FEASIBILITY OF AN ED-INITIATED ONLINE MANAGEMENT PROGRAM FOR URBAN TEENS

教育部发起的针对城市青少年的在线管理计划的可行性

• 批准号: 8386254
• 负责人: Christine LM Joseph
• 金额: $ 35.85万
• 依托单位: HENRY FORD HEALTH SYSTEM
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-15 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8386254
• 关键词: 19 year old; Academic Medical Centers; Accident and Emergency department; Acute; Adolescent; African American; Age; Asthma; Behavior; Budgets; Caregivers; Caring; Child; Childhood; Cities; Clinical; Clinical Research; Clinical Trials; Communication Research; Communities; Computers; Data; Death Rate; Development; Disease; Effectiveness; Effectiveness of Interventions; Emergency Medicine; Epidemiologist; Evaluation; Head; Health Communication; Health Sciences; Health Services Accessibility; Hospitalization; Hypersensitivity; Informal Social Control; Internet; Intervention; Leadership; Link; Measures; Michigan; Morbidity - disease rate; Online Systems; Outcome; Ownership; Participant; Patient Care; Patients; Pediatric Hospitals; Persons; Physicians; Pilot Projects; Population; Preventive; Principal Investigator; Protocols documentation; Quality of life; Questionnaires; Randomized; Randomized Controlled Trials; Recruitment Activity; Reporting; Research; Research Design; Research Personnel; Resources; Role; Schools; Services; Source; Students; Surveys; Symptoms; System; Teenagers; Translational Research; Universities; Visit; abstracting; aged; base; behavior change; clinical research site; comparative effectiveness; cost; cost effective; effectiveness research; experience; follow-up; functional status; high risk; high school; innovation; intervention effect; low socioeconomic status; mortality; outreach; pilot trial; pragmatic trial; primary outcome; programs; randomized trial; research to practice; skills; therapy design

DESCRIPTION (provided by applicant): Death rates for asthma are higher for African American adolescents aged 15-19 years, than for adolescent Whites and younger children. Teens in underserved communities are more likely to use the Emergency Department (ED) for asthma as a primary source of care. This episodic care impedes development of the patient self-regulation skills necessary for asthma control. Strategies for connecting with high risk groups of urban adolescents with uncontrolled asthma remain elusive. Acute care settings, however, represent a promising means of identifying and intervening upon asthma patients with the greatest need. Puff City is a web-based, computer-tailored intervention that targets urban teens. Under R01 HL68971-01 and a Competing Renewal (R01 HL68971-05), Puff City has been rigorously evaluated using randomized trials conducted in Detroit high schools. Results of both trials showed significantly fewer symptom-days (primary outcome) at the 12 month follow-up for treatment teens compared to controls, while preliminary results from the Competing Renewal show a strong intervention effect for treatment students of few resources (symptom days, p=0.008; missed school, p=0.04; and ED visits, p=0.03). The objective of this project is to evaluate the feasibility of conducting a randomized controlled trial to evaluate implementation of Puff City in an urban ED setting. This pilot will target adolescents presenting to an urban ED with acute asthma. Specifically, we will (1) Engage ED staff in the finalization and implementation of a protocol for recruiting 15-19 year old teens with acute asthma into an ED-initiated pilot trial of an online asthma management program and describe resulting recruitment and refusal rates; (2) measure participant compliance with the pilot study protocol including 4 online sessions (teens) and a 6 (teens and caregivers) and 12 month (teens) follow-up survey); (3) determine the Internet accessibility of participating teens and the impact of accessibility on study participation, compliance and retention; and (4) collectively use pilot study results to describe the intervention effect on selected outcomes (ED visits, Asthma Control Questionnaire, functional status, quality of life, behavior change), describe costs, and the potential for detecting a positive intervention effect in a larger trial. Outreach to urban teens with asthma will require innovative and non-traditional strategies. Puff City has excellent dissemination potential and high fidelity. Before conducting a full-scale randomized trial, feasibility must be assessed. If study findings are positive, the resut will be a more efficient, streamlined and cost effective RCT, and by incorporating as many features of comparative effectiveness research and pragmatic study design as possible, we hope to accelerate translation from research to practice. PUBLIC HEALTH RELEVANCE: The objective of this application is to determine the feasibility of conducting a randomized controlled trial to evaluate the effectiveness of an online, Emergency Department- initiated asthma management intervention designed to reduce asthma-related morbidity among urban teenagers aged 15-19 years with uncontrolled asthma. The study will examine issues around recruitment, participant compliance with the study protocol, Internet access, and attrition. (End of Abstract)

描述（由申请人提供）： 15-19 岁非裔美国青少年的哮喘死亡率高于白人青少年和年龄较小的儿童。服务欠缺社区的青少年更有可能将哮喘急诊科 (ED) 作为主要护理来源。这种间歇性护理阻碍了患者控制哮喘所需的自我调节技能的发展。与哮喘未受控制的城市青少年高危人群建立联系的策略仍然难以捉摸。然而，急性护理机构是识别和干预最需要的哮喘患者的一种有前途的方法。 Puff City 是一项基于网络、针对城市青少年的计算机定制干预措施。根据 R01 HL68971-01 和竞争性更新 (R01 HL68971-05)，帕夫城已使用在底特律高中进行的随机试验进行了严格评估。两项试验的结果均显示，与对照组相比，接受治疗的青少年在 12 个月的随访中出现症状的天数（主要结果）显着减少，而竞争更新的初步结果显示，对于资源匮乏的接受治疗的学生（症状天数、症状天数、 p=0.008；缺课，p=0.04；急诊就诊，p=0.03）。该项目的目的是评估进行随机对照试验的可行性，以评估 Puff City 在城市 ED 环境中的实施情况。该试点项目将针对因急性哮喘而到城市急诊科就诊的青少年。具体来说，我们将 (1) 让 ED 工作人员参与最终确定和实施一项方案，招募 15-19 岁患有急性哮喘的青少年参加 ED 发起的在线哮喘管理计划试点试验，并描述最终的招募率和拒绝率； (2) 衡量参与者对试点研究方案的遵守情况，包括 4 次在线会议（青少年）以及 6 个月（青少年和看护者）和 12 个月（青少年）跟踪调查）； (3) 确定参与青少年的互联网可访问性以及可访问性对研究参与、依从性和保留的影响； (4) 共同使用试点研究结果来描述对选定结果的干预效果（急诊就诊、哮喘控制问卷、功能状态、生活质量、行为改变），描述成本以及检测积极干预效果的潜力 更大的审判。对患有哮喘的城市青少年进行宣传需要创新和非传统的策略。泡芙城具有出色的传播潜力和高保真度。在进行全面随机试验之前，必须评估可行性。如果研究结果是积极的，结果将是一个更高效、更精简和更具成本效益的随机对照试验，并且通过尽可能多地结合比较有效性研究和务实的研究设计的特点，我们希望加速从研究到实践的转化。 公共卫生相关性： 本应用程序的目的是确定进行随机对照试验的可行性，以评估急诊科发起的在线哮喘管理干预措施的有效性，该干预措施旨在降低 15-19 岁哮喘不受控制的城市青少年中与哮喘相关的发病率。该研究将审查有关招募、参与者遵守研究方案、互联网访问和人员流失等问题。 （摘要完）