CHILDHOOD ASTHMA PROGRAM IN NYC HEALTH DEPT CLINICS

我们建议证明纽约市卫生署儿童 健康诊所可以改善黑人和西班牙裔儿童的健康状况 通过为他们提供一个全面的系统， 包括药物治疗、家庭健康教育和 社区外展为了发展这个全面的护理系统，我们会 为卫生部的医生和护士提供最新的培训， 诊断哮喘的方法，以及提供临床护理和健康 对患者和家属进行教育，作为一系列常规20分钟 病人访问。护士和公共卫生助理也将接受培训， 通过教授我们的开放航空公司自我管理计划来补充这一点， 家庭团体。24小时电话咨询服务， 哮喘患者将由训练有素的卫生部医生担任工作人员。 干预将基于社会认知理论，特别是 自我调节在第一阶段，卫生部的医疗和护理部门 工作人员将由哥伦比亚大学教员授课，并由 卫生部医生和护士主管。自律将是 通过使用哮喘访视记录在医生中培养， 使用哮喘日记。将随机分配7对匹配的诊所 来控制或接受干预。我们将测试以下内容 假设：一个全面的护理连续性系统，包括 医疗、家庭健康教育和社区外展将（1） 提高医务人员诊断和治疗儿童哮喘的信心;（2） 吸引和留住有哮喘儿童的家庭， 卫生署诊所的护理关系;及（3）改善 患者的健康状况及其家属的生活质量。 相 第二阶段将测试这一综合系统是否能够自我维持 在卫生部内，有医生和护士监督员， 我参加了第一阶段教计划的工作人员从第二组 匹配的诊所该计划有可能达到5000多少数民族 儿童哮喘如果成功，它可以推广到其他健康领域。 在国内的部门。

We propose to demonstrate that the New York City Department of Health Child Health Clinics can improve the health status of Black and Hispanic children with asthma by providing them with a comprehensive system of continuity of care that includes pharmacologic treatment, family health education and community outreach. To develop this comprehensive care system, we will provide training for Health Department physicians and nurses in up-to-date methods of diagnosing asthma, and providing clinical care and health education to patients and families as part of a series of regular 20 minute patient visits. Nurses and public health assistants will also be trained to supplement this by teaching our Open Airways self-management program to groups of families. A 24-hour telephone advice service for families of asthma patients will be staffed by trained Health Department physicians. The intervention will be based on social cognitive theory, especially self-regulation. In Phase I, the Health Department medical and nursing staff will be taught by Columbia University faculty with reinforcement by Health Department physician and nurse supervisors. Self-regulation will be fostered in physicians by use of an Asthma Visit Record and in families by use of an Asthma Diary. Seven pairs of matched clinics will be randomized to be controls or receive the intervention. We will test the following hypotheses: that a comprehensive system of continuity of care, including medical care, family health education and community outreach will (1) increase staff confidence to diagnose and treat childhood asthma; (2) attract and retain families who have children with asthma in continuing care relationships in the Health Department clinics; and (3) improve the health status of patients and the quality of life of their families. Phase II will test whether this comprehensive system can be made self-sustaining within the Health Department by having physician and nurse super-visors who took part in Phase I teach the program to staff from a second set of matched clinics. This program has the potential to reach > 5000 minority children with asthma. If successful it could be generalized to other health departments in the country.