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: 9386479
• 负责人: Daphne Koinis Mitchell
• 金额: $ 82.63万
• 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/9386479
• 关键词: Address; Algorithms; Area; Asthma; Care given by nurses; Caregivers; Caring; Child; Child Care; Child health care; Childhood Asthma; Cities; Clinical; Communities; Contracts; Cost Savings; Data; Databases; Disease Management; Disease Outcome; Dose; Education; Effectiveness; Emergency department visit; Employee Strikes; 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; design; ethnic diversity; evidence base; health care service utilization; 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： 罗德岛州大普罗维登斯由几个高度贫困和重要的城市“核心”城市组成 儿童哮喘差异 RI-哮喘综合反应 (RI-AIR) 哮喘护理实施 计划（ACIP）是一个针对儿科的识别、筛查和干预的综合系统 核心组件包括： 1) 最先进的技术平台（RI-AIR 信息数据） 系统或 RI-AIR IDS）来集成来自 LifeChart (EHR)、REDCap（研究数据系统）和 KIDSNet 的数据 （基于国家的儿童健康信息数据库），2）哮喘管理分层算法 基于哮喘控制/风险水平的服务，3) 多层次校本教育 (CASE) 针对哮喘未得到良好控制的儿童的家庭/儿童/学校系统，4) 强化家庭治疗 对哮喘控制不佳的儿童进行干预 (HARP)，以及 5) 加强儿童之间的协调 护理人员、学校护士和医疗保健提供者促进跨护理部门的融合 第一个目标。 拟议工作的目的是使用随机、逐步的方法来评估 RI-AIR ACIP 的有效性 在第 2-4 年期间，我们将依次向 16 个高风险社区提供干预措施。 大约 1500 名患有哮喘的城市、不同种族的儿童（2-12 岁）及其家人参与其中。 将评估个人水平（例如哮喘控制）和社区特定结果（即 ED 发生率） 多层次的过程 在实施期间（第 2-5 年）评估 RI-AIR ACIP 我们将评估已确定的渗透率。 社区和学区，并评估接受并完成该计划的家庭的特征 干预与不干预的情况 我们将确定 RI-AIR IDS 技术平台在分配时的保真度。 根据哮喘控制/风险以及 HARP 的治疗保真度和剂量进行干预 我们将利用焦点小组和提供者调查来确定 CASE 计划的促进因素和障碍。 该应用程序的第二个目的是为患有哮喘的儿童进行访问。 第三个目标涉及对可持续性进行混合方法评估。 RI-AIR ACIP 的定义，以及我们社区利益相关者在第 5-6 年期间的持续投入。 可持续性是持续的能力、持续的活动和持续的效益，我们预计超过一年， 接受 RI-AIR ACIP 的参与者将改善哮喘控制并减少无症状天数 相对于基线，我们预计一年后，护理人员的哮喘症状将会得到改善。 我们期望超过 1 的知识、自我效能、哮喘生活质量和有效疾病管理指标。 年，接受 RI-AIR ACIP 的社区相对于其社区而言将减少急诊就诊和住院治疗 基准年，以及相对于尚未接受 RI-AIR 的目标社区，我们计划进行示范。 RI-AIR ACIP 是一种可复制、基于证据且节省成本的模型，可改善哮喘结果 儿童面临的风险最大，可以传播到其他城市社区以解决哮喘差异问题。