Translating an Evidence-based Urban Asthma Program for Rural Adolescents: Testing Effectiveness & Cost-effectiveness and Understanding Factors Associated with Implementation

将循证城市哮喘方案转化为农村青少年：测试有效性

• 批准号: 10226972
• 负责人: Jean-Marie Bruzzese
• 金额: $ 62.24万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-05 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10226972
• 关键词: Accident and Emergency department; Address; Administrator; Adolescent; Adoption; African American; African American student; Aftercare; Asthma; Caregivers; Caring; Childhood; Chronic Disease; Clinic; Clinical; Clinical effectiveness; Communities; Community Health Aides; Cost Analysis; Cost Effectiveness Analysis; Costs and Benefits; Coupled; Data; Detection; Dimensions; Education; Effectiveness; Elements; Emergency department visit; Enrollment; Ensure; Ethics; Evaluation; Future; Geography; Health Status; Healthcare; High Prevalence; High School Student; Hispanic Americans; Home; Hospitalization; Human Resources; Intention; Intervention; Intervention Studies; Interview; Latino; Maintenance; Measures; Medical; Methodology; Methods; Modeling; Morbidity - disease rate; Outcome; Participant; Penetration; Pharmaceutical Preparations; Population; Process; Provider; Public Health; Quality Control; Quality of life; Quality-Adjusted Life Years; Randomized; Randomized Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Reporting; Research; Research Design; Resources; Risk; Rural; Rural Community; Rural Population; Schools; Self Management; South Carolina; Speed; Steroids; Students; Surveys; Symptoms; Testing; Time; Translating; Translational Research; Urban Population; Use Effectiveness; Vulnerable Populations; Wheezing; Youth; attentional control; base; clinical implementation; cost; cost effective; cost effectiveness; design; effectiveness evaluation; effectiveness implementation study; effectiveness testing; eleventh grade; ethnic diversity; evidence base; experience; follow-up; health care service utilization; high school; hybrid type 1 study; implementation intervention; implementation research; improved; intervention cost; intervention effect; markov model; mathematical model; mortality; post intervention; pragmatic trial; primary outcome; programs; public health relevance; randomized trial; research to practice; rural setting; secondary outcome; skills; success; theories

PROJECT SUMMARY / ABSTRACT Background and Rationale: Asthma, the most common pediatric chronic illness, has high prevalence and morbidity among adolescents. Few interventions are tested in high schools; none when delivered by Community Health Workers (CHWs), despite this model's success in clinic- and home-based interventions. Further, rural adolescents, who represent a very large population, are overlooked in asthma intervention research. Given the high prevalence of asthma in this group, this oversight is a significant public health concern. Cost effectiveness analyses and implementation research are also lacking in asthma intervention research. This study addresses these treatment and methodological gaps. We developed and established the efficacy of Asthma Self-Management for Adolescents (ASMA), an 8-week, high school-based intervention, in urban Hispanic and African American adolescents. Objective: Using an effectiveness-implementation hybrid design, we: (1) evaluate systematically the effectiveness of ASMA when delivered under real world conditions by CHWs to rural adolescents with uncontrolled asthma; (2) assess the cost-effectiveness of ASMA; and (3) conduct a theory-based, mixed-methods, multi-stakeholder process evaluation of the barriers and facilitators of ASMA's widespread implementation. Hypotheses: Over 1 year, relative to controls, ASMA students will have significantly fewer (1) night awakenings due to asthma symptoms, and (2) days with asthma-related activity limitations (primary outcomes). Secondary outcomes include other measures of morbidity (e.g., ED visits, hospitalizations, quality of life) and care-process outcomes. We also hypothesize that ASMA will have favorable value (ICER < 100,000/QALY) compared to alternative uses of health care resources over 1 and 5 years. Methods: We will enroll over 3 years, 400 9th through 11th grade students with uncontrolled asthma from 9 high schools in rural communities in South Carolina; we will randomize students within a school to ASMA and to an attention control condition. CHWs will deliver both interventions. Students and caregivers will be followed for 12-months post-treatment. The intention-to-treat (ITT) principle will be applied using linear and general linear mixed effects models. The cost-effective analysis will rely on a decision-analytic Markov model. The process evaluation is built on the RE-AIM model; we collect qualitative and quantitative data from students, caregivers, CHWs and school administrators. Together with key stakeholders from a variety of settings, we will develop models to widely disseminate and implement ASMA. Significance: The study has high public health significance because (1) it targets an understudied population, (2) it relies on existing community resources for intervention implementation, (3) it assesses ASMA's value through cost-effectiveness analyses, and (4) it bridges the gap between research and practice by identifying factors associated with implementation.

项目概要/摘要 背景和基本原理：哮喘是最常见的儿科慢性疾病，患病率很高，而且 青少年中的发病率。高中很少测试干预措施；交付时无 社区卫生工作者 (CHW)，尽管这种模式在诊所和家庭干预方面取得了成功。 此外，占人口数量很大的农村青少年在哮喘干预中被忽视 研究。鉴于该群体哮喘患病率较高，这种监督对公共卫生具有重要意义 忧虑。哮喘干预也缺乏成本效益分析和实施研究 研究。这项研究解决了这些治疗和方法上的差距。我们开发并建立了 青少年哮喘自我管理 (ASMA) 的有效性，这是一项为期 8 周、以高中为基础的干预措施， 城市西班牙裔和非裔美国青少年。目标：使用有效性与实施混合体 设计时，我们：(1) 系统地评估 ASMA 在现实条件下交付时的有效性 由社区卫生工作者向哮喘未得到控制的农村青少年提供帮助； (2) 评估ASMA的成本效益；和（3） 对障碍和促进因素进行基于理论、混合方法、多利益相关者的过程评估 ASMA 的广泛实施。假设：在 1 年多的时间里，相对于对照组，ASMA 学生将 (1) 因哮喘症状而夜间醒来，以及 (2) 与哮喘相关的活动明显减少 局限性（主要结果）。次要结果包括其他发病率指标（例如急诊就诊、 住院治疗、生活质量）和护理过程结果。我们还假设 ASMA 将有 与超过 1 和 5 的医疗保健资源替代用途相比，具有有利价值 (ICER < 100,000/QALY) 年。方法：我们将在 3 年多的时间里招收 400 名患有未受控制哮喘的 9 至 11 年级学生。 南卡罗来纳州农村社区的 9 所高中；我们将学校内的学生随机分配到 ASMA 并 达到注意力控制状态。社区卫生工作者将提供这两种干预措施。学生和看护人将受到跟踪 治疗后12个月。意向治疗 (ITT) 原则将使用线性和一般方法来应用 线性混合效应模型。成本效益分析将依赖于决策分析马尔可夫模型。这 过程评估建立在RE-AIM模型之上；我们从学生那里收集定性和定量数据， 护理人员、社区卫生工作者和学校管理人员。我们将与来自不同背景的主要利益相关者一起 开发模型以广泛传播和实施 ASMA。意义：该研究具有较高的公共卫生意义 意义重大，因为（1）它针对的是未被充分研究的人群，（2）它依赖于现有的社区资源 干预措施的实施，(3) 通过成本效益分析评估 ASMA 的价值，(4) 通过确定与实施相关的因素，弥合研究与实践之间的差距。