Translating an Efficacious Illness Management Intervention for African American Youth with Poorly Controlled Asthma to Real World Settings

将针对哮喘控制不佳的非裔美国青年的有效疾病管理干预措施应用到现实世界中

• 批准号: 9380048
• 负责人: DEBORAH A. ELLIS
• 金额: $ 69.74万
• 依托单位: WAYNE STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-20 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9380048
• 关键词: 17 year old; Accident and Emergency department; Adherence; Admission activity; Adolescent; Adoption; Affect; African American; Algorithms; Area; Asthma; Caring; Child; Childhood; Childhood Asthma; Chronic Disease; Cities; Clinical; Clinical Pathways; Clinical Trials; Collaborations; Communities; Community Health Aides; Cost Analysis; Cost Savings; Development; Dose; Education; Effectiveness; Eligibility Determination; Emergency Care; Emergency department visit; Emergency medical service; Evidence based intervention; Evidence based practice; Family; Funding; Future; Guidelines; Health; Health Care Costs; Health Planning; Health Professional; Healthcare; Home environment; Home visitation; Hospitalization; Hospitals; Hybrids; Individual; Intervention; Intervention Studies; Literature; Measures; Medicaid; Mental Health; Methodology; Methods; Michigan; Minority; Morbidity - disease rate; Outcome; Patient Care; Patients; Pediatric Hospitals; Pharmaceutical Preparations; Policies; Procedures; Process Measure; Provider; Psychotherapy; Quality of life; Randomized; Randomized Clinical Trials; Reporting; Respiratory physiology; Risk; Schools; Self Management; Services; Specific qualifier value; Symptoms; System; Testing; Training; Training and Education; Translating; Translational trial; United States Dept. of Health and Human Services; Use Effectiveness; Visit; Vulnerable Populations; Youth; age group; base; cost; design; dissemination research; effectiveness trial; evidence base; experience; family support; follow-up; health care availability; health care service; health disparity; high risk; high-risk adolescents; implementation research; improved; inner city; innovation; minority children; mortality; programs; quality assurance; research data dissemination; screening; skills training; standard care; tool

There is a critical need to develop interventions to reduce barriers to optimal asthma management and reduce the significant risk for asthma-related morbidity experienced by minority children, especially African- American adolescents with poorly controlled asthma. There are few clinical trials focusing on African-American adolescents with poorly controlled asthma, and intervention studies targeting African-American adolescents with asthma in general or African-American children with poorly controlled asthma in particular are characterized by methodological limitations and/or limited effects on objective health outcomes. Multisystemic Therapy-Health Care (MST-HC) is an intensive, multi-component, home-based psychotherapy that targets the multiple causes of poor adolescent asthma management across individual, family and community systems. In a randomized clinical trial, we showed that MST-HC was significantly more effective than home-based family support in improving adherence to controller medications and improving lung functioning among African- American adolescents with moderate to severe, poorly controlled asthma up to six months after the completion of the intervention. In addition, MST-HC reduced asthma-related hospitalizations and associated ED visits. The primary purpose of the proposed study is to adapt MST-HC for use in real world, public healthcare settings and test it in a T3 translational trial. The new intervention, Reach for Control (RFC), will be housed in a pediatric emergency department (ED) at Children's Hospital of Michigan (CHM)and will be adapted for delivery by community health workers (CHWs). The design is an effectiveness-implementation “Hybrid 1” design where the primary aims are to determine the effectiveness of an evidence-based intervention in a real-world setting, and the secondary aims are to gather information about the context for implementation and barriers/ facilitators to implementation. For our effectiveness aim, we will conduct a randomized effectiveness trial with 170 high risk adolescents with poorly controlled asthma seen in the ED for an asthma exacerbation. RFC will be delivered by Wayne Children's Healthcare Access Program, a community agency providing health care services to underserved children in the Detroit area and will be compared to the agency's standard care intervention for youth with poorly controlled asthma. For our implementation aims, we will evaluate the effectiveness of identification, screening and referral to RFC by ED clinical staff via a clinical pathway. We will study barriers and facilitators to the implementation of RFC (both its integration within the ED and delivery by CHWs) using a mixed methods approach. We will also develop and evaluate an efficient and effective method of measuring CHW fidelity to RFC and conduct a cost analysis that will inform decisions such as treatment dose and CHW caseload in future real-world implementations. If successful, the study has the potential to improve quality of life for a vulnerable population while reducing healthcare costs.

迫切需要制定干预措施，以减少实现最佳哮喘管理和治疗的障碍