The Breathmobile Program: structure, implementation, and evolution of a large-scale, urban, pediatric asthma disease management program.
The Breathmobile Program: structure, implementation, and evolution of a large-scale, urban, pediatric asthma disease management program.
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DOI：
10.1089/dis.2005.8.205
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发表时间：
2005-08-01
影响因子：
--
通讯作者：
Guterman, Jeffrey J
中科院分区：
文献类型：
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作者：
Jones, Craig A;Clement, Loran T;Guterman, Jeffrey J
尽管开展了十多年的教育和以研究为导向的干预项目，市中心患有哮喘的儿童继续参与断断续续的“抢救”模式的医疗保健，并经历了不成比例的发病率。本研究的目的是建立和评估一个可持续的社区范围的儿童哮喘疾病管理计划，旨在将洛杉矶市中心的儿童从急性发作性护理转变为按照国家标准的定期预防性护理。1995年，美国哮喘和过敏基金会（AAFA）南加州分会、洛杉矶县卫生服务部（LAC DHS）和洛杉矶联合学区（LAUSD）建立了一项协议，以启动和维持Breathmobile计划。该计划包括自动病例识别、基于学校的流动诊所以及由先进信息技术解决方案支持的高度结构化的临床接触。哮喘护理专家的跨学科团队在洛杉矶城市的广泛地理区域为学校和县诊所站点的儿童提供定期和持续的护理。每个小组在配备特殊设备的流动诊所（Breathmobile）中运作，有效地将结构化的医疗保健流程转移到有大量儿童的学校和县诊所。在电子医疗记录系统中仔细跟踪人口统计、临床和参与数据。项目操作、临床监督和患者跟踪都集中在一个护理协调中心。临床操作和方法已在洛杉矶县+南加州大学医学中心的固定专业诊所复制。临床和过程措施定期评估，以确保质量，计划迭代改进，并支持循证护理。四个Breathmobiles在90多个学校提供持续护理。这个项目已经让5000多名病人和他们的家人参与到一个持续的护理模式中，这个模式已经证明比通常的偶发性护理更有效。在所有哮喘严重程度类别中，超过90%的患者实现了哮喘的临床控制，住院（IP）和急诊（ED）的使用显著减少。2002年2月14日，该项目成为美国第一个获得医疗机构认证联合委员会（JCAHO）颁发的疾病特异性护理认证的项目。适当的设计和资源分配可以维持以学校为基础的社区范围的儿童哮喘疾病管理计划，并根据国家标准将市中心儿童人口从急性发作性护理转变为常规预防性护理。以证据为基础的评估和保持质量的方法，加上分层的护理提供，可以确保有效利用安全网医疗保健资源。
Despite more than a decade of education and research-oriented intervention programs, inner city children with asthma continue to engage in episodic "rescue" patterns of healthcare and experience a disproportionate level of morbidity. The aim of this study was to establish and evaluate a sustainable community-wide pediatric asthma disease management program designed to shift inner city children in Los Angeles from acute episodic care to regular preventive care in accordance with national standards. In 1995 the Southern California Chapter of the Asthma and Allergy Foundation of America (AAFA), the Los Angeles County Department of Health Services (LAC DHS), and the Los Angeles Unified School District (LAUSD) established an agreement to initiate and sustain the Breathmobile Program. This program includes automated case identification, mobile school-based clinics, and highly structured clinical encounters supported by an advanced information technology solution. Interdisciplinary teams of asthma care specialists provide regular and ongoing care to children at school and county clinic sites over a wide geographic area of urban Los Angeles. Each team operates in a specially equipped mobile clinic (Breathmobile), efficiently moving a structured healthcare process to school and county clinic sites with large numbers of children. Demographic, clinical, and participation data is tracked carefully in an electronic medical record system. Program operations, clinical oversight, and patient tracking are centralized at a care coordination center. Clinical operations and methods have been replicated in fixed specialty clinic sites at the Los Angeles County + University of Southern California Medical Center. Clinical and process measures are regularly evaluated to assure quality, plan iterative improvement, and support evidence-based care. Four Breathmobiles deliver ongoing care at more than 90 school sites. The program has engaged over five thousand patients and their families in a continuity care model that has demonstrated efficacy over usual episodic care. More than 90% of patients in all asthma severity categories achieved clinical control of asthma with significant reductions in inpatient (IP) and emergency department (ED) use. On February 14, 2002, the program became the first program in the United States to receive the award of disease-specific care certification by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Proper design and resource allocation can sustain a school-based community-wide pediatric asthma disease management program and shift a population of inner city children from acute episodic care to routine preventive care in accordance with national standards. An evidence-based approach to evaluating and maintaining quality, coupled with stratified care delivery, can assure the efficient use of safety net healthcare resources.