Rhode Island Asthma Integrated Response Program (RI-AIR)

罗德岛州哮喘综合应对计划 (RI-AIR)

• 批准号: 9768560
• 负责人: Daphne Koinis Mitchell
• 金额: $ 182.8万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-15 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9768560
• 关键词: Address; Algorithms; Area; Asthma; Care given by nurses; Caregivers; Caring; Child; Child Care; Child Health; Childhood Asthma; Cities; Clinical; Communities; Contracts; Cost Savings; Data; Databases; Disease Management; Disease Outcome; Dose; Education; Effectiveness; Emergency department visit; Evaluation; Family; Family Characteristics; Family health status; Focus Groups; Funding; Goals; Guidelines; Health; Health Personnel; Healthcare; Home environment; Hospitalization; Individual; Information Systems; Inhalators; Insurance; Intervention; Investments; Knowledge; Latino; Medical; Methods; Minority; Modeling; Needs Assessment; Outcome; Participant; Penetration; Pharmaceutical Preparations; Poverty; Prevalence; Process; Program Evaluation; Provider; Public Health; Quality of life; Randomized; Recommendation; Research; Rhode Island; Risk; School Nursing; Schools; Secure; Self Efficacy; Services; Stratification; Surveys; Symptoms; System; Techniques; Technology; Visit; Work; aged; base; care systems; community involvement; design; ethnic diversity; evidence base; health care service utilization; health care settings; high risk; improved; programs; racial and ethnic; reduce symptoms; remediation; response; school district; screening

Project Summary/Abstract: Greater Providence, Rhode Island is comprised of several urban “core” cities of high poverty and significant pediatric asthma disparity. The RI-Asthma Integrated Response (RI-AIR) Asthma Care Implementation Program (ACIP) is a comprehensive system of identification, screening and intervention for pediatric asthma. Core components include: a 1) state of the art technology platform (the RI-AIR information data system, or RI-AIR IDS) to integrate data from LifeChart (EHR), REDCap (research data system), and KIDSNet (state-based database of child health information), 2) algorithm for stratification of asthma management services based on level of asthma control/risk, 3) multilevel school-based education (CASE) to family/child/school system for children whose asthma is not well-controlled, 4) intensive home-based intervention (HARP) for children with poorly controlled asthma, and 5) enhanced coordination between caregiver, school nurse, and health care provider to promote integration across sectors of care. The first aim of the proposed work is to evaluate the effectiveness of the RI-AIR ACIP using a randomized, stepped wedge design. During Years 2-4, we will provide our intervention sequentially to sixteen high-risk communities involving approximately 1500 urban, ethnically diverse children (aged 2-12) with asthma and their families. We will evaluate both individual-level (e.g., asthma control) and community-specific outcomes (i.e., rates of ED a multi-level process evaluation of the RI-AIR ACIP during implementation (Years 2-5). We will assess penetration within identified communities and school districts, and evaluate characteristics of families that accept and complete the intervention vs. those who do not. We will determine fidelity of the RI-AIR IDS technology platform in assigning interventions according to asthma control/risk, and treatment fidelity and dose delivered of the HARP and CASE programs. We will use focus groups and provider surveys to determine facilitators of and barriers to visits) for children with asthma. The second aim of this application involves conducting effective implementation. The third aim involves conducting a mixed-methods evaluation of the sustainability of the RI-AIR ACIP, with ongoing input from our community stakeholders during Years 5-6. We define sustainability as continued capacity, continued activities, and continued benefits. We expect over 1 year, participants receiving the RI-AIR ACIP will have improved asthma control and fewer symptom free days relative to baseline. We expect over 1 year, relative to baseline, caregivers will have improved asthma knowledge, self-efficacy, asthma QOL, and indicators of effective disease management. We expect over 1 year, communities receiving the RI-AIR ACIP will have reduced ED visits and hospitalizations relative to their baseline year, and relative to targeted communities that have not yet received RI-AIR. We plan to demonstrate that RI-AIR ACIP is a replicable, evidence-based and cost-saving model that improves asthma outcomes for children at most risk, and can be disseminated to other urban communities to address asthma disparities.

项目摘要/摘要： 大普罗维登斯（Rhode Island 小儿哮喘差异。 RI-ASTHMA综合响应（RI-AIR）哮喘护理实施 计划（ACIP）是小儿识别，筛查和干预的全面系统 哮喘。核心组件包括：a 1）最先进的技术平台（RI-AIR信息数据 系统或RI-Air ID）集成了LifeChart（EHR），REDCAP（研究数据系统）和KIDSNET的数据 （基于州的儿童健康信息数据库），2）用于分层的算法 基于哮喘控制/风险水平的服务，3）多层次的学校教育（案例） 哮喘无法控制的儿童家庭/儿童/学校系统，4）密集型家庭 干预（HARP）针对哮喘控制不良的儿童，以及5）增强的协调 护理人员，学校护士和医疗保健提供者，以促进护理部门的整合。第一个目标 拟议的工作是使用随机的，步进 楔形设计。在2 - 4年中，我们将依次提供干预措施至16个高风险社区 涉及大约1500名城市，种族多元化的儿童（2-12岁），哮喘及其家人。我们 将评估个人级别（例如，哮喘控制）和社区特定结果（即ED的比率） 一个多层次的过程 在实施过程中评估RI-AIR ACIP（2 - 5年）。我们将评估确定的渗透率 社区和学区，并评估接受和完成的家庭特征 干预与那些没有的人。我们将确定RI-Air IDS技术平台的保真度 根据哮喘控制/风险的干预，以及竖琴的治疗保真度和剂量 案例程序。我们将使用焦点小组和提供者调查来确定 访问）哮喘儿童。该应用的第二个目的涉及进行 有效的实施。第三个目的涉及对可持续性进行混合方法评估 RI-Air ACIP，在5 - 6年内，我们的社区利益相关者的投入持续。我们定义 可持续性作为持续的能力，持续的活动以及持续的利益。我们预计超过1年， 接收RI-AIR ACIP的参与者将改善哮喘控制和较少症状的日子 相对于基线。我们期望超过1年，相对于基线，护理人员将改善哮喘 知识，自效，哮喘质量和有效疾病管理的指标。我们期望超过1 一年，接收RI-Air ACIP的社区将减少相对于他们的ED访问和住院 基准年，相对于尚未收到RI Air的目标社区。我们计划证明 RI-Air ACIP是一种可复制的，基于证据和节省成本的模型，可改善哮喘的结果 最大风险的儿童，可以分散到其他城市社区以解决哮喘差异。