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400万患有哮喘的人居住在城市地区。这些患者大多数都在经常管理哮喘的初级保健环境中看到，这代表了很大的护理差距。患有哮喘的粗糙儿童的健康分配包括贫困，获得专业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。我们建议制定一项全面的哮喘护理实施计划（ACIP），以改善对哮喘患有哮喘的粗糙儿童的护理。该项目将将亚利桑那大学和国家犹太人健康的调查人员聚集到1）在科罗拉多州西南部和北亚利桑那州农村地区与四个社区互动，以建立成功的合作； 2）对社区农村儿科哮喘计划进行随机务实试验。在第一阶段（U34）阶段，我们将在2014年进行的最初的社区外展工作以25,000英里四角地区（包括南部Ute，Ute Mountain Ute和Navajo Nation Reservations）的最初社区外展工作为基础。在最初的参与阶段，我们将巩固与父母，社区领导者，医院管理人员，学校和提供者在内的利益相关者的关系并评估社区需求。在第二（U01）阶段，我们将采用阶梯楔形的随机试验设计来测试ACIP的能力，以改善四种综合干预措施：1）医疗服务组件将包括对PCPS和医院工作人员进行循证培训的全面培训； 2）家庭组件将解决社区对空气质量的担忧，并确定衡量和减少哮喘儿童环境风险的潜在方法； 3）社区组成部分将包括一项基于学校的计划，以确定未诊断的哮喘，提供教育并促进学校，家庭和提供者之间的沟通； 4）家庭组成部分将与上述所有家庭联系起来，包括护理协调，教育和其他形式的援助，例如运输或低成本药物。最终试验将根据利益相关者的意见在参与阶段进行修改，并在RE-AIM框架内进行评估。我们认为，干预措施可以作为实施在粗糙环境中改善儿童哮喘护理（包括居住在美国原住民预订的人）中的策略的模型。（抽象的结尾）