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

项目总结/摘要 背景和原理：哮喘在少数民族青少年中的患病率和发病率很高。然而， 在青少年中测试的干预措施很少，只有一项是基于网络的。考虑到哮喘的严重影响 对这个群体，以及技术在他们生活中扮演的重要角色，这种疏忽是一个重大的公共健康问题。 关心哮喘干预的成本效益分析和实施研究缺乏 research.本研究旨在解决这些治疗和方法的差距。我们开发并建立了 青少年控制哮喘计划（CAMP空气）的初步影响，一个七个模块 为患有不受控制的哮喘的青少年提供个性化的电子健康干预。目的：我们的目标是：（1） 系统评价CAMP Air对370例未控制哮喘的城市青少年的疗效;（2）评估其 成本效益;（3）确定与成功实施CAMP Air相关的多层次因素 为今后的规模扩大提供信息。假设：相对于对照组，超过1年的CAMP空气参与者将有 哮喘控制显著更好，表现为（a）哮喘控制测试（ACT）得分更高，和（B） 减少哮喘相关的紧急护理访视（主要结局）。CAMP Air的参与者也将有显著的 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）， 和（d）生活质量;以及显著降低的（e）类固醇爆发，（f）症状日，（g）夜间醒来， (h)活动限制;（i）缺课。我们假设与对照组相比，CAMP Air将 具有有利的价值（增量成本效益比<10万美元/质量调整生命年[Qs]）。 方法：我们将招募370名来自纽约市19所高中的9 - 11年级哮喘不受控制的学生。我们 将参与者随机分配到CAMP Air或哮喘教育控制干预，并随访12 治疗后数月。使用决策分析马尔可夫模型，我们将估计CAMP Air的增量成本 从社会和支付者的角度来看，每QALY获得和每症状无天数的成本。为 过程评估，建立在RE-AIM和实施研究的统一框架之上 （CFIR）模型，我们将从学生，护理人员和学校收集定性和定量数据， 管理员。我们将与利益相关者一起制定广泛实施CAMP的战略 空气，了解我们的临床疗效，成本效益和实施结果。意义：研究 具有很高的公共卫生意义，因为它（1）针对受以下因素影响很大的未充分研究的人群 哮喘，（2）在健康状况不同的人群中利用技术促进自我保健，（3）评估CAMP 空气的经济价值，使用QEARS和无广告的日子，（4）弥合研究和 通过确定实施因素，为广泛实施CAMP Air的战略提供信息。

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.