关（泼尼松爆发，ED访问，ED访问，住院，生活质量，FEV1，FEV1，FEV1）（特定的AIM 2）（特定的AIM 2）。次要目标将评估PA-哮喘结局关系的介体和主持人。特定目标3评估干预的成本效益。我们将探讨干预对研究后焦点小组中提供者的影响。 This proposal is innovative and significant because it 1) compares the effectiveness of the PA to usual care, 2) focuses on inner-city low-income predominantly minority adults who experience high asthma morbidity, 3) uses a real-world behavioral intervention tested for sustainability in an RCT design, 4) tests a multi-faceted individualized intervention which considers comorbidities as it provides a model of chronic asthma management and is thus可推广到患有其他慢性疾病和合并症的患者，5）检查患者提供沟通，6）使用独特的PA，7）考虑英语和西班牙语的患者，以及8）评估干预相对于UC的干预成本效益。