A School-based Approach to Helping Urban H.S. Students with Undiagnosed Asthma

以学校为基础的方法来帮助城市 H.S.

基本信息

批准号：
8065548
负责人：
Jean-Marie Bruzzese
金额：
$ 77.86万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-08-01 至 2013-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8065548
关键词：
18 year old Abbreviations Academic Detailing Accounting Address Adolescent Asthma Breathing Caregivers Caring Child Chronic Disease Clinical Treatment Control Groups Detection Diagnosis Education Educational Intervention Enrollment Evaluation Family Goals Health Personnel Healthcare Individual Intervention Knowledge Logistic Regressions Low income Mails Measures Medical Medical Students Methods Modeling Morbidity - disease rate Outcome Pamphlets Participant Pharmaceutical Preparations Policy Maker Prevalence Prevalence Study Provider Public Health Quality of life Randomized Relative (related person)Reporting Research Research Personnel Schools Self Management Severities Stress Students Symptoms Teenagers Telephone Testing Universities Vulnerable Populations Writing Youth age group base control trial design efficacy testing ethnic minority population experience follow-up group intervention health care service utilization high school improved inner city medical schools meetings post intervention programs public health relevance research clinical testing respiratory

项目摘要

DESCRIPTION (provided by applicant): Rationale: Recent studies consistently report substantial rates of youth with asthma-like symptoms that are undiagnosed. Undiagnosed symptomatic youth have appreciable morbidity and activity limitations. Despite successful school-based interventions for diagnosed youth, few programs have been implemented solely with undiagnosed adolescents. Asthma Self-Management for Adolescents with Undiagnosed Asthma (ASMA- Undx), an 8-week intensive school-based intervention that expands the caseworker model and has three complementary components designed to help families of adolescents with asthma-like symptoms obtain a clinical evaluation, obtain a diagnosis and manage their asthma-like symptoms: (1) student sessions group sessions, individual coaching sessions and referral to medical providers; (2) caregiver sessions referral to a medical provider, education via mailed booklets, telephone contacts, and a group session; and (3) academic detailing for students' medical providers. Specific Study Aim: This 5-year study addresses the unmet needs of adolescents who meet criteria for persistent asthma but who have yet to be diagnosed through the testing of ASMA-Undx compared to an information-and-referral control group. Hypotheses: Relative to controls, students in ASMA-Undx will show significant improvement over one year on: (1a) the proportion who see a medical provider for an evaluation, (1b) the proportion whose medical providers diagnose them with asthma, (1c) the proportion whose medical providers prescribe medication, (1d) the proportion who obtain medication if prescribed, (1e) rate of night wakening and (1f) rate of daily activity limitation due to asthma symptoms. They will also show greater improvement on: (2a) rate of day symptoms; (2b) asthma symptom severity; (2c) school absences due to asthma; (2d) asthma knowledge; (2e) asthma self-management; (2f) urgent health care utilization; (2g) quality of life; (2h) the proportion of students whose medical providers provide a written asthma management plan; and (2i) stress related to breathing problems. Methods: We will use a controlled trial with 400 9th through 11th grade undiagnosed students who report persistent asthma-like. Participants are randomly assigned to an intervention group or an information-and-referral control group. Students, who will primarily be from low-income, ethnic minority backgrounds, will be enrolled over four years from 16 NYC public high schools. All students will be followed for 12-months post-intervention. Outcomes will be analyzed according to the intent to treat (ITT) principle using a logistic regression model and a Poisson regression model that take into account the repeated measures post-intervention, covariates identified at baseline and school clustering effects. Significance: This study has high public health significance given: (1) the lack of interventions for undiagnosed youth despite the significant prevalence of undiagnosed asthma and the appreciable asthma morbidity and activity limitation suffered by these youth; (2) that it is delivered in the real-world setting of schools; and (3) that it targets under-served low-income, ethnic minority adolescents. PUBLIC HEALTH RELEVANCE: Targeting underserved inner-city, ethnic minority adolescents who meet criteria for persistent asthma but who have yet to be diagnosed, this study investigates whether a multi-component psycho-educational intervention (student, caregivers and medical providers) is efficacious at helping families obtain a diagnosis and treatment, and reduce asthma-like symptoms. This application has considerable public health relevance because it is delivered in high schools, and therefore will be informative for students with undiagnosed asthma from other age group and other SES backgrounds, and it will serve as a model for interventions in other chronic disease that also have high undiagnosed rates. Results also will be of significant use to health care providers, researchers, and policy makers, and will have significant public health implication for a highly vulnerable population of adolescents

描述（由申请人提供）：基本原理：最近的研究始终报告未诊断的哮喘样症状的年轻人率很高。未诊断的有症状的青年具有明显的发病率和活动限制。尽管成功针对被诊断的青年进行了基于学校的干预措施，但很少有未诊断的青少年实施的计划。 Asthma Self-Management for Adolescents with Undiagnosed Asthma (ASMA- Undx), an 8-week intensive school-based intervention that expands the caseworker model and has three complementary components designed to help families of adolescents with asthma-like symptoms obtain a clinical evaluation, obtain a diagnosis and manage their asthma-like symptoms: (1) student sessions group sessions, individual coaching sessions and referral to medical提供者；（2）护理人员会议转介给医疗提供者，通过邮寄小册子，电话联系人和小组会议的教育；（3）学生医疗提供者的学术细节。具体研究目的：这项为期5年的研究解决了符合持续性哮喘标准但与信息和推荐对照组相比的ASMA-INDX的持续性哮喘标准但尚未诊断出的青少年需求。 Hypotheses: Relative to controls, students in ASMA-Undx will show significant improvement over one year on: (1a) the proportion who see a medical provider for an evaluation, (1b) the proportion whose medical providers diagnose them with asthma, (1c) the proportion whose medical providers prescribe medication, (1d) the proportion who obtain medication if prescribed, (1e) rate of night wakening and (1f) rate of daily activity哮喘症状引起的限制。他们还将显示出更大的改善：（2A）日症状；（2b）哮喘症状严重程度；（2C）由于哮喘而缺席；（2d）哮喘知识；（2E）哮喘自我管理；（2F）紧急医疗保健利用；（2G）生活质量；（2H）医疗提供者提供书面哮喘管理计划的学生比例；（2i）与呼吸问题有关的压力。方法：我们将使用400至11年级的400至11年级学生使用对照试验，他们报告了持久性哮喘。参与者被随机分配到干预组或信息和转诊对照组。主要来自低收入，少数民族背景的学生将在16个纽约市公立高中招收四年来。所有学生都将在干预后12个月进行。将根据逻辑回归模型和Poisson回归模型来分析结果，并考虑到干预后重复测量，在基线和学校聚类效应下确定的协变量。意义：这项研究具有很高的公共卫生意义：（1）尽管未诊断的哮喘和明显的哮喘发病率和这些年轻人遭受的明显哮喘发病率和活动限制，但未诊断未诊断的青年的干预措施缺乏干预措施；（2）它是在学校的现实环境中交付的；（3）它针对服务不足的低收入，少数民族青少年。公共卫生相关性：针对符合持续性哮喘但尚未诊断出的标准但尚未诊断出的标准的城市内城市，少数族裔青少年的目标，这项研究调查了多种组成的心理教育干预（学生，看护者和医疗提供者）是否有效地帮助家庭获得诊断和治疗，并降低了类似的症状。该申请具有相当大的公共卫生相关性，因为它是在高中提供的，因此对于来自其他年龄段和其他SES背景的未诊断哮喘的学生将提供信息，并且它将作为干预其他慢性病的模型，这些慢性疾病也具有很高的识别率。结果对医疗保健提供者，研究人员和政策制定者也有很大的用途，并将对高度脆弱的青少年人口产生重大影响。