The Cost Effectiveness of School-Based Supervised Asthma Therapy

学校监督哮喘治疗的成本效益

• 批准号: 8716806
• 负责人: Lynn B Gerald
• 金额: $ 127.21万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-10 至 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8716806
• 关键词: Academy; Adherence; Adopted; Adoption; Adrenal Cortex Hormones; African American; American; American Lung Association; Arizona; Asthma; Breathing; Caring; Centers for Disease Control and Prevention (U.S.); Child; Child health care; Chronic; Clinical Trials; Collaborations; Communities; Cost Effectiveness Analysis; Data; Development; Diagnosis; Directly Observed Therapy; Education; Effectiveness; Ensure; Evaluation; Event; Focus Groups; Gold; Guidelines; Health; Health Resources; Hispanics; Hypersensitivity; Immunology; Intervention; Interview; Juniper; Low income; Measures; Medicine; Modeling; Monitor; Morbidity - disease rate; Parents; Participant; Pharmaceutical Preparations; Policy Maker; Population; Population Heterogeneity; Prevention program; Process; Program Effectiveness; Provider; Public Health; Publishing; Quality of life; Quality-Adjusted Life Years; Questionnaires; Randomized Controlled Trials; Recommendation; Reference Standards; Research; Research Personnel; Schools; Students; Supervision; Symptoms; System; Time; Tuberculosis; base; computerized data processing; cost effective; cost effectiveness; disorder prevention; elementary school; experience; health care service utilization; improved; informant; inner city; medication compliance; programs; public health relevance; school health; screening; secondary outcome; treatment as usual

DESCRIPTION (provided by applicant): Asthma is a common chronic condition among children that is associated with significant morbidity. Because medication non-adherence is an important cause of excess morbidity, the National Asthma Education and Prevention Program guidelines have called for the development of more effective adherence programs. Schools represent a logical setting where adherence programs could reach the inner-city, low-income, and ethnically diverse populations that have the highest morbidity and lowest adherence. A recent clinical trial demonstrated that supervised therapy of daily controller medication at school increased medication adherence and asthma control among primarily African-American students in urban, low-income elementary schools. This study aims to evaluate: (1) the effectiveness of supervised therapy when administered by the community under real world conditions via a randomized controlled trial of 500 children with asthma in a large urban, predominantly Hispanic school system; (2) the cost-effectiveness of supervised therapy from the societal perspective using dollars per quality-adjusted life year (QALY) gained; and 3) the program's implementation fidelity, optimal delivery mechanisms, and construct validity via a comprehensive process evaluation. Supervised therapy is hypothesized to be both an effective and cost-effective mechanism to improve population-level asthma control among students with asthma. This project will provide critical information regarding the program's value, feasibility, and sustainability within communities with large asthma burden. In addition, it will provide important recommendations to accelerate the adoption of guideline-based care for students with asthma in urban, low-income, and ethnically diverse populations. With this information, policy makers can optimize the use of scarce public health resources by adopting programs that efficiently maximize child health.

描述(由申请人提供)：哮喘是儿童中一种常见的慢性疾病，与显著的发病率有关。由于药物不依从性是过度发病率的重要原因，国家哮喘教育和预防计划指南呼吁开发更有效的依从性计划。学校代表着一个合乎逻辑的环境，在这里，遵守计划可以覆盖到发病率最高、遵守程度最低的市中心、低收入和种族多元化人口。最近的一项临床试验表明，学校每日控制性药物的监督治疗 在城市低收入小学主要是非洲裔美国学生中，提高了服药依从性和哮喘控制。这项研究旨在评估：(1)在现实世界条件下，通过在以西班牙裔为主的大型城市学校系统中对500名哮喘儿童进行随机对照试验，由社区实施监督治疗的有效性；(2)从社会角度出发，使用获得的每质量调整生命年(QALY)的美元来评估监督治疗的成本效益；以及(3)该计划的实施保真度、最优交付机制，以及通过综合过程评估构建的有效性。监督治疗被认为既是一种有效的、具有成本效益的机制，也是改善哮喘学生人群水平哮喘控制的一种机制。该项目将提供有关该计划的价值、可行性、 以及哮喘负担大的社区内的可持续性。此外，它还将提供重要建议，以加快在城市、低收入和种族多元化人群中采用以指南为基础的哮喘学生护理。有了这些信息，政策制定者可以通过采取有效地最大化儿童健康的计划来优化稀缺的公共卫生资源的使用。