A community toolkit to improve asthma care for rural children

改善农村儿童哮喘护理的社区工具包

基本信息

批准号：
9020657
负责人：
Bruce George Bender
金额：
$ 38.1万
依托单位：
NATIONAL JEWISH HEALTH
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 2017-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9020657
关键词：
Address Adherence Agriculture Air Air Pollution Allergens Ambulatory Care Arizona Asthma Biomass Caring Child Childhood Asthma Chronic Disease Clinical Cluster randomized trial Coal Collaborations Colorado Communication Communities Community Health Education Community Outreach Diagnosis Disease Education Effectiveness Environmental Risk Factor Environmental Wind Epidemiologic Studies Evaluation Exposure to Family Family Physicians Guidelines Health Health Personnel Heating Home environment Hospital Administrators Hospitals House Dust Housing Incidence Indian reservation Indoor Air Pollution Intervention Life Link Measures Medical Methods Modeling Monitor National Heart, Lung, and Blood Institute Native Americans Navajo Needs Assessment Outcome Outcome Measure Parents Particulate Patients Perception Pharmaceutical Preparations Phase Pollen Population Poverty Power Plants Primary Health Care Process Provider Quality of life Randomized Research Personnel Reservations Resources Risk Rural Rural Community Sampling Biases Schools Specialist Spirometry Surveys Target Populations Testing Training Transportation Travel United States Universities Urban Population abstracting animal dander base biomass smoke care systems cost cost effectiveness critical access hospital disorder control effective therapy evidence base evidence based guidelines follower of religion Jewish health care delivery health care service utilization health disparity improved medical specialties meetings patient home care pediatrician pragmatic trial prevent primary care setting programs public health relevance randomized trial rural area satisfaction treatment adherence trial design urban area

项目摘要

DESCRIPTION (Provided By Applicant): Abstract More than four million people with asthma live outside of urban areas. Most of these patients are seen in primary care settings where their asthma is often inadequately managed, representing a significant gap in care. Health disparities for rural children with asthma include poverty, limited access to specialty care, and environmental challenges including high levels of outdoor and indoor air pollution exposure. We propose to develop a comprehensive Asthma Care Implementation Program (ACIP) to improve care for rural children with asthma. This project will bring together investigators from the University of Arizona and National Jewish Health to 1) engage four communities in rural southwestern Colorado and northern Arizona to build a successful collaboration; and 2) conduct a randomized pragmatic trial of a community rural pediatric asthma program. In the first (U34) phase, we will build on initial community outreach efforts conducted in 2014 with over 50 healthcare providers and critical access hospitals in the 25,000 mile Four Corners region (including the Southern Ute, Ute Mountain Ute, and Navajo Nation Reservations). During the initial engagement phase, we will solidify relationships and assess community needs with stakeholders including parents, community leaders, hospital administrators, schools, and providers. In the second (U01) phase, we will employ a stepped wedge, randomized trial design to test the capacity of the ACIP to improve asthma care and outcomes with four integrated interventions: 1) the medical care component will include comprehensive training of PCPs and hospital staff in evidence-based pediatric asthma management; 2) the home component will address community concerns about air quality and determine potential methods to measure and reduce environmental risks to children with asthma; 3) the community component will include a school-based program to identify undiagnosed asthma, provide education, and facilitate communication between school, family, and provider; and 4) the family component will connect families with all of the above including care coordination, education, and other forms of assistance such as transportation or low-cost medication. The final trial will be modified in accord with stakeholder input during the engagement phase and evaluated within the RE-AIM framework. We believe that the intervention could serve as a model for implementation of strategies to improve asthma care among children in rural settings, including those living on Native American reservations. (End of Abstract)

描述（由申请人提供）：摘要超过 400 万哮喘患者居住在城市地区以外的地区，其中大多数患者都在初级保健机构就诊，他们的哮喘病往往得不到充分的治疗，这表明农村地区的医疗保健存在巨大差距。患有哮喘的儿童面临贫困、获得特殊护理的机会有限以及环境挑战（包括高水平的室外和室内空气污染暴露）的问题。我们建议制定一项全面的哮喘护理实施计划（ACIP），以改善对农村哮喘儿童的护理。会带来亚利桑那大学和国家犹太健康中心的研究人员一起 1) 与科罗拉多州西南部农村和亚利桑那州北部的四个社区建立成功的合作；2) 对社区农村儿科哮喘项目进行随机实用试验 U34) 阶段。我们将在 2014 年开展的初步社区外展工作的基础上，与 25,000 英里四角地区（包括南尤特、尤特山尤特和纳瓦霍）的 50 多家医疗保健提供者和关键医院进行合作在最初的参与阶段，我们将巩固与家长、社区领导、医院管理人员、学校和服务提供者等利益相关者的关系并评估社区需求。在第二阶段 (U01)，我们将采用阶梯式楔形、随机化。试验设计旨在测试 ACIP 通过四项综合干预措施改善哮喘护理和结果的能力：1) 医疗护理部分将包括对 PCP 和医院工作人员进行基于证据的儿科哮喘管理的全面培训；2) 家庭部分将解决社区对空气质量的担忧和确定潜力测量和减少哮喘儿童的环境风险的方法； 3) 社区部分将包括一项以学校为基础的计划，以识别未确诊的哮喘、提供教育并促进学校、家庭和提供者之间的沟通；以及 4) 家庭部分将包括将家庭与上述所有方面联系起来，包括护理协调、教育和其他形式的援助，例如交通或低成本药物。最终试验将根据利益相关者在参与阶段的意见进行修改，并在 RE-AIM 框架内进行评估。我们认为干预措施可以作为一种手段。实施改善农村儿童哮喘护理策略的模型，包括生活在美洲原住民保留地的儿童（摘要结束）。