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存在持续差异。哮喘控制不良和反复住院或急诊（艾德）就诊的高风险人群通常集中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采取行动的知识方面存在根本性的差距。就像营销人员和政治活动使用地理数据来定位资源一样，拟议研究的贡献是确定关键的地理因素或地理标记，这可能意味着充分告知护理并改善患者结果。最初的重点将是与地区一级或邻里、贫困、住房质量和卫生服务获得有关的地理标志。中心假设是，这种地理标志物将预测哮喘相关的再入院和艾德再访的风险沿着潜在的可改变的患者特征。其基本原理是，知情的住院哮喘护理计划，旨在减少出院后的发病率，可以个性化的那一刻起，孩子到达的单位。在强有力的初步数据的指导下，该假设将通过三个具体目标进行检验：1）确定地理标志物在多大程度上预测住院哮喘儿童随后的再入院和艾德再访风险; 2）检查地理标志物与相应患者水平风险之间的关联;以及3）通过基于地理标志的识别策略和社区卫生工作者，开发并试点干预患者慢性哮喘护理的可行性。拟议的研究是创新的，因为它将以表征和预测个人风险的方式新颖地利用公共数据，有效地告知在患者遇到早期启动的评估和行动。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，家庭将看到满意度的提高和随后的发病率的降低。摘要：拟议的项目将为住院儿童哮喘护理带来一种基于场所的方法。Beck博士的研究和临床培训，调查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。该奖项将为他提供培训和研究所需的成功，在未来的大规模试验的地理接地干预。此外，这个职业发展奖将促进贝克博士发展成为一个国家认可的独立调查员和领导者，进行研究，通过确定和减轻健康的关键社会和环境决定因素，改善儿童健康的结果。

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.