A community toolkit to improve asthma care for rural children

改善农村儿童哮喘护理的社区工具包

• 批准号: 9020657
• 负责人: Bruce George Bender
• 金额: $ 38.1万
• 依托单位: NATIONAL JEWISH HEALTH
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-09 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9020657
• 关键词: Address; Adherence; Agriculture; Air; Air Pollution; Allergens; Ambulatory Care; Arizona; Asthma; Biomass; Caring; Child; Childhood Asthma; Chronic Disease; Clinical; Cluster randomized trial; Coal; Collaborations; Colorado; Communication; Communities; Community Health Education; Community Outreach; Diagnosis; Disease; Education; Effectiveness; Environmental Risk Factor; Environmental Wind; Epidemiologic Studies; Evaluation; Exposure to; Family; Family Physicians; Guidelines; Health; Health Personnel; Heating; Home environment; Hospital Administrators; Hospitals; House Dust; Housing; Incidence; Indian reservation; Indoor Air Pollution; Intervention; Life; Link; Measures; Medical; Methods; Modeling; Monitor; National Heart, Lung, and Blood Institute; Native Americans; Navajo; Needs Assessment; Outcome; Outcome Measure; Parents; Particulate; Patients; Perception; Pharmaceutical Preparations; Phase; Pollen; Population; Poverty; Power Plants; Primary Health Care; Process; Provider; Quality of life; Randomized; Research Personnel; Reservations; Resources; Risk; Rural; Rural Community; Sampling Biases; Schools; Specialist; Spirometry; Surveys; Target Populations; Testing; Training; Transportation; Travel; United States; Universities; Urban Population; abstracting; animal dander; base; biomass smoke; care systems; cost; cost effectiveness; critical access hospital; disorder control; effective therapy; evidence base; evidence based guidelines; follower of religion Jewish; health care delivery; health care service utilization; health disparity; improved; medical specialties; meetings; patient home care; pediatrician; pragmatic trial; prevent; primary care setting; programs; public health relevance; randomized trial; rural area; satisfaction; treatment adherence; trial design; urban area

 DESCRIPTION (Provided By Applicant): Abstract More than four million people with asthma live outside of urban areas. Most of these patients are seen in primary care settings where their asthma is often inadequately managed, representing a significant gap in care. Health disparities for rural children with asthma include poverty, limited access to specialty care, and environmental challenges including high levels of outdoor and indoor air pollution exposure. We propose to develop a comprehensive Asthma Care Implementation Program (ACIP) to improve care for rural children with asthma. This project will bring together investigators from the University of Arizona and National Jewish Health to 1) engage four communities in rural southwestern Colorado and northern Arizona to build a successful collaboration; and 2) conduct a randomized pragmatic trial of a community rural pediatric asthma program. In the first (U34) phase, we will build on initial community outreach efforts conducted in 2014 with over 50 healthcare providers and critical access hospitals in the 25,000 mile Four Corners region (including the Southern Ute, Ute Mountain Ute, and Navajo Nation Reservations). During the initial engagement phase, we will solidify relationships and assess community needs with stakeholders including parents, community leaders, hospital administrators, schools, and providers. In the second (U01) phase, we will employ a stepped wedge, randomized trial design to test the capacity of the ACIP to improve asthma care and outcomes with four integrated interventions: 1) the medical care component will include comprehensive training of PCPs and hospital staff in evidence-based pediatric asthma management; 2) the home component will address community concerns about air quality and determine potential methods to measure and reduce environmental risks to children with asthma; 3) the community component will include a school-based program to identify undiagnosed asthma, provide education, and facilitate communication between school, family, and provider; and 4) the family component will connect families with all of the above including care coordination, education, and other forms of assistance such as transportation or low-cost medication. The final trial will be modified in accord with stakeholder input during the engagement phase and evaluated within the RE-AIM framework. We believe that the intervention could serve as a model for implementation of strategies to improve asthma care among children in rural settings, including those living on Native American reservations. (End of Abstract)

 描述（申请人提供）：摘要超过400万哮喘患者生活在城市地区以外。这些患者中的大多数是在初级保健机构中看到的，他们的哮喘往往得不到充分的管理，这代表了护理方面的重大差距。农村哮喘儿童的健康差距包括贫困，获得专业护理的机会有限，以及环境挑战，包括高水平的室外和室内空气污染暴露。我们建议制定一项全面的哮喘护理实施计划（ACIP），以改善农村哮喘儿童的护理。该项目将汇集来自亚利桑那大学和国家犹太健康的调查人员，以1）参与科罗拉多西南部和北方亚利桑那州农村的四个社区，以建立成功的合作; 2）对社区农村儿童哮喘项目进行随机实用试验。在第一阶段（U34），我们将在2014年进行的初步社区外展工作的基础上，在25，000英里的四角地区（包括南乌特，乌特山乌特和纳瓦霍民族保留地）与50多家医疗保健提供者和关键接入医院建立联系。在最初的参与阶段，我们将巩固关系，并评估与利益相关者，包括家长，社区领袖，医院管理人员，学校和供应商的社区需求。在第二阶段（U 01），我们将采用阶梯楔形随机试验设计，通过四项综合干预措施来测试ACIP改善哮喘护理和结局的能力：1）医疗护理部分将包括对PCP和医院工作人员进行循证儿科哮喘管理的全面培训; 2）家庭部分将解决社区对空气质量的关注，并确定衡量和减少哮喘儿童环境风险的潜在方法; 3）社区部分将包括一个以学校为基础的计划，以识别未确诊的哮喘，提供教育，并促进学校，家庭和提供者之间的沟通;家庭部分将把家庭与上述所有方面联系起来，包括护理协调，教育，以及其他形式的援助，如交通或廉价药物。最终试验将在参与阶段根据利益相关者的意见进行雅阁，并在RE-AIM框架内进行评价。我们认为，干预措施可以作为一种模式，实施战略，以改善儿童哮喘护理在农村环境中，包括那些生活在美洲原住民保留。(End摘要）