Medicaid Asthma Home Visit Project- Improving Health and Reducing Costs of Health

医疗补助哮喘家访项目 - 改善健康并降低健康成本

• 批准号: 7928097
• 负责人: JAMES W KRIEGER
• 金额: $ 45万
• 依托单位: SEATTLE-KING COUNTY PUBLIC HEALTH DEPT
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2012-08-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7928097
• 关键词: Medicaid; Asthma; Home; Visit; Project

DESCRIPTION (provided by applicant): Seattle-King County Healthy Homes is an evidence-based approach for controlling asthma among low-income children. The first aim of our proposal is to translate the research-based model into practice, assess the impact of translation on the asthma-related outcomes included in evaluation of the original model, and describe the translation process. Our second aim is to assess the cost-effectiveness and return on investment (ROI) of the translated model. We hope to demonstrate that Healthy Homes is a replicable and cost-effective model that can be provided to all children with uncontrolled asthma insured by Medicaid. Background: Asthma remains the most common chronic condition of childhood, affecting 9.1% of all American children. The rate of asthma has doubled since 1980 and remains at historically high levels. Asthma education is effective in reducing asthma morbidity and urgent health services utilization. The National Institutes of Health has identified it as a core asthma control strategy. However, many children with asthma and their caretakers do not participate in asthma education because of access barriers. Offering education in the home may increase participation. Recent research shows that providing asthma education through home visits results in reductions in asthma symptoms and urgent health care utilization. The CDC Guide to Community Preventive Services recently recommended home visits as an effective intervention. A major barrier to wider implementation of the home visit approach is lack of reimbursement for this service by health care payers, who need evidence of the ROI of this intervention. Intervention: A community health workers (CHW) will visit 200 Medicaid-insured children with uncontrolled asthma in their homes over a year. A CHW is a peer educator who provides tailored, culturally-appropriate asthma education. She will assess current asthma control status, self-management practices and the presence of asthma triggers in the home and help children and their caretakers use medications more effectively, prevent and manage exacerbations, facilitate access health services and communication with providers, and reduce exposure to asthma triggers. They will provide participants with tools to reduce exposure to triggers (e.g. a vacuum). Another important role will be provision of instrumental, informational and emotional support. Evaluation: We will use the RE-AIM framework and community-based participatory research methods to assess the translation process. We will complete a quasi-experimental study to assess the cost-effectiveness and ROI of the intervention using administrative claims and self-reported asthma control data. PUBLIC HEALTH RELEVANCE: Information on the cost-effectiveness of CHW home visits for asthma will enable policy makers to assess the health and economic benefits of providing this service to all children with uncontrolled asthma who are insured by Medicaid. Home visits have the potential not only to improve children's health but also to reduce Medicaid expenditures.

描述（由申请人提供）：西雅图国王县健康之家是一种以证据为基础的方法，用于控制低收入儿童的哮喘。我们建议的第一个目的是将基于研究的模型转化为实践，评估翻译对原始模型评估中包含的哮喘相关结果的影响，并描述翻译过程。我们的第二个目标是评估翻译模型的成本效益和投资回报率（ROI）。我们希望证明，健康之家是一个可复制的和具有成本效益的模式，可以提供给所有儿童与不受控制的哮喘保险的医疗补助。背景：哮喘仍然是儿童最常见的慢性病，影响着9.1%的美国儿童。自1980年以来，哮喘发病率翻了一番，并保持在历史最高水平。哮喘教育可有效降低哮喘发病率和紧急卫生服务利用率。美国国立卫生研究院已将其确定为哮喘控制的核心策略。然而，许多哮喘儿童和他们的照顾者不参加哮喘教育，因为访问障碍。在家中提供教育可以增加参与。最近的研究表明，通过家访提供哮喘教育可以减少哮喘症状和紧急医疗服务的利用。CDC的社区预防服务指南最近建议家访作为一种有效的干预措施。更广泛地实施家访方法的一个主要障碍是卫生保健支付者对这项服务的报销不足，他们需要这项干预措施的投资回报率的证据。干预：社区卫生工作者（CHW）将在一年内访问200名患有不受控制的哮喘的医疗保险儿童。CHW是一名同伴教育者，提供量身定制的、符合文化的哮喘教育。她将评估目前的哮喘控制状况，自我管理实践和家中哮喘触发因素的存在，并帮助儿童及其护理人员更有效地使用药物，预防和管理病情加重，促进获得卫生服务和与提供者的沟通，并减少暴露于哮喘触发因素。它们将为参与者提供减少接触触发物的工具（例如真空）。另一个重要作用是提供工具、信息和情感支持。评估：我们将使用RE-AIM框架和基于社区的参与式研究方法来评估翻译过程。我们将完成一项准实验性研究，使用行政索赔和自我报告的哮喘控制数据评估干预措施的成本效益和投资回报率。 公共卫生相关性：关于CHW哮喘家访的成本效益信息将使政策制定者能够评估向所有接受医疗补助保险的哮喘不受控制的儿童提供这项服务的健康和经济效益。家访不仅有可能改善儿童的健康，而且还可以减少医疗补助支出。