Asthma Care Implementation Program for the District of Columbia (ACIP-DC)

哥伦比亚特区哮喘护理实施计划 (ACIP-DC)

基本信息

批准号：
9018607
负责人：
STEPHEN John TEACH
金额：
$ 38.7万
依托单位：
CHILDREN'S RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-09-09 至 2016-10-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9018607
关键词：
Accident and Emergency department Accounting Address Adolescent Advocacy Affect African American Asthma Caring Centers for Disease Control and Prevention (U.S.)Child Child health care Childhood Childhood Asthma Chronic Chronic Disease Clinic Clinical Clinical Trials Communities Community Health Death Rate Disadvantaged Disease District of Columbia Drops Economically Deprived Population Education Electronics Elements Emergency Department patient Emergency department visit Employee Strikes Evaluation Evidence based intervention Family Fee-for-Service Plans Goals Guidelines Health Services Research Health system Hispanics Home environment Hospitalization Individual Institutes Intervention Measures Medicaid Medical Minority Modeling Morbidity - disease rate Nature Needs Assessment Not Hispanic or Latino Outcome Parents Patient Discharge Patients Primary Health Care Process Protocols documentation Quality of life Randomized Recording of previous events Reporting Research Research Personnel Risk Self Care Services Single-Blind Study Source Stress System Testing United States United States Centers for Medicare and Medicaid Services United States Environmental Protection Agency United States National Institutes of Health Validation Visit Youth abstracting base clinical care community burden community intervention disorder prevention evidence base evidence based guidelines experience follow-up high risk improved inner city novel patient home care payment programs prospective racial and ethnic racial and ethnic disparities randomized trial recidivism success treatment as usual trial comparing

项目摘要

DESCRIPTION (Provided By Applicant): Asthma is the most common chronic disease of childhood, and despite evidence-based guidelines from the National Institutes of Health, overall morbidity from the disease has decreased only modestly. In addition, striking and unacceptable disparities in care and outcomes persist that disproportionately affect poor, urban, and minority children and adolescents. Addressing these disparities is a central priority for multiple federal agencies, local communities, parents and patients, and investigators. There are notable examples of evidence- based interventions that do reduce pediatric asthma morbidity and disparities. The validated IMPACT DC intervention, for example, has improved multiple measures of pediatric asthma care and outcomes in Washington, DC. Nevertheless, pediatric asthma morbidity in DC remains high, and further improving pediatric asthma care and outcomes in DC and elsewhere will require moving beyond the largely medical model of interventions and incorporating additional evidence-based interventions from the domains of medical care, family, home, and community. The overall goal of our proposed project is therefore to use a community driven process to integrate such interventions into a highly patient and family-centered program ready for rigorous subsequent validation as a reproducible means to improve asthma outcomes among vulnerable urban youth. The Asthma Care Implementation Program for the District of Columbia (ACIP-DC) will incorporate the existing IMPACT DC intervention, but will expand it by adding a Community Asthma Navigator (based on a Community Health Worker model) to coordinate multiple other ongoing patient services and by using an electronic care coordination platform to integrate those services. The ACIP-DC proposal is highly significant in that it will create a new and highly collaborative program ready for rigorous evaluation in a randomized trial. If efficacious in Washington DC, the program will then be ready for dissemination elsewhere as a means to address disparities in similar communities burdened with high pediatric asthma morbidity. In order to achieve our overall goal, we will pursue three specific aims: (1) we will partner with our Child Health Advocacy Institute to conduct a community needs assessment focused on understanding the existing network of care for DC's children at high risk of poor asthma outcomes through an iterative process of engaging a diverse group of local stakeholders; (2) informed by this needs assessment, we will create, pilot test, and modify ACIP-DC by integrating evidence-based interventions from the domains of medical care, family, home, and community; and (3) we will plan and pilot the elements of a rigorous protocol for the evaluation of ACIP-DC in a prospective, randomized, single-blind clinical trial that compares it to the IMPACT DC intervention alone (usual care). In pursuing this goal, the experienced research team will leverage its existing network of local collaborators, and will engage new ones as well. Key elements of ACIP-DC will be pilot tested, and the entire intervention will be scripted with a high fidelity checklist ready to serve as the basis for a clincal trial. (End of Abstract)

描述（由申请人提供）：哮喘是儿童期最常见的慢性疾病，尽管美国国立卫生研究院制定了基于证据的指南，但该疾病的总体发病率仅略有下降。此外，在护理和治疗方面存在惊人且不可接受的差异。解决这些差异是多个联邦机构、当地社区、患者和研究人员的首要任务。有一些基于证据的显着例子。例如，经过验证的 IMPACT DC 干预措施改善了华盛顿特区儿科哮喘护理和结果的多项措施，但华盛顿特区的儿科哮喘发病率仍然很高，并进一步改善了儿科哮喘护理。华盛顿特区和其他地方的结果将需要超越主要的医学干预模式，并纳入来自医疗保健、家庭、家庭和社区领域的额外循证干预措施。因此，我们拟议项目的总体目标是利用社区。将此类干预措施整合到一个高度驱动的过程中以患者和家庭为中心的计划已准备好接受严格的后续验证，作为改善弱势城市青少年哮喘结果的可重复手段。哥伦比亚特区哮喘护理实施计划 (ACIP-DC) 将纳入现有的 IMPACT DC 干预措施，但将扩大范围。 ACIP-DC 提案非常重要，因为它将创建一个社区哮喘导航器（基于社区卫生工作者模型）来协调多个其他正在进行的患者服务，并使用电子护理协调平台来整合这些服务。新颖且高度如果在华盛顿特区有效，该合作计划将准备好在其他地方传播，作为解决儿童哮喘高发病率的类似社区的差异的手段，以实现我们的总体目标。我们将追求三个具体目标：(1) 我们将与儿童健康倡导研究所合作，进行社区需求评估，重点是通过让不同的当地利益相关者群体参与的迭代过程，了解 DC 哮喘结果不良高风险儿童的现有护理网络；(2) 根据此需求评估，我们将创建、试点通过整合来自医疗保健、家庭、家庭和社区领域的循证干预措施来测试和修改 ACIP-DC；(3) 我们将规划和试点评估 ACIP-DC 的严格方案的要素；前瞻性、随机、单盲临床将其与单独的 IMPACT DC 干预（常规护理）进行比较的试验为了实现这一目标，经验丰富的研究团队将利用其现有的当地合作者网络，并将与新的合作者进行试点。测试，整个干预措施将用高保真检查表编写，准备作为临床试验的基础。（摘要完）