The Asthma Action at Erie Trial

伊利试验中的哮喘行动

基本信息

批准号：
8884931
负责人：
MOLLY A MARTIN
金额：
$ 70.18万
依托单位：
UNIVERSITY OF ILLINOIS AT CHICAGO
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：
2015-04-01 至 2020-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8884931
关键词：
Accounting Address Adherence Adopted Advocate African American Asthma Beds Behavior Therapy Behavioral Behavioral Genetics Caring Case Manager Chicago Child Childhood Asthma Clinic Clinical Communities Community Health Cost Savings Education Educational Intervention Ensure Equipment Family Federally Qualified Health Center Guidelines Health Personnel Health Services Accessibility Health education Healthcare Systems Home environment Individual Intervention Intervention Trial Lead Life Low income Maintenance Measures Medical Mental Depression Mental Health Minority Modeling Modification Morbidity - disease rate Outcome Participant Patients Pharmaceutical Preparations Population Post-Traumatic Stress Disorders Prevalence Provider Public Health Puerto Rican Questionnaires Randomized Randomized Controlled Trials Relative (related person)Research Research Design Resources Role Savings Self Management Services Social Health Services Social Workers Stress Symptoms System Testing Treatment Efficacy Vacuum Writing arm base clinical practice clinically relevant combat cost cost effectiveness cultural competence efficacy testing evidence base experience high risk improved medication compliance psychosocial public health relevance remediation trial comparing

项目摘要

DESCRIPTION (provided by applicant): Asthma Action at Erie Trial Asthma prevalence and morbidity has been increasing among children over the last three decades despite significant advances in environmental control and asthma care. The annual costs for children with asthma range between $2.0 and $3.2 billion. Asthma morbidity and its associated costs are not borne equally; they are highest for urban, low income, African American and Puerto Rican children. Community health workers (CHWs) have been growing in popularity as a potential intervention to combat these asthma disparities. CHWs are frontline public health workers who serve as liaisons between health and social services and communities to facilitate access to services and improve the quality and cultural competence of service delivery. The evidence on CHW asthma intervention efficacy has been growing but several critical gaps still exist. The Asthma Action at Erie Trial will test the ability of a CHW intervention with three important modifications to achiev asthma control in high-risk children: 1) CHWs will be integrated into both the clinical and the home setting, 2) A system for directly addressing mental health and psychosocial barriers will be provided, and 3) Participants will be provided only materials and equipment for trigger remediation that are supported by the current medical reimbursement system. A two-arm behavioral randomized controlled trial (N=220) will be conducted in partnership with a federally- qualified health center (FQHC) serving a low income, minority population that is at high-risk for significant asthma morbidity. The intervention arm will receive an integrated CHW home intervention for pediatric asthma education. The comparison arm will received clinic-based certified asthma educator (AE-C) services. Primary Aim 1 is to assess the efficacy of the integrated CHW home asthma intervention, relative to clinic-based AE-C education over 12-months, as demonstrated by asthma control. We hypothesize that the CHW arm will have at least 30% fewer days with activity limitation than the AE-C arm at 12-months. Specific Aim 2 is to assess maintenance of intervention efficacy, as demonstrated by asthma control at 18 and 24 months after randomization. Specific Aim 3 is to determine the cost-effectiveness at 12-months of CHW and AE-C intervention delivery, and additional costs or savings related to asthma exacerbations at 12- and 24-months. Specific Aim 4 is to assess the efficacy of the integrated CHW home asthma intervention relative to clinic- based AE-C education, as demonstrated by asthma control, among those experiencing depression, stress, and/or a post-traumatic stress disorder. This trial compares the current best practice in asthma self- management education (AE-C services) to an integrated CHW home intervention in which the real-life challenges of patients and the health care system are taken fully into account. This trial will provide clarity a to the expected effect size, cost savings, and resources needed to integrate asthma CHWs into clinical practice. .

描述（由申请人提供）：伊利试验中的哮喘行动尽管环境控制和哮喘护理取得了显着进步，但过去三十年儿童哮喘患病率和发病率一直在增加，每年哮喘儿童的费用在 2.0 至 32 亿美元之间。哮喘发病率及其相关费用并不平等；对于城市、低收入、非裔美国人和波多黎各儿童来说，哮喘发病率及其相关费用是最高的，作为潜在的社区卫生工作者（CHW）越来越受欢迎。社区卫生工作者是一线公共卫生工作者，他们充当卫生和社会服务与社区之间的联络人，以促进获得服务并提高服务提供的质量和文化能力。有关社区卫生工作者哮喘干预效果的证据不断增加。但仍然存在一些关键差距，伊利哮喘行动试验将通过三项重要修改来测试社区卫生工作者干预的能力，以实现高危儿童的哮喘控制：1）社区卫生工作者将融入临床和家庭环境， 2) 将提供直接解决心理健康和社会心理障碍的系统，并且 3) 将仅向参与者提供由当前医疗报销系统支持的触发补救材料和设备一项双臂行为随机对照试验（N）。 =220）将与联邦合格的健康中心（FQHC）合作进行，该中心为低收入、哮喘发病率高的少数群体提供服务。干预部门将接受针对儿科哮喘教育的综合社区卫生工作者家庭干预。 .比较臂将接受基于临床的认证哮喘教育者 (AE-C) 服务主要目标 1 是通过证明哮喘控制来评估综合 CHW 家庭哮喘干预相对于 12 个月内基于临床的 AE-C 教育的效果。我们力求在 12 个月时，CHW 组的活动受限天数比 AE-C 组至少少 30%。具体目标 2 是评估干预效果的维持，如 18 个月和 18 个月时的哮喘控制所证明的那样。随机化后 24 个月，具体目标 3 是确定 CHW 和 AE-C 干预实施 12 个月时的成本效益，以及 12 个月和 24 个月时与哮喘恶化相关的额外成本或节省。评估在经历抑郁、压力和/或创伤后应激障碍的患者中，社区卫生工作者家庭哮喘综合干预相对于基于临床的 AE-C 教育的有效性，如哮喘控制所证明的那样。将当前哮喘自我管理教育（AE-C 服务）的最佳实践与综合社区卫生工作者家庭干预进行了比较，其中充分考虑了患者和医疗保健系统的现实挑战。该试验将提供清晰的答案。将哮喘社区卫生工作者纳入临床实践所需的预期效果大小、成本节省和资源。