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: 9380048
• 负责人: DEBORAH A. ELLIS
• 金额: $ 69.74万
• 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 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9380048
• 关键词: 17 year old; Accident and Emergency department; Adherence; Admission activity; Adolescent; Adoption; Affect; African American; Algorithms; Area; Asthma; Caring; Child; Childhood; Childhood Asthma; Chronic Disease; Cities; Clinical; Clinical Pathways; Clinical Trials; Collaborations; Communities; Community Health Aides; Cost Analysis; Cost Savings; Development; Dose; Education; Effectiveness; Eligibility Determination; Emergency Care; Emergency department visit; Emergency medical service; Evidence based intervention; Evidence based practice; Family; Funding; Future; Guidelines; Health; Health Care Costs; Health Planning; Health Professional; Healthcare; Home environment; Home visitation; Hospitalization; Hospitals; Hybrids; 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; Randomized Clinical Trials; Reporting; Respiratory physiology; 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; age group; base; cost; design; dissemination research; effectiveness trial; evidence base; experience; family support; follow-up; health care availability; health care service; health disparity; high risk; high-risk adolescents; implementation research; improved; inner city; innovation; minority children; mortality; programs; quality assurance; research data dissemination; 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和治疗的障碍 降低少数民族儿童，尤其是非洲儿童患哮喘相关发病的显着风险 哮喘控制不佳的美国青少年 很少有针对非裔美国人的临床试验。 哮喘控制不佳的青少年以及针对非裔美国青少年的干预研究 一般患有哮喘的人，特别是哮喘控制不佳的非洲裔美国儿童 其特点是方法学上的局限性和/或对客观健康结果的有限影响。 治疗保健 (MST-HC) 是一种强化、多成分、以家庭为基础的心理治疗，针对 个人、家庭和社区系统中青少年哮喘管理不善的多种原因。 一项随机临床试验，我们表明 MST-HC 明显比家庭家庭更有效 支持提高非洲人对控制药物的依从性并改善肺功能 完成后六个月内患有中度至重度且控制不佳的哮喘的美国青少年 此外，MST-HC 还减少了与哮喘相关的住院治疗和相关的急诊就诊。 拟议研究的主要目的是使 MST-HC 用于现实世界的公共医疗保健环境 并在 T3 转化试验中进行测试，新的干预措施“Reach for Control”（RFC）将被安置在一个实验室中。 密歇根儿童医院 (CHM) 儿科急诊室 (ED) 并将进行调整以适应分娩 由社区卫生工作者 (CHW) 设计 该设计是一种有效性实施“混合 1”设计，其中 主要目的是确定基于证据的干预措施在现实世界中的有效性， 次要目标是收集有关实施背景和障碍/促进因素的信息 为了实现我们的有效性目标，我们将进行一项针对 170 个高水平患者的随机有效性试验。 在急诊室就诊的哮喘控制不佳的青少年将面临哮喘恶化的风险。 由韦恩儿童医疗保健服务计划提供，该计划是一家提供医疗保健的社区机构 为底特律地区服务不足的儿童提供的服务，并将与该机构的标准护理进行比较 对哮喘控制不佳的青少年进行干预 对于我们的实施目标，我们将评估 急诊科临床工作人员通过临床路径进行识别、筛查和转诊至 RFC 的有效性。 研究实施 RFC 的障碍和促进因素（包括将其整合到 ED 中以及由 CHW）使用混合方法我们还将开发和评估一种高效且有效的方法。 衡量 CHW 对 RFC 的忠诚度并进行成本分析，为治疗等决策提供信息 如果成功，该研究有可能在未来的实际实施中确定剂量和社区卫生工作者的病例量。 提高弱势群体的生活质量，同时降低医疗费用。