PRIMARY INSTEAD OF EMERGENCY CARE FOR CHILDHOOD ASTHMA

此应用程序是以下四个合作研究提案之一 来自哈莱姆医院中心和哥伦比亚长老会的调查人员 医疗中心(CPMC)。在这项建议中，CPMC的三个部门，即， 肺、过敏和普通儿科已经联合起来进行研究 如何最好地改善少数民族儿童的健康状况 经常去急诊科(ED)治疗哮喘。同相 在研究中，我们将对300名儿童进行病例对照研究 患有哮喘的人了解为什么有些家庭经常去教育署寻求帮助 哮喘。我们将比较三次或三次以上急诊室就诊的儿童 每年因其他疾病去急诊室就诊的儿童患哮喘，但 不是用来测试频繁使用急诊服务的假设 哮喘护理与(1)缺乏持续关系有关 初级保健提供者；(2)哮喘的严重程度；(3)缺乏足够的 在家中控制哮喘的药物治疗或使用它的知识 正确；(4)在家中接触过敏原和刺激物；(5)社交 或家庭的人口统计特征；及(6)社会混乱或 孩子的照顾者所经历的压力。在第二阶段，我们将开发一个 通过开展减少少数族裔儿童哮喘发病率的模式 确定最佳招生和留用方法的试点研究 子女经常到急诊室探访继续小学的家庭 由门诊护理网络公司提供的护理关系 (ACNC)，这是CPMC的儿科教职实践。在第三阶段，我们将承诺 一项对150名儿童进行的对照研究，对照组接受 与试验组的常规急诊护理和转诊做法 接受病例经理/健康教育人员的干预以登记和 留住儿童在ACNC的持续初级护理中。我们假设 试验组中的孩子和他们的家人更有可能 而不是控制(1)登记并保持持续护理关系， 和(2)改善了健康状况和生活质量，通过 减少症状和急诊室就诊频率，提高峰值流速， 提高自我管理能力，减少对家庭生活的干扰。

This application is one of four collaborative research proposals by investigators from Harlem Hospital Center and Columbia Presbyterian Medical Center (CPMC). In this proposal, three divisions of CPMC, i.e., Pulmonary, Allergy, and General Pediatrics, have joined together to study how best to improve the health status of minority children who make frequent visits to the emergency department (ED) for asthma care. In Phase 1 of the research we will conduct a case-control study of 300 children with asthma to learn why some families make frequent visits to the ED for asthma. We will compare children who make three or more ED visits for asthma per year with children who made ED visits for other conditions, but not for asthma to test the hypotheses that frequent use of ED services for asthma care is associated with (1) absence of a continuing relationship with a primary care provider; (2) severity of asthma; (3) lack of adequate medical therapy to control asthma at home or the knowledge to use it correctly; (4) exposure to allergens and irritants in the home; (5) social or demographic characteristics of the family; and (6) social disruption or stress experienced by the child's caretaker. In Phase 2 we will develop a model for reducing asthma morbidity in minority children by conducting pilot studies to determine the best method for enrolling and retaining families whose children make frequent ED visits into continuing primary care relationships delivered by the Ambulatory Care Network Corporation (ACNC), a pediatric faculty practice at CPMC. In Phase 3 we will undertake a controlled study of 150 children comparing a control group that receives usual ED care and referral practices with an experimental group that receives an intervention by a case manager/health educator to enroll and retain children in continuing primary care with ACNC. We hypothesize that children and their families in the experimental group will be more likely than controls to (1) enroll and remain in continuing care relationships, and (2) have improved health status and quality of life, as measured by reduced frequency of symptoms and ED visits, improved peak flow rates, improved self-management skill, and reduced disruption of family life.