Promoting Asthma Guidelines and Management through Technology-Based Intervention and Care Coordination (PRAGMATIC)

通过基于技术的干预和护理协调（PRAGMATIC）促进哮喘指南和管理

• 批准号: 9291500
• 负责人: Marina Reznik
• 金额: $ 83.21万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE, INC
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-01 至 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9291500
• 关键词: Address; Adherence; Adopted; Adoption; Affect; Age; Asthma; Caregiver support; Caregivers; Caring; Child; Childhood; Clinic; Clinical; Cluster randomized trial; Communication; Data; Decision Making; Education; Effectiveness; Electronic Health Record; Emergency Situation; Ensure; Evaluation; Feedback; Guidelines; Health Personnel; Healthcare; Intervention; Interview; Knowledge; Low income; Maintenance; Measures; Mediating; Morbidity - disease rate; Office Visits; Outcome; Outcome Measure; Paper; Patient Care; Patients; Performance; Pharmaceutical Preparations; Preventive; Preventive care; Problem Solving; Process; Provider; Public Health; Recommendation; Research; Resources; Sampling; Self Management; Severities; Symptoms; System; Technology; Telephone; Testing; Time; Translating; Translations; Visit; Work; base; clinical practice; effective intervention; experience; follow-up; health care service utilization; improved; inner city; innovation; intervention program; medical specialties; medication compliance; minority children; outreach; primary care setting; primary outcome; programs; response; routine care; routine practice; translational study; treatment as usual; trial comparing; trial design; uptake; urban children

PROJECT SUMMARY/ABSTRACT Asthma disproportionately affects low-income, minority children residing in inner cities such as the Bronx, NY. The use of national guidelines reduces asthma morbidity by 70%; yet, these guidelines are not consistently implemented by health care providers. Although several interventions to improve provider adherence to asthma guidelines have been described, few studies have addressed translation of guidelines into routine care. This study builds on our experience evaluating a multifaceted prompting intervention (MPI) in 12 urban clinics (R01HL091835, PI Halterman). Although effective in the short-term, this intervention must be modified to translate into routine practice. We will enhance MPI in several ways: (1) use clinic rather than research staff to facilitate assessment for prompts at every visit; (2) ensure prompting for guideline-based care for all children ages 2-12 with persistent or uncontrolled asthma, rather than just a research sample; (3) routinely deliver prompts to the provider via Electronic Health Record (EHR); (4) offer telephone-based care coordination, education and support to children with the highest morbidity via a dedicated Outreach Worker (OW); and (5) provide practice-level supports (e.g. clinic champions, on-going performance feedback and participatory problem solving) to promote full adoption of guidelines. The enhanced MPI program (eMPI) consists of innovative multi-level and team-based strategies to enable providers to effectively and efficiently adopt asthma care guidelines. In response to PAR-15-279, this study will address the guideline-to-practice gap by evaluating eMPI in real-world primary care settings. We will conduct a cluster randomized trial comparing eMPI to enhanced usual care (eUC) in 22 Bronx practices serving over 5,000 children ages 2-12 years with persistent or uncontrolled asthma. Practices will join the study in 4 waves over 4 years. Lessons learned about facilitators and barriers to eMPI implementation in earlier study waves will be used to improve the implementation in later clinics. Eleven eUC practices will receive guideline information and assess children's asthma severity and control, but active intervention components will not be provided. This study will (1) test the impact of eMPI on provider adoption of asthma management guidelines (primary outcome measure is the proportion of visits with >1 guideline-based corrective actions taken by the provider); (2) determine whether consistent use of eMPI leads to both short- and long-term improvements in clinical outcomes (measured by the symptom-free days); and (3) evaluate the process of program implementation using RE-AIM framework. We will also evaluate group differences in the extent of healthcare utilization and resources used (i.e., adherence to follow-up visits, specialty referrals, emergency and in-patient care, referrals to OW). The proposed research will provide critical new knowledge about how to implement guideline-based asthma care in routine pediatric practice, in order to facilitate widespread dissemination and adoption across the U.S.

项目摘要/摘要 哮喘不成比例地影响低收入，居住在纽约州布朗克斯等内城市的少数族裔儿童。 国家准则的使用将哮喘发病率降低了70％；但是，这些准则并非一致 由医疗保健提供者实施。尽管有几种干预措施可以改善提供商的遵守 已经描述了哮喘指南，很少有研究涉及将准则转化为常规护理。 这项研究以我们评估12个城市诊所的多方面促进干预（MPI）的经验为基础 （R01HL091835，Pi Halterman）。尽管在短期内有效，但必须修改此干预措施 转化为常规练习。我们将通过几种方式增强MPI：（1）使用诊所而不是研究人员来 每次访问时便有助于评估提示； （2）确保提示为所有儿童提供基于指南的护理 年龄在2-12岁之间，持续或不受控制的哮喘，而不仅仅是研究样本； （3）常规交付 通过电子健康记录（EHR）提示提供者； （4）提供基于电话的护理协调， 通过专门的外展工作者（OW）对发病率最高的儿童的教育和支持； （5） 提供实践级别的支持（例如诊所冠军，持续的表现反馈和参与性 解决问题）以促进完全采用准则。增强的MPI计划（EMPI）包括 创新的多层次和团队基于团队的策略，使提供者能够有效，有效地采用哮喘 护理指南。为了响应PAR-15-279，本研究将通过评估来解决实践差距 现实世界中的初级保健环境中的EMPI。我们将进行一项将EMPI与EMPI进行比较的群集随机试验 在22个布朗克斯实践中增强了常规护理（EUC） 或不受控制的哮喘。实践将在4年内以4次浪潮加入研究。关于促进者的经验教训 在较早的研究浪潮中，将使用EMPI实施的障碍来改善实施 诊所。十一项EUC实践将获得指南信息，并评估儿童哮喘的严重性和 控制，但是不会提供主动干预组件。这项研究将（1）测试EMPI对 提供者采用哮喘管理指南（主要结果指标是访问的比例 >提供者采取的基于指南的纠正措施）； （2）确定是否持续使用EMPI 导致临床结局的短期和长期改善（通过无症状的日子来衡量）； （3）使用RE-AIM框架评估程序实施过程。我们还将评估小组 医疗保健利用和所使用资源程度的差异（即，遵守后续访问， 专业推荐，紧急和住院护理，转介到OW）。拟议的研究将提供关键 有关如何在常规儿科实践中实施基于指南的哮喘护理的新知识，以便 促进美国各地广泛的传播和采用