Project ASTHMA - Aligning with Schools to Help Manage Asthma and Decrease Health Inequities

ASTHMA 项目 - 与学校合作，帮助管理哮喘并减少健康不平等

基本信息

批准号：
10803747
负责人：
Lucy Holmes
金额：
$ 68.47万
依托单位：
STATE UNIVERSITY OF NEW YORK AT BUFFALO
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-24 至 2028-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10803747
关键词：
Absenteeism Adherence Adrenal Cortex Hormones Age Asthma Back Black race Caregivers Caring Child Child Health Childhood Asthma Chronic Chronic Care Chronic Disease Clinical Cluster randomized trial Communities Comprehensive Health Care Cost Savings Country County Decision Making Directly Observed Therapy Disease Management Dose Economics Education Emergency department visit Employment Enrollment Family Goals Guidelines Health Health Care Costs Health Services Accessibility Healthcare Hispanic Home Hospitalization Inequity Inhalation Interruption Intervention Medical Medical Care Costs Medication Management Methodology Methods Modeling Morbidity - disease rate Observational Study Outcome Outcome Measure Pharmaceutical Preparations Physicians&apos Offices Pilot Projects Policy Maker Poverty Prevalence Prevention Preventive Productivity Provider Public Health Public Sector Quality of life Randomized Recommendation Research Resource Allocation Resources School Nursing Schools Self Management Service delivery model Spirometry Students Symptoms Testing Time Training Translating Transportation United States Vulnerable Populations Work asthma exacerbation asthma inhaler asthma model cost cost effective cost effectiveness design effectiveness evaluation effectiveness testing experience functional improvement functional outcomes health assessment health care availability health care delivery health inequalities hospitalization rates improved marginalized community multi-component intervention novel poor communities prevent primary care provider primary outcome programs prospective randomized trial safety net school based health center social determinants social health determinants socioeconomics suburb success treatment as usual underserved community

项目摘要

PROJECT SUMMARY/ABSTRACT Multicomponent interventions delivered in school-based health centers (SBHCs) have the potential to decrease asthma morbidity in children from communities that experience health inequities. Asthma is the most common chronic disease in children. Black and Hispanic children from low-socioeconomic communities account for a disproportionate percentage of asthma exacerbations, emergency department (ED) visits, and hospitalizations. These children often do not receive guideline-based asthma care, and adherence to daily preventive asthma medication is poor. Traditional health service delivery models where care is received in physicians’ offices have limited success in improving asthma outcomes in vulnerable populations. This is attributable to multiple social determinants of health that interrupt consistent comprehensive care, including limited availability of health services, lack of transportation, and caregiver employment demands. As a result, these children often receive crisis-driven care rather than prevention-driven care. SBHCs can serve as a safety net for children living in poor communities and improve health outcomes. SBHCs are staffed by advanced practice providers (APPs) who can assess and manage diseases. There are therefore minimal costs to integrating an asthma management program within this existing health care delivery model. Project ASTHMA (Aligning with Schools To Help Manage Asthma) is a prospective, stepped wedge cluster randomized trial based on a successful pilot study, that aims to assess the effectiveness of SBHCs as a cost effective health care delivery model to reduce asthma symptoms, exacerbations, ED visits, and hospitalizations in children with uncontrolled asthma who live in communities with health inequities. The intervention will take place in SBHCs located in 10 Buffalo Public Schools. The APPs at the SBHCs randomized to Project ASTHMA that year will be trained and supported to deliver guideline-based chronic asthma care. Students enrolled in Project ASTHMA will receive asthma assessments and preventive medication management from the APPs, directly observed therapy of their preventive asthma medication from school nurses to support adherence, and self-management support to improve adherence to home doses of asthma medication. Students enrolled at the SBHCs randomized to the control that year will be in an enhanced usual care group who will receive an asthma assessment by the research team and then be referred to their primary care provider for assessment and medication management. SBHCs are a financially and clinically sustainable health care delivery model, and have the potential to substantially decrease inequities in asthma morbidity. If disseminated, Project ASTHMA has the potential to improve the health of children in high-poverty schools throughout the country. These improvements are likely to be cost-effective for state and county health departments because over 2,500 SBHCs already exist in hundreds of communities in the United States. Evidence generated through our findings can assist public health policymakers in determining priorities and allocating resources to SBHCs.

项目概要/摘要在学校健康中心 (SBHC) 提供的多成分干预措施有可能降低健康不平等社区儿童的哮喘发病率。来自低社会经济社区的黑人和西班牙裔儿童的常见慢性病。哮喘发作、急诊科 (ED) 就诊以及这些儿童通常没有接受基于指南的哮喘护理，也没有遵守日常护理。预防性哮喘药物治疗效果不佳。医生办公室在改善弱势群体哮喘结果方面取得的成功有限。可归因于多个影响健康的社会决定因素，这些因素干扰了持续的综合护理，包括因此，医疗服务的可用性有限、交通缺乏以及护理人员的就业需求。这些儿童经常接受危机驱动的护理，而不是预防驱动的护理，SBHC 可以作为安全保障。 SBHC 配备了先进的工作人员，为生活在贫困社区的儿童提供网络并改善健康状况。因此，可以评估和管理疾病的执业提供者 (APP) 的成本最低。将哮喘管理计划整合到现有的医疗保健提供模式中。 ASTHMA 项目（与学校合作帮助管理哮喘）是一个前瞻性的阶梯式楔形集群基于成功试点研究的随机试验，旨在评估 SBHC 作为成本的有效性有效的医疗保健提供模式可减少哮喘症状、哮喘发作、急诊就诊和住院治疗对于居住在健康不平等社区的哮喘未受控制的儿童，将采取干预措施。位于 10 所布法罗公立学校的 SBHC 中 SBHC 中的 APP 随机分配到 ASTHMA 项目。当年将接受培训和支持，以提供基于指南的慢性哮喘护理。 Project ASTHMA 将接收来自 APP 的哮喘评估和预防性药物管理，学校护士直接观察预防性哮喘药物的治疗，以支持依从性，以及自我管理支持，以提高就读哮喘药物的学生的家庭剂量依从性。当年随机分配到对照组的 SBHC 将属于强化常规护理组，他们将接受由研究团队进行哮喘评估，然后转介给他们的初级保健提供者进行评估 SBHC 是一种财务上和临床上可持续的医疗保健提供模式，如果得到传播，有可能大幅减少哮喘发病率的不平等。哮喘有可能改善全国高度贫困学校儿童的健康。这些改进对于州和县卫生部门来说可能具有成本效益，因为超过通过我们生成的证据，美国数百个社区已存在 2,500 个 SBHC。研究结果可以帮助公共卫生政策制定者确定优先事项并向 SBHC 分配资源。