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的差异。哮喘控制不佳、反复住院或急诊（ED）的高危人群往往集中在受哮喘相关社会和环境风险不成比例影响的地区。然而，在如何识别这些风险并在住院儿童哮喘护理期间采取行动的知识方面存在根本差距。就像市场营销人员和政治竞选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，或地理标志，这可能有意义-充分告知护理和改善患者的结果。最初的重点将放在与区域或社区、贫困、住房质量和卫生服务获取相关的地理标志上。中心假设是这样的地理标记将预测与哮喘相关的再入院风险和ED复诊以及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，从孩子到达的那一刻起。在强有力的初步数据的指导下，这一假设将有三个具体目标进行检验：1)确定地理标记物在多大程度上预测住院哮喘患儿的再入院和ED重访风险；2)检验地理标志与相应患者层面风险之间的关系；3)通过基于地理标记的识别策略和社区卫生工作者，开发和试点一种干预措施的可行性，以个性化患者的慢性哮喘护理。这项拟议中的研究具有创新性，因为它将以新颖的方式利用公共数据来描述和预测个人的风险，有效地为早期患者接触的评估和行动提供信息。这将是重要的，因为如果住院病人的临床护理更有效，更有针对性，家庭将看到满意度的提高，并减少随后的发病率。摘要：拟议的项目将为住院儿童哮喘护理带来一种基于地点的方法。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方面的研究。该奖项将为他提供所需的培训和研究，使他在未来的大规模地理干预试验中取得成功。此外，这一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研究者和领导者，通过确定和减轻健康的关键社会和环境决定因素来进行研究，改善儿童健康结果。

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.