Inpatient Asthma Care for Children: Adding a Place-Based, Community-Focused Appro

描述(由申请人提供)：儿童哮喘发病率的分布一直存在差异。哮喘控制不佳和反复住院或急诊科就诊的高危人群往往聚集在受哮喘相关社会和环境风险影响不成比例的地区。然而，在住院儿童哮喘护理期间如何识别这些风险并对其采取行动的知识存在根本性的差距。就像营销者和政治竞选活动使用地理数据来瞄准资源一样，拟议的研究的贡献是确定关键的地理因素或地理标志，这可能意味着充分告知护理和改善患者结果。最初的重点将是与地区或社区、贫困、住房质量和医疗服务可获得性相关的地理标志。中心假设是，这些地理标志物将预测哮喘相关的再入院和ED再访风险，以及潜在的可修改的患者特征。其基本原理是，旨在减少出院后发病率的知情住院哮喘护理计划，可以从儿童到达病房的那一刻起就个性化。在强大的初步数据的指导下，这一假设将得到三个具体目标的检验：1)确定地理标记在多大程度上预测哮喘住院儿童随后再次入院和急诊的风险；2)检查地理标记与相应的患者水平风险之间的关联；以及3)开发和试点干预措施的可行性，通过基于地理标记的识别策略和社区卫生工作者对患者的慢性哮喘护理进行个性化设置。这项拟议的研究具有创新性，因为它将以描述和预测个人风险的方式新颖地使用公共数据，有效地为在患者就诊早期启动的评估和行动提供信息。这将是重要的，因为如果住院临床护理更有效和更有针对性，家庭将看到更高的满意度和减少随后的发病率。摘要：拟议的项目将为住院儿童哮喘护理带来一种以地点为基础的方法。贝克博士的研究和临床培训、研究这些方法的试点工作以及经验丰富的指导和咨询团队使他非常适合从事这一领域的研究。这一奖项将为他提供在未来的大规模地理干预试验中取得成功所需的培训和研究。此外，这一职业发展奖将促进贝克博士发展成为全国公认的独立调查员和领导者，进行通过识别和减轻关键的社会和环境健康决定因素来改善儿童健康结果的研究。

DESCRIPTION (provided by applicant): There are persistent disparities in the distribution of pediatric asthma morbidity. Populations at high risk for poor asthma control and repeated hospitalizations or emergency department (ED) visits often cluster within areas disproportionately impacted by asthma-relevant social and environmental risks. There is a fundamental gap, however, in the knowledge of how such risks can be identified and acted upon during inpatient pediatric asthma care. Much as marketers and political campaigns use geographic data to target resources, the contribution of the proposed research is to identify key geographic factors, or geomarkers, that could meaning- fully inform care and improve patient outcomes. The initial focus will be on geomarkers related to area-level, or neighborhood, poverty, housing quality, and health service access. The central hypothesis is that such geo- markers will predict asthma-related risk of readmission and ED revisit along with potentially modifiable patient characteristics. The rationale is that informed inpatient asthma care plans, aimed at reducing post-discharge morbidity, can be personalized from the moment a child arrives on the unit. Guided by strong preliminary data, this hypothesis will be tested with three specific aims: 1) Determine the extent to which geomarkers predict subsequent risk of readmission and ED revisit among hospitalized children with asthma; 2) Examine the association between geomarkers and corresponding patient-level risks; and 3) Develop and pilot the feasibility of an intervention to personalize a patient's chronic asthma care via a geomarker-based identification strategy and a community health worker. The proposed research is innovative because it would make novel use of public data in ways that characterize and predict an individual's risk, efficiently informing assessments and actions to be initiated early in a patient encounter. This will be significant because if inpatient clinical care is more effective and targeted, families will see improved satisfaction and reduced subsequent morbidity. Summary: The proposed project will bring a place-based approach to inpatient pediatric asthma care. Dr. Beck's research and clinical training, pilot work investigating these methods, and experienced mentorship and advisory team make him ideally suited to pursue this line of research. This award will provide him with the training and research needed to be successful in a future, large-scale trial of a geographically-grounded intervention. Furthermore, this career development award will facilitate Dr. Beck's development into a nationally- recognized independent investigator and leader conducting research that improves child health outcomes by identifying and mitigating key social and environmental determinants of health.