Rhode Island Asthma Integrated Response Program (RI-AIR)

项目摘要/摘要： 大普罗维登斯，罗德岛州由几个高度贫困和重要的城市“核心”城市组成 儿童哮喘差异。RI-哮喘综合反应(RI-AIR)哮喘护理实施 计划(ACIP)是一个综合的儿科疾病识别、筛查和干预系统 哮喘。核心组件包括：a)最先进的技术平台(RI-AIR信息数据 系统，或RI-AIR IDS)，以集成来自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(案例)，以 为哮喘未得到很好控制的儿童提供家庭/儿童/学校系统，4)密集的居家 对哮喘控制不佳的儿童进行干预(HARP)，以及5)加强 护理员、学校护士和卫生保健提供者，以促进跨保健部门的整合。第一个目标 建议的工作之一是评估RI-AIR ACIP的有效性，使用随机、步进式 楔形设计。在2-4年内，我们将按顺序向16个高危社区提供干预 涉及大约1500名患有哮喘的城市不同种族儿童(2-12岁)及其家人。我们 将评估个人水平(例如哮喘控制)和社区特定结果(即ED率 一个多层次的过程 在实施期间对RI-AIR ACIP进行评估(第2-5年)。我们将在确定的范围内评估渗透率 社区和学区，并评估接受并完成 干预者与不干预者。我们将确定RI-AIR入侵检测技术平台在分配 根据哮喘控制/风险以及HARP和HARP提供的治疗保真度和剂量进行干预 CASE程序。我们将使用焦点小组和提供商调查来确定促进者和障碍 访问)为哮喘儿童提供服务。此应用程序的第二个目标涉及进行 有效实施。第三个目标涉及对可持续性进行混合方法评估。 在5-6年间，我们的社区利益相关者不断提供意见。我们定义 可持续性是指持续的能力、持续的活动和持续的效益。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，相对于基线，照顾者的哮喘将在一年内得到改善 知识、自我效能、哮喘生活质量和有效疾病管理的指标。我们预计会超过1 年，接受RI-AIR ACIP的社区将减少急诊就诊和住院治疗 基准年，以及相对于尚未获得RI-AIR的目标社区。我们计划演示 RI-AIR ACIP是一种可复制的、基于证据的、节省成本的模式，可以改善哮喘患者的预后 儿童哮喘是最危险的，并可传播到其他城市社区，以解决哮喘差距问题。

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.