Asthma Management Support Training in Pediatrics

描述（由申请人提供）：儿童自我管理支持干预措施落后于成人。协作管理要求提供者认识到行为改变的挑战，并承认患者愿意改变，同时提高自我效能。本探索性/发展性R21的目的是(1)评估干预措施的可行性和可接受性，以加强儿科住院医师和哮喘儿童家庭的协作管理，(2)估计住院医师技能和以患者为中心的结果的效应大小，(3)评估用于评估住院医师技能的客观标准化临床检查（oses）的可靠性。我们将开展儿科协作管理（CMP）的试点随机对照试验，这是一个培训住院医生行为改变技术的课程，用于哮喘儿童及其家庭的协作管理。CMP是基于Kaiser Permanente开发的动机性访谈的简短谈判方法的儿科改编。我们将同意，招募并随机抽取20名第一年儿科住院医师。干预住院医师将接受CMP培训（两次3小时的培训），对照组住院医师将学习传统的哮喘患者教育。标准化患者的osce将在培训前后和6个月后评估住院医师的技能。我们将从每个住院医师的门诊小组中招募5-10名2-12岁的患有持续性哮喘的儿童。在知情同意和筛查后，将通过电话调查获得过程和结果措施（如症状天数、控制者依从性、使用书面护理计划、避免吸烟、其他自我保健行为和满意度）的家长报告。调查将在6周和3小时重复进行。将对基线和3米头发样本进行尼古丁检测，以确定烟草烟雾暴露程度。干预居民的患者将安排一次计划哮喘护理访问，重点关注健康行为，并在一周后打电话跟进行为改变目标。对照组居民的患者将安排一次哮喘教育访问。拟议的活动将产生数据，为设计和实施全面有效性随机对照试验提供信息。我们假设CMP将是可行的，可接受的，并导致住院医师咨询技能和以患者为中心的结果的临床显着改善。此外，这个新颖的项目将通过提供培训儿科医生协作管理的工具来推进该领域。

DESCRIPTION (provided by applicant): Pediatric self-management support interventions have lagged behind those for adults. Collaborative management requires that providers appreciate the challenges of behavior change and acknowledge patients' readiness to change, while enhancing self-efficacy. The aims of this Exploratory/Developmental R21 are (1) to evaluate the feasibility and acceptability of an intervention to enhance collaborative management by pediatrics residents and families of children with asthma, (2) to estimate the effect size on resident skill and patient-centered outcomes, and (3) to evaluate reliability of the objective standardized clinical examinations (OSCEs) used to assess resident skill. We will conduct a pilot RCT of the Collaborative Management in Pediatrics (CMP), a curriculum for training residents in behavior change techniques for collaborative management of children with asthma and their families. CMP is a pediatric adaptation of Brief Negotiation, an approach based on Motivational Interviewing developed by Kaiser Permanente. We will consent, recruit and randomize 20 first year pediatrics residents. Intervention residents will receive CMP training (two 3-hr sessions) and control residents will learn traditional asthma patient education. OSCEs with standardized patients will evaluate resident skill before and after training, and 6 months later. We will recruit 5-10 children aged 2-12 y with persistent asthma from the clinic panels of each resident. After informed consent and screening, parent report of process and outcome measures (e.g. symptom days, controller adherence, use of written care plan, tobacco avoidance, other self-care behaviors and satisfaction) will be obtained by phone survey. The survey will be repeated at 6 wks and 3 m. Baseline and 3 m hair samples will be assayed for nicotine to determine tobacco smoke exposure. Patients of intervention residents will be scheduled for a planned asthma care visit to focus on health behaviors, and a phone call one week later to follow-up on behavior change goals. Patients of control residents will be scheduled for an asthma education visit. The proposed activities will yield data to inform design and implementation of a full-scale effectiveness RCT. We hypothesize that CMP will be feasible, acceptable and lead to clinically significant improvements in resident counseling skills and patient-centered outcomes. In addition, this novel project will advance the field by providing tools for training pediatricians in collaborative management.