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

项目概要/摘要。 尽管存在几种基于证据的哮喘治疗方法， 尽管对高危儿科人群采取了基于社区的干预措施，但儿童哮喘的差异仍然存在。 里士满经常被美国过敏和哮喘基金会称为美国的"哮喘之都"， 并且一直被认为是哮喘患者最具挑战性的居住地之一。然而，迄今为止， 没有一个全面的，社区参与的哮喘护理计划，为那些儿童在最高风险的穷人， 哮喘的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调查， 混合方法社区需求评估（U34HL130759）。出现的主要优先领域包括： 支持，宣传，将家庭视为一个系统，增加学校护士教育，并与 学校和供应商。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 在乎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） 卫生工作者[CHW]与公共卫生创新研究所），家庭环境整治（与 里士满市卫生区的健康家园倡议），以及学校护士组成部分（小学 里士满市公立学校系统的学校）。这些干预措施利用现有资源 以及与里士满的利益相关者的关系，每个利益相关者都致力于RVA呼吸。三百 患有哮喘的儿童和他们的照顾者将参加RVA呼吸的随机临床试验。后 完成基线评估后，家庭将被随机分配到三个条件之一：1）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 增强型标准治疗（E-SOC）。家庭将参加该计划12个月， 完成随访评估（治疗后和3、6和12个月），以测量医疗保健的变化 利用率和该计划对儿童哮喘结果的影响。条件将在 医疗保健利用的主要结局，包括哮喘特异性艾德访视和住院，以及 作为学校缺席和药物使用;次要结果包括哮喘控制，症状， 生活质量我们还将在12个月后评估RVA呼吸的可持续性（无活性 干预），包括对参与者和方案利益攸关方的定性数据进行审查。结果 从这个试验将允许传播和实施RVA呼吸作为一个可持续的计划， 里士满地区。 !

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. !