Community organization to reduce the need for acute care for asthma among African American children in low-income neighborhoods: The Neighborhood Asthma Coalition
Community organization to reduce the need for acute care for asthma among African American children in low-income neighborhoods: The Neighborhood Asthma Coalition
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DOI：
10.1542/peds.114.1.116
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发表时间：
2004-07-01
期刊：
影响因子：
8
通讯作者：
Walker, MS
中科院分区：
文献类型：
--
作者：
Fisher, EB;Strunk, RC;Walker, MS
背景低收入的非洲裔美国人表现出不成比例的患病率，发病率和死亡率的哮喘。为了确定是否以社区为基础的干预，邻里哮喘联盟（NAC），通过一个完善的邻里组织在圣路易斯进行，可以提高对哮喘的认识，改变态度的照顾，改善哮喘管理的做法，并减少急性哮喘护理的需要。《国家行动计划》包括针对父母和儿童的教育方案、宣传活动以及由受过培训的社区居民提供的个性化支持。非裔美国儿童，5至14岁，在过去一年内至少有1次急性护理事件（急诊室就诊或住院），从8个邮政编码地区招募，这些地区有低收入居民和高比例的符合医疗补助条件的儿童，即4个NAC社区和4个可比较的对照社区。评估包括每季度一次的电话访谈，以评估哮喘的态度和管理以及护理地点。在NAC开始前12个月至3年的计划中，对急性护理场所进行了审计。共联系了371名患者，确定其有资格参加本研究，345名同意参加，招募率为93%。其中，15人退出，24人在初次接触后失访。此外，57人因搬迁或其他原因被排除在分析之外。收集了249例患者（100例NAC受试者和149例对照受试者）的使用数据，以确定急性护理率（急诊科就诊和住院）。从干预前一年到干预的最后一年，NAC组和对照组的急性护理率都有所下降，NAC组和对照组之间没有显著差异。参与NAC规划影响急性护理结果; NAC低参与组和对照组没有差异，但NAC高参与组与合并对照组和NAC低参与组在急性护理率降低方面存在显着差异。与NAC工作人员的接触和参加教育活动都与哮喘可以管理的更强烈观点的变化相关（分别为偏相关= 0.27和偏相关= 0.24）。结构方程模型表明，参与NAC与哮喘态度指数量表的积极变化和较低的急性护理率相关。社会隔离与更多的参与该计划，从而降低护理率。NAC达到了它的目标受众，包括那些在社会上孤立的人，带来了管理实践的变化，并与积极参与该计划的人中急性护理率的下降有关。
Background. Low-income African Americans exhibit disproportionate prevalences, morbidity rates, and mortality rates for asthma.Objective. To determine whether a community-based intervention, the Neighborhood Asthma Coalition (NAC), conducted through a well-established neighborhood organization in St. Louis could improve awareness of asthma, change attitudes about its care, improve asthma management practices, and reduce the need for acute care for asthma.Methods. The NAC included educational programs for parents and children, promotional activities, and individualized support provided by trained neighborhood residents. African American children, 5 to 14 years of age, with at least 1 incident of acute care ( emergency department visit or hospitalization) within the previous year were enrolled from 8 zip code areas with low-income residents and high proportions of Medicaid-eligible children, ie, 4 NAC neighborhoods and 4 comparable control neighborhoods. Evaluations included quarterly telephone interviews to assess asthma attitudes and management and sites of care. Audits of acute care sites covered 12 months before initiation of the NAC through 3 years of the program.Results. A total of 371 patients were contacted and determined to be eligible for the study, and 345 agreed to participate, representing a recruitment rate of 93%. Of those, 15 withdrew and 24 were lost to follow-up monitoring after the initial contact. In addition, 57 were excluded from analysis because of relocation or for other reasons. Utilization data to determine rates of acute care ( emergency department visits and hospitalizations) were collected for 249 patients ( 100 NAC subjects and 149 control subjects). Acute care rates decreased for both the NAC and control groups from the year before intervention to the last year of intervention, with no significant differences between the NAC and control groups. Participation in NAC programming affected the acute care outcome; the NAC-low participation and control groups did not differ but the NAC-high participation group differed significantly from the pooled control and NAC-low participation groups in reductions in acute care rates. Both contacts with NAC staff members and attendance at educational events were associated with changes toward stronger views that asthma can be managed ( partial correlation = .27 and partial correlation = .24, respectively). Structural equation modeling demonstrated that participation in the NAC was associated with positive changes on the Index of Asthma Attitudes scale and lower rates of acute care. Social isolation was associated with greater participation in the program and thus reduced care rates.Conclusions. The NAC reached its intended audience, including those who were socially isolated, brought about changes in management practices, and was associated with promising reductions in acute care rates among active participants in the program.