Rhode Island Asthma Integrated Response Program (RI-AIR)

项目概要/摘要： 大普罗维登斯，罗得岛是由几个城市的“核心”城市的高度贫困和重要的 小儿哮喘差异。RI哮喘综合反应（RI-AIR）哮喘护理实施 ACIP计划是一个全面的儿童疾病识别、筛查和干预系统， 哮喘核心组成部分包括：1）先进的技术平台（RI-AIR信息数据 系统，或RI-AIR IDS），以整合来自LifeChart（EHR）、REDCap（研究数据系统）和KIDSNet的数据 （基于状态的儿童健康信息数据库），2）哮喘管理分层算法 基于哮喘控制/风险水平的服务，3）多层次校本教育（CASE）， 针对哮喘控制不佳的儿童的家庭/儿童/学校系统，4）强化家庭基础 对控制不佳的哮喘儿童进行干预（HARP），以及5）加强 护理人员、学校护士和保健提供者，以促进各护理部门的融合。第一个目标 建议的工作是使用随机的，步进的， 楔形设计在第2-4年期间，我们将依次向16个高风险社区提供干预措施 涉及约1500名城市、不同种族的哮喘儿童（2-12岁）及其家庭。我们 将评估个体水平（例如，哮喘控制）和社区特异性结果（即，艾德率 多层次的过程 RI-AIR ACIP实施期间的评估（第2-5年）。我们将评估渗透范围， 社区和学区，并评估接受和完成 干预与不干预的人。我们将在分配中确定RI-AIR IDS技术平台的保真度 根据哮喘控制/风险、治疗保真度和HARP的剂量进行干预， CASE程序。我们将使用焦点小组和提供者调查，以确定促进和障碍， 儿童哮喘的治疗方法本申请的第二个目的涉及进行 有效执行。第三个目标涉及对可持续性进行混合方法评估 RI-AIR ACIP，在第5-6年期间，我们的社区利益相关者持续投入。我们定义 可持续性是指持续的能力、持续的活动和持续的利益。我们预计超过1年， 接受RI-AIR ACIP的参与者将改善哮喘控制，减少无症状天数 相对于基线。我们预计在1年内，相对于基线，护理人员的哮喘将有所改善 知识、自我效能、哮喘QOL和有效疾病管理的指标。预计超过1 每年，接受RI-AIR ACIP的社区将减少艾德就诊和住院， 基准年，相对于尚未收到RI-AIR的目标社区。我们计划展示 RI-AIR ACIP是一种可复制的、以证据为基础的、节省成本的模型， 儿童是最危险的，并可以传播到其他城市社区，以解决哮喘的差距。

Project Summary/Abstract: Greater Providence, Rhode Island is comprised of several urban “core” cities of high poverty and significant pediatric asthma disparity. The RI-Asthma Integrated Response (RI-AIR) Asthma Care Implementation Program (ACIP) is a comprehensive system of identification, screening and intervention for pediatric asthma. Core components include: a 1) state of the art technology platform (the RI-AIR information data system, or RI-AIR IDS) to integrate data from LifeChart (EHR), REDCap (research data system), and KIDSNet (state-based database of child health information), 2) algorithm for stratification of asthma management services based on level of asthma control/risk, 3) multilevel school-based education (CASE) to family/child/school system for children whose asthma is not well-controlled, 4) intensive home-based intervention (HARP) for children with poorly controlled asthma, and 5) enhanced coordination between caregiver, school nurse, and health care provider to promote integration across sectors of care. The first aim of the proposed work is to evaluate the effectiveness of the RI-AIR ACIP using a randomized, stepped wedge design. During Years 2-4, we will provide our intervention sequentially to sixteen high-risk communities involving approximately 1500 urban, ethnically diverse children (aged 2-12) with asthma and their families. We will evaluate both individual-level (e.g., asthma control) and community-specific outcomes (i.e., rates of ED a multi-level process evaluation of the RI-AIR ACIP during implementation (Years 2-5). We will assess penetration within identified communities and school districts, and evaluate characteristics of families that accept and complete the intervention vs. those who do not. We will determine fidelity of the RI-AIR IDS technology platform in assigning interventions according to asthma control/risk, and treatment fidelity and dose delivered of the HARP and CASE programs. We will use focus groups and provider surveys to determine facilitators of and barriers to visits) for children with asthma. The second aim of this application involves conducting effective implementation. The third aim involves conducting a mixed-methods evaluation of the sustainability of the RI-AIR ACIP, with ongoing input from our community stakeholders during Years 5-6. We define sustainability as continued capacity, continued activities, and continued benefits. We expect over 1 year, participants receiving the RI-AIR ACIP will have improved asthma control and fewer symptom free days relative to baseline. We expect over 1 year, relative to baseline, caregivers will have improved asthma knowledge, self-efficacy, asthma QOL, and indicators of effective disease management. We expect over 1 year, communities receiving the RI-AIR ACIP will have reduced ED visits and hospitalizations relative to their baseline year, and relative to targeted communities that have not yet received RI-AIR. We plan to demonstrate that RI-AIR ACIP is a replicable, evidence-based and cost-saving model that improves asthma outcomes for children at most risk, and can be disseminated to other urban communities to address asthma disparities.