NATIONAL COOPERATIVE INNER-CITY ASTHMA STUDY

描述(改编自申请者摘要)：哮喘最常见 儿童时期的慢性病，这一负担由 市中心的非裔美国儿童。可能减少哮喘的因素 发病率是高质量的综合医疗护理，对文化敏感 外展，强调自我管理技能、环境和 行为矫正，以及更协调的护理提供方法。 申请者提出一项前瞻性随机对照试验，以 评估对文化敏感、协调一致的方法的有效性 对患有中度或重度哮喘的市中心儿童进行哮喘护理。 儿童将被随机分成三组：(1)加强日常护理 (1)协调护理(第1组)；(2)协调护理(第2组)；(3)协调护理加 环境改良(III组)，每组24个月。 所有群体的提供者将接受国家心肺和血液方面的培训 协会(NHLBI)哮喘管理指南，并将有几个 教育和管理方面的改进。第II组每两个月领取一次 非专业哮喘患者的家访 外展工作人员和学校护士每周的评估。这个 照顾这些儿童的儿科医生将在 预定的诊所就诊，其中将包括哮喘教育课程。 第三组将接受协调护理干预加上特定的 旨在最大限度地减少儿童接触尘螨的干预措施 环境烟草烟雾(ETS)。 将评估第二组和第三组干预措施的影响 根据以下四个领域：(1)生理指标 (乙酰甲胆碱挑战，一秒用力呼气量(FEV-1)， 最大呼气流速；(2)保健使用(哮喘住院和 急诊室)；及(3)环境措施 (家用粉尘浓度、二氧化氮(N02)和细颗粒物 颗粒物浓度、尿可替宁水平和家庭 湿)；和(4)功能状态测量(用药、质量 生活和家庭功能)。

DESCRIPTION (adapted from applicant's Abstract): Asthma is the most common chronic illness of childhood, a burden disproportionately shared by inner-city, African-American children. Factors that may decrease asthma morbidity are high-quality comprehensive medical care, culturally-sensitive outreach which emphasizes self-management skills, environmental and behavioral modification, and a more coordinated approach to care delivery. The applicants propose a prospective, randomized controlled trial to evaluate the effectiveness of a culturally-sensitive, coordinated approach to asthma care in inner-city children with moderate or severe asthma. Children will be randomized into three groups: (1) augmented usual care (Group I); (2) coordinated care (Group II); and (3) coordinated care plus environmental modification (Group III), each of 24-months duration. Providers for all groups will be trained in National Heart Lung and Blood Institute (NHLBI) asthma management guidelines and will have several educational and management enhancements. Group II will receive bi-monthly home visits by a lay asthma outreach worker and weekly assessments by the school nurse. The pediatricians caring for these children will use this information during scheduled clinic visits, which will include an asthma education curriculum. Group III will receive the coordinated care intervention plus specific interventions designed to minimize the child's exposure to dust mites and environmental tobacco smoke (ETS). The impact of the interventions in Groups II and III will be assessed according to the following four domains: (1) physiologic measures (methacholine challenge, forced expiratory volume in one second (FEV-1), peak expiratory flow rate; (2) health care use (asthma hospitalizations and acute visits to clinics and emergency rooms); and (3) environmental measures (household dust mite concentrations, nitrogen dioxide (N02) and fine particulate matter concentrations, urinary cotinine levels, and household dampness); and (4) functional status measures (medication use, quality of life, and family function).