Translating an Efficacious Illness Management Intervention for African American Youth with Poorly Controlled Asthma to Real World Settings

将针对哮喘控制不佳的非裔美国青年的有效疾病管理干预措施应用到现实世界中

• 批准号: 10227125
• 负责人: DEBORAH A. ELLIS
• 金额: $ 60.06万
• 依托单位: WAYNE STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-20 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10227125
• 关键词: 17 year old; Accident and Emergency department; Adherence; Admission activity; Adolescent; Adoption; Affect; African American; Algorithms; Area; Asthma; Caring; Child; Child health care; Childhood Asthma; Chronic Disease; Cities; Clinical; Clinical Pathways; Clinical Trials; Collaborations; Communities; Community Health Aides; Cost Analysis; Cost Savings; Development; Dose; Education; Effectiveness; Emergency Care; Emergency department visit; Emergency medical service; Evidence based intervention; Evidence based practice; Family; Funding; Future; Guidelines; Health; Health Care Costs; Health Professional; Healthcare; Home; Home visitation; Hospitalization; Hospitals; Individual; Intervention; Intervention Studies; Literature; Measures; Medicaid; Mental Health; Methodology; Methods; Michigan; Minority; Morbidity - disease rate; Outcome; Patient Care; Patients; Pediatric Hospitals; Pharmaceutical Preparations; Policies; Procedures; Process Measure; Provider; Psychotherapy; Quality of life; Randomized Clinical Trials; Reporting; Risk; Schools; Self Management; Services; Specific qualifier value; Symptoms; System; Testing; Training; Training and Education; Translating; Translational trial; United States Dept. of Health and Human Services; Use Effectiveness; Visit; Vulnerable Populations; Youth; adherence rate; age group; asthma exacerbation; base; care providers; cost; cost estimate; design; dissemination research; effectiveness evaluation; effectiveness implementation study; effectiveness testing; effectiveness trial; evidence base; experience; family support; follow-up; health care availability; health care service; health care settings; health disparity; health plan; high risk; high-risk adolescents; implementation barriers; implementation facilitators; implementation intervention; implementation research; improved; inner city; innovation; minority children; mortality; pediatric emergency; programs; pulmonary function; quality assurance; randomized effectiveness trial; screening; skills training; standard care; tool

There is a critical need to develop interventions to reduce barriers to optimal asthma management and reduce the significant risk for asthma-related morbidity experienced by minority children, especially African- American adolescents with poorly controlled asthma. There are few clinical trials focusing on African-American adolescents with poorly controlled asthma, and intervention studies targeting African-American adolescents with asthma in general or African-American children with poorly controlled asthma in particular are characterized by methodological limitations and/or limited effects on objective health outcomes. Multisystemic Therapy-Health Care (MST-HC) is an intensive, multi-component, home-based psychotherapy that targets the multiple causes of poor adolescent asthma management across individual, family and community systems. In a randomized clinical trial, we showed that MST-HC was significantly more effective than home-based family support in improving adherence to controller medications and improving lung functioning among African- American adolescents with moderate to severe, poorly controlled asthma up to six months after the completion of the intervention. In addition, MST-HC reduced asthma-related hospitalizations and associated ED visits. The primary purpose of the proposed study is to adapt MST-HC for use in real world, public healthcare settings and test it in a T3 translational trial. The new intervention, Reach for Control (RFC), will be housed in a pediatric emergency department (ED) at Children's Hospital of Michigan (CHM)and will be adapted for delivery by community health workers (CHWs). The design is an effectiveness-implementation “Hybrid 1” design where the primary aims are to determine the effectiveness of an evidence-based intervention in a real-world setting, and the secondary aims are to gather information about the context for implementation and barriers/ facilitators to implementation. For our effectiveness aim, we will conduct a randomized effectiveness trial with 170 high risk adolescents with poorly controlled asthma seen in the ED for an asthma exacerbation. RFC will be delivered by Wayne Children's Healthcare Access Program, a community agency providing health care services to underserved children in the Detroit area and will be compared to the agency's standard care intervention for youth with poorly controlled asthma. For our implementation aims, we will evaluate the effectiveness of identification, screening and referral to RFC by ED clinical staff via a clinical pathway. We will study barriers and facilitators to the implementation of RFC (both its integration within the ED and delivery by CHWs) using a mixed methods approach. We will also develop and evaluate an efficient and effective method of measuring CHW fidelity to RFC and conduct a cost analysis that will inform decisions such as treatment dose and CHW caseload in future real-world implementations. If successful, the study has the potential to improve quality of life for a vulnerable population while reducing healthcare costs.

迫切需要制定干预措施，以减少最佳哮喘管理的障碍和 减少少数族裔儿童（尤其是非洲）经历的与哮喘相关的发病率的重大风险 美国青少年控制哮喘。很少有针对非裔美国人的临床试验 针对非裔美国青少年的哮喘控制哮喘和干预研究的青少年 特别是哮喘或非裔美国人尤其控制哮喘不良的儿童是 以方法上的局限性和/或对客观健康结果的影响有限的特征。多系统 治疗健康护理（MST-HC）是一种密集的，多组件的家庭心理疗法，针对的是 个人，家庭和社区体系中青少年哮喘管理差的多重原因。在 一项随机临床试验，我们表明MST-HC比以家庭为基础的家庭有效得多 支持改善控制器药物的依从性并改善非洲的肺功能 完成后六个月的美国青少年中度至重度，控制哮喘的哮喘控制不佳 干预。此外，MST-HC减少了与哮喘相关的住院和相关的ED访问。 拟议的研究的主要目的是调整MST-HC用于现实世界中的公共医疗环境 并在T3翻译试验中对其进行测试。新的干预措施（RFC）将安置在 密歇根州儿童医院（CHM）的儿科急诊科（ED），将适应交货 由社区卫生工作者（CHW）。该设计是一个有效性实现的“混合1”设计 主要目的是确定在现实环境中基于证据的干预的有效性， 次要目的是收集有关实施和障碍/促进者的上下文的信息 实施。为了我们的有效性，我们将进行170高的随机有效性试验 在ED中，哮喘恶化的哮喘患者的风险青少年患有哮喘。 RFC会 由Wayne儿童医疗访问计划提供的社区机构提供医疗保健 为底特律地区服务不足的儿童提供服务，并将与该机构的标准护理进行比较 干预哮喘控制不善的年轻人。为了我们的实施目标，我们将评估 ED临床人员通过临床途径对识别，筛查和转介给RFC的有效性。我们将 研究RFC的实施障碍和促进者（既其在ED内的集成和通过 CHWS）使用混合方法方法。我们还将开发和评估一种有效的方法 测量CHW保真度到RFC并进行成本分析，该成本分析将为诸如治疗等决策提供信息 未来现实世界实施中的剂量和CHW案件。如果成功，该研究有可能 改善脆弱人群的生活质量，同时降低医疗保健成本。

项目成果

Evaluating barriers and facilitators to healthcare providers' use of an emergency department electronic referral portal for high-risk children with asthma using the Theoretical Domains Framework.

使用理论领域框架评估医疗保健提供者使用急诊科电子转诊门户来治疗高危哮喘儿童的障碍和促进因素。

• DOI: 10.1080/02770903.2023.2257318
• 发表时间: 2024
• 期刊: The Journal of asthma : official journal of the Association for the Care of Asthma
• 作者: Shukla,Meghna;Carcone,April;Mooney,Michael;Kannikeswaran,Nirupama;Ellis,DeborahA
• 通讯作者: Ellis,DeborahA