The Efficacy of CAMP Air, a Web-based Asthma Intervention, Among Urban Adolescents with Uncontrolled Asthma

CAMP Air（一种基于网络的哮喘干预措施）对哮喘不受控制的城市青少年的疗效

基本信息

批准号：
10677621
负责人：
Jean-Marie Bruzzese
金额：
$ 77.96万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-07-07 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10677621
关键词：
Address Administrator Adolescence Adolescent Adopted Adoption Affect African American Aftercare Age Air Asthma Black race Caregivers Characteristics Child Childhood Chronic Disease Collection Consolidated Framework for Implementation Research Cost Analysis Cost Effectiveness Analysis Data Development Dissemination and Implementation Education Educational process of instructing Enrollment Future Goals Growth Health Health behavior Health education High Prevalence Hispanic Hispanic Americans Intervention Intervention Studies Interview Latino Learning Maintenance Measures Methodology Methods Modeling Morbidity - disease rate Online Systems Outcome Participant Pattern Pharmaceutical Preparations Pilot Projects Play Population Public Health Quality Control Quality of life Quality-Adjusted Life Years Randomized Randomized, Controlled Trials Reach, Effectiveness, Adoption, Implementation, and Maintenance Recommendation Reduce health disparities Research Resources Risk Role Schools Science Self Care Self Management Spirometry Steroids Students Symptoms Technology Teenagers Testing Translation Process Visit Youth age group clinical efficacy clinical implementation comparison control cost cost effectiveness cost per quality-adjusted life year cost-effectiveness ratio disparity reduction eHealth economic value efficacy evaluation efficacy testing ethnic minority experience follow-up graduate school health disparity populations high school implementation determinants implementation research implementation science implementation study incremental cost incremental cost-effectiveness intervention cost intervention delivery intervention effect markov model minority children mortality motivational enhancement therapy online intervention pilot trial post intervention primary outcome process evaluation programs public health relevance pulmonary function randomized trial scale up secondary outcome skills social cognitive theory success urgent care

项目摘要

PROJECT SUMMARY / ABSTRACT Background and Rationale: Asthma has high prevalence and morbidity among minority adolescents. Yet, few interventions are tested in adolescents, with only one being web-based. Given asthma's significant impact on this group, and the important role technology plays in their lives, this oversight is a significant public health concern. There is a dearth of cost-effectiveness analyses and implementation studies in asthma intervention research. This study addresses these treatment and methodological gaps. We developed and established the preliminary impact of the Controlling Asthma Program for Adolescents (CAMP Air), a seven-module personalized, e-health intervention for adolescents with uncontrolled asthma. Objective: We aim to: (1) systematically evaluate CAMP Air's efficacy in 370 urban adolescents with uncontrolled asthma; (2) assess its cost-effectiveness; and (3) identify multi-level factors associated with successful implementation of CAMP Air to inform its future scale-up. Hypotheses: Relative to controls, over 1-year CAMP Air participants will have significantly better asthma control as indicated by (a) higher scores on the Asthma Control Test (ACT) and (b) fewer asthma-related urgent care visits (primary outcomes). CAMP Air participants will also have significantly better (a) asthma self-care skills, (b) controller medication use, (c) lung function (measured by spirometry), and (d) quality of life; and significantly lower rates of (e) steroid bursts, (f) symptoms days, (g) nights woken, (h) activity limitations, and (i) school absences. We hypothesize that compared to the control, CAMP Air will have favorable value (incremental cost-effectiveness ratio<$100,000/ quality adjusted life years [QALYs]). Methods: We will enroll 370 9th – 11th graders with uncontrolled asthma from up to 19 NYC high schools. We will randomize participants to CAMP Air or an asthma education control intervention and follow them for 12 months post-treatment. Using a decision-analytic Markov model, we will estimate CAMP Air's incremental cost per QALY gained and cost per symptom free days, from both the societal and payer perspectives. For the process evaluation, which is built on the RE-AIM and Consolidated Framework for Implementation Research (CFIR) models, we will collect qualitative and quantitative data from students, caregivers, and school administrators. Together with stakeholders we will develop strategies for widespread implementation of CAMP Air, informed by our clinical efficacy, cost-effectiveness, and implementation results. Significance: The study has high public health significance because it (1) targets an understudied population impacted greatly by asthma, (2) leverages technology in a health disparate population to promote self-care, (3) assesses CAMP Air's economic value using QALYs and symptom-free days, and (4) bridges a gap between research and practice by identifying implementation factors to inform strategies for widespread implementation of CAMP Air.

项目概要/摘要背景和理由：哮喘在少数民族青少年中的患病率和发病率很高。鉴于哮喘的显着影响，很少有干预措施在青少年中进行测试，其中只有一项是基于网络的。对于这个群体，以及技术在他们的生活中发挥的重要作用，这种监督是一个重要的公共卫生问题哮喘干预方面缺乏成本效益分析和实施研究。这项研究解决了这些治疗和方法上的差距。青少年哮喘控制计划 (CAMP Air) 的初步影响，该计划由七个模块组成对哮喘未受控制的青少年进行个性化的电子健康干预目的：我们的目标是：(1) 系统评估 CAMP Air 对 370 名哮喘未受控制的城市青少年的疗效 (2) 评估其效果；成本效益；(3) 确定与成功实施 CAMP Air 相关的多层次因素为其未来的扩大规模提供信息：相对于控制，超过 1 年的 CAMP Air 参与者将有 (a) 哮喘控制测试 (ACT) 得分较高和 (b) 表明哮喘控制明显更好哮喘相关的紧急护理就诊次数（主要结果）也将显着减少。更好的 (a) 哮喘自我护理技能，(b) 控制药物的使用，(c) 肺功能（通过肺活量测定法测量）， (d) 生活质量；以及 (e) 类固醇爆发率、(f) 症状日、(g) 夜间醒来率显着降低， (h) 活动限制，以及 (i) 学校缺勤我们发现，与对照组相比，CAMP Air 会缺勤。具有有利的价值（增量成本效益比<100,000 美元/质量调整生命年 [QALY]）。方法：我们将从纽约市 19 所高中招募 370 名哮喘未得到控制的 9 至 11 年级学生。将随机分配参与者参加 CAMP Air 或哮喘教育控制干预措施，并跟踪他们 12 使用决策分析马尔可夫模型，我们将估算 CAMP Air 的增量成本。从社会和付款人的角度来看，获得的每 QALY 和每无症状天的成本。过程评估，建立在 RE-AIM 和实施研究综合框架的基础上 (CFIR) 模型，我们将从学生、看护者和学校收集定性和定量数据我们将与利益相关者一起制定广泛实施 CAMP 的战略。空气，根据我们的临床疗效、成本效益和实施结果提供信息。具有很高的公共卫生意义，因为它 (1) 针对的是受以下因素严重影响的未充分研究人群哮喘，(2) 在健康状况不同的人群中利用技术来促进自我护理，(3) 评估 CAMP 使用 QALY 和无症状天数来评估空气的经济价值，以及 (4) 弥合研究与结果之间的差距通过实施实践来确定因素，为广泛实施 CAMP Air 的策略提供信息。