Translating an Evidence-based Urban Asthma Program for Rural Adolescents: Testing Effectiveness & Cost-effectiveness and Understanding Factors Associated with Implementation

将循证城市哮喘方案转化为农村青少年：测试有效性

• 批准号: 9521522
• 负责人: Jean-Marie Bruzzese
• 金额: $ 72.72万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-05 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9521522
• 关键词: Accident and Emergency department; Address; Administrator; Adolescent; Adoption; African American; African American student; Aftercare; Asthma; Caregivers; Caring; Childhood; Chronic Disease; Clinic; Clinical; Clinical effectiveness; Communities; Community Health Aides; Cost Analysis; Cost Effectiveness Analysis; Costs and Benefits; Coupled; Data; Detection; Dimensions; Education; Effectiveness; Elements; Emergency department visit; Enrollment; Ensure; Ethics; Evaluation; Future; Geography; Health Status; Healthcare; High Prevalence; High School Student; Hispanic Americans; Home environment; Hospitalization; Human Resources; Hybrids; Intention; Intervention; Intervention Studies; Interview; Latino; Maintenance; Measures; Medical; Methodology; Methods; Modeling; Morbidity - disease rate; Outcome; Participant; Penetration; Pharmaceutical Preparations; Population; Process; Provider; Public Health; Quality Control; Quality of life; Quality-Adjusted Life Years; Randomized; Randomized Controlled Trials; Reporting; Research; Research Design; Resources; Risk; Rural; Rural Community; Rural Population; Schools; Self Management; South Carolina; Speed; Steroids; Students; Surveys; Symptoms; Testing; Time; Translating; Translational Research; Urban Population; Use Effectiveness; Vulnerable Populations; Wheezing; Youth; attentional control; base; clinical implementation; cost; cost effective; cost effectiveness; design; eleventh grade; ethnic diversity; evidence base; experience; follow-up; health care service utilization; high school; implementation research; improved; intervention cost; intervention effect; markov model; mathematical model; mortality; post intervention; pragmatic trial; primary outcome; programs; public health relevance; randomized trial; research to practice; rural setting; secondary outcome; skills; success; theories

PROJECT SUMMARY / ABSTRACT Background and Rationale: Asthma, the most common pediatric chronic illness, has high prevalence and morbidity among adolescents. Few interventions are tested in high schools; none when delivered by Community Health Workers (CHWs), despite this model's success in clinic- and home-based interventions. Further, rural adolescents, who represent a very large population, are overlooked in asthma intervention research. Given the high prevalence of asthma in this group, this oversight is a significant public health concern. Cost effectiveness analyses and implementation research are also lacking in asthma intervention research. This study addresses these treatment and methodological gaps. We developed and established the efficacy of Asthma Self-Management for Adolescents (ASMA), an 8-week, high school-based intervention, in urban Hispanic and African American adolescents. Objective: Using an effectiveness-implementation hybrid design, we: (1) evaluate systematically the effectiveness of ASMA when delivered under real world conditions by CHWs to rural adolescents with uncontrolled asthma; (2) assess the cost-effectiveness of ASMA; and (3) conduct a theory-based, mixed-methods, multi-stakeholder process evaluation of the barriers and facilitators of ASMA's widespread implementation. Hypotheses: Over 1 year, relative to controls, ASMA students will have significantly fewer (1) night awakenings due to asthma symptoms, and (2) days with asthma-related activity limitations (primary outcomes). Secondary outcomes include other measures of morbidity (e.g., ED visits, hospitalizations, quality of life) and care-process outcomes. We also hypothesize that ASMA will have favorable value (ICER < 100,000/QALY) compared to alternative uses of health care resources over 1 and 5 years. Methods: We will enroll over 3 years, 400 9th through 11th grade students with uncontrolled asthma from 9 high schools in rural communities in South Carolina; we will randomize students within a school to ASMA and to an attention control condition. CHWs will deliver both interventions. Students and caregivers will be followed for 12-months post-treatment. The intention-to-treat (ITT) principle will be applied using linear and general linear mixed effects models. The cost-effective analysis will rely on a decision-analytic Markov model. The process evaluation is built on the RE-AIM model; we collect qualitative and quantitative data from students, caregivers, CHWs and school administrators. Together with key stakeholders from a variety of settings, we will develop models to widely disseminate and implement ASMA. Significance: The study has high public health significance because (1) it targets an understudied population, (2) it relies on existing community resources for intervention implementation, (3) it assesses ASMA's value through cost-effectiveness analyses, and (4) it bridges the gap between research and practice by identifying factors associated with implementation.

项目摘要 /摘要 背景和理由：哮喘是最常见的儿科慢性病，患病率很高， 青少年的发病率。高中很少有干预措施。没有交付时没有 尽管该模型在诊所和家庭干预措施中取得了成功，但社区卫生工作者（CHW）。 此外，代表大量人口的农村青少年在哮喘干预中被忽视 研究。鉴于该小组中哮喘的患病率很高，这是一个重要的公共卫生 忧虑。成本效益分析和实施研究也缺乏哮喘干预 研究。这项研究解决了这些治疗方法和方法论差距。我们开发并建立了 哮喘自我管理对青少年的疗效（ASMA）是一项为期8周的高中干预措施， 城市西班牙裔和非裔美国青少年。目的：使用有效性实施混合动力 设计，我们：（1）在现实世界条件下交付时，系统地评估ASMA的有效性 通过CHW向农村青少年进行了不受控制的哮喘； （2）评估ASMA的成本效益； （3） 进行基于理论的混合方法，多方利益相关者的过程评估 Asma的广泛实现。假设：相对于对照组，超过1年，ASMA学生将拥有 由于哮喘症状而导致的（1）夜间觉醒，并且（2）与哮喘相关活动 局限性（主要结果）。次要结果包括其他发病率的措施（例如，ED访问， 住院，生活质量）和护理过程。我们还假设Asma将拥有 与1和5的医疗保健资源的替代用途相比，有利的价值（ICER <100,000/QALY） 年。方法：我们将注册3年，400年9至11年级的学生，哮喘不受控制 南卡罗来纳州农村社区的9所高中；我们将在学校内的学生随机到Asma和 注意力控制条件。 CHW将提供两种干预措施。将遵循学生和照顾者 治疗后12个月。意向性治疗（ITT）原理将使用线性和一般性应用 线性混合效应模型。具有成本效益的分析将依赖于决策分析的马尔可夫模型。这 流程评估是基于Re-AIM模型的；我们从学生那里收集定性和定量数据， 护理人员，CHW和学校管理员。与来自各种环境的主要利益相关者一起，我们将 开发模型以广泛传播和实施ASMA。意义：该研究具有很高的公共卫生 意义是因为（1）它针对研究的人口，（2）它依靠现有的社区资源来实现 干预实施，（3）它通过成本效益分析评估ASMA的价值，（4） 通过确定与实施相关的因素来弥合研究和实践之间的差距。