RVA Breathes: A Richmond City Collaboration to Reduce Pediatric Asthma Disparities

项目摘要/摘要。 尽管存在几种以证据为基础的哮喘治疗方法，但对有效的 以社区为基础的干预措施对于高危儿科人群来说，儿童哮喘的差距依然存在。 里士满经常被美国过敏和哮喘基金会誉为美国的“哮喘之都”， 一直被认为是哮喘患者最具挑战性的地方之一。然而，到目前为止，有 对贫困风险最高的儿童没有全面的、社区参与的哮喘护理计划 哮喘结果。为了解决这一紧迫的公共卫生问题，我们的调查小组进行了长达一年的 混合方法社区需求评估(U34HL130759)。出现的关键优先领域包括对等 支持、倡导，将家庭视为一个系统，增加学校护士教育，并与 学校和提供者。我们的社区参与团队将需求评估结果转化为一个项目， RVA呼吸，协调四个部门的哮喘护理：家庭、家庭、社区和医疗 关心。RVA呼吸包括以家庭为基础的哮喘自我管理教育(由社区提供 公共卫生创新研究所的卫生工作者)、家庭环境补救(与 里士满卫生区的健康家庭倡议)和一个学校护士部分(包括小学 里士满公立学校系统中的学校)。这些干预措施充分利用了现有资源。 以及与里士满的利益相关者的关系，每一个都致力于RVA的呼吸。三百元 哮喘儿童和他们的照顾者将参加RVA呼吸的随机临床试验。之后 完成基线评估后，家庭将被随机分为三种情况之一：1)哮喘教育 家庭治疗学校干预，2)哮喘教育家庭治疗和3)对照 条件(增强型护理标准，E-SOC)。家庭将参加为期12个月的计划，并 完成跟踪评估(治疗后以及3个月、6个月和12个月)，以衡量医疗保健的变化 以及该计划对儿童哮喘结局的影响。情况将在以下时间进行比较 医疗保健利用的主要结果，包括哮喘专科急诊室就诊和住院 作为缺课和药物使用；次要结果包括哮喘控制、症状和 生活质量。我们还将在12个月后评估RVA呼吸的可持续性(没有活动 干预)，包括对项目参与者和利益相关者的定性数据进行审查。发现 这项试验将使RVA呼吸作为一项可持续的计划在 里士满地区。 好了！

Project Summary/Abstract. Despite the existence of several evidence-based asthma treatments, and increased understanding of effective community-based interventions for high-risk pediatric populations, childhood asthma disparities persist. Richmond is often cited as the “Asthma Capital” of the U.S. by the Allergy and Asthma Foundation of America, and is consistently identified as one of the most challenging places to live with asthma. To date, however, there is no comprehensive, community-engaged asthma care program for those children at highest risk for poor asthma outcomes. To address this urgent public health concern, our investigative team conducted a year-long, mixed-methods community needs assessment (U34HL130759). Key priority areas that emerged included peer support, advocacy, treating the home as a system, increased school nurse education, and coordination with schools and providers. Our community-engaged team translated the needs assessment findings to a program, RVA Breathes, that coordinates asthma care across four sectors: the family, home, community, and medical care. RVA Breathes includes family-based asthma self-management education (delivered by Community Health Workers [CHWs] with the Institute for Public Health Innovation), home environmental remediation (with Richmond City Health District’s Healthy Homes Initiative), and a school nurse component (with elementary schools in the Richmond City Public School System). These interventions capitalize among existing resources and relationships with stakeholders in Richmond, each of which is committed to RVA Breathes. Three-hundred children with asthma and their caregivers will participate in a randomized clinical trial of RVA Breathes. After completing a baseline assessment, families will be randomized to one of three conditions: 1) asthma education + home remediation + school intervention, 2) asthma education + home remediation and 3) comparator condition (Enhanced Standard of Care, E-SOC). Families will participate in the program for 12 months and complete follow-up assessments (post-treatment and 3-, 6-, and 12-months) to measure changes in healthcare utilization and the impact of the program on child asthma outcomes. Conditions will be compared on the primary outcomes of healthcare utilization, including asthma-specific ED visits and hospital admissions, as well as school absences and medication usage; secondary outcomes include asthma control, symptoms, and quality of life. We will also evaluate the sustainability of RVA Breathes after 12 months (without active intervention), including a review of qualitative data from participants and stakeholders in the program. Findings from this trial will allow for dissemination and implementation of RVA Breathes as a sustainable program in the Richmond area. !