A Randomized Controlled Evaluation of the Effect of Community Health Workers on Hospitalization for Asthma The Asthma Coach
A Randomized Controlled Evaluation of the Effect of Community Health Workers on Hospitalization for Asthma The Asthma Coach
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DOI：
10.1001/archpediatrics.2008.577
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发表时间：
2009-03-01
影响因子：
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通讯作者：
Musick, Judith
中科院分区：
文献类型：
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作者：
Fisher, Edwin B.;Strunk, Robert C.;Musick, Judith
目的：为了测试社区卫生工作者是否能够接触到因哮喘住院的非裔美国儿童的低收入父母，并减少他们的再住院率，设计：常规护理与2年哮喘教练干预的随机对照评价。306名因哮喘住院的儿童符合纳入标准，年龄为2至8岁，非裔美国人，并有医疗补助。在这些人中，有200人接受了接触，191人被招募，承诺参与评价活动，但为了评估覆盖面，没有承诺参与干预措施。教练加强了基本的哮喘教育，并通过家访和电话鼓励关键的管理行为，以适应父母采取管理措施的准备，并强调非指导性的支持方式（合作并接受感受和选择）。结果衡量标准：根据医院记录，干预对父母的影响、与教练的联系以及2年以上的再住院治疗。结果：在随机分配到哮喘教练组的3个月内，89.6%的父母与教练有至少一次实质性接触，在24个月的干预中，平均每位家长有21.1次接触。在控制了父母教育程度和儿童年龄、性别以及指标住院前一年的住院情况后，哮喘指导组96名儿童中有35名（36.5%）再次住院，常规治疗组93名儿童中有55名（59.1%）再次住院（P <0.01）。在调查中，家长表示的重要性，非指令性的方法来support.Conclusions：哮喘教练可以达到低收入的父母的非裔美国儿童住院治疗哮喘，并减少再住院的儿童。
Objective: To test whether community health workers are able to reach low-income parents of African American children hospitalized for asthma and to reduce rehospitalization among them.Design: A randomized controlled evaluation of usual care vs 2-year asthma coach intervention.Setting: An urban children's hospital and the surrounding community.Participants: A population-based sample of 306 children hospitalized for asthma met the inclusion criteria of being 2 to 8 years of age, of African American ethnicity, and having Medicaid coverage. Of these, 200 were contacted and 191 recruited with commitment to evaluation activities but, in order to assess reach, no commitment to participating in intervention.Interventions: Coaches reinforced basic asthma education and encouraged key management behaviors through home visits and phone calls tailored to parent's readiness to adopt management practices and emphasizing a nondirective supportive style (cooperative and accepting of feelings and choices).Outcome Measures: The reach of intervention to parents, contacts with coaches, and rehospitalization over 2 years based on hospital records.Results: Within 3 months of randomization to the asthma coach group, 89.6% of parents had at least 1 substantive contact with the coach, with an average of 21.1 contacts per parent over the 24-month intervention. The proportion of children rehospitalized was 35 of 96 (36.5%) in the asthma coach group and 55 of 93 (59.1%) in the usual care group (P < .01), controlling for parental education and child age, sex, and hospitalization in the year prior to the index hospitalization. In surveys, parents indicated the importance of the nondirective approach to support.Conclusions: An asthma coach can reach low-income parents of African American children hospitalized for asthma and reduce rehospitalization among the children.