The Efficacy of CAMP Air, a Web-based Asthma Intervention, Among Urban Adolescents with Uncontrolled Asthma

项目摘要/摘要 背景和理论：哮喘在少数族裔青少年中有很高的患病率和发病率。然而， 很少有干预措施在青少年中进行测试，只有一项是基于网络的。鉴于哮喘的重大影响 对于这一群体，以及技术在他们生活中扮演的重要角色，这种疏忽是一个重大的公共卫生 担忧。在哮喘干预中缺乏成本-效果分析和实施研究 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 七个模块的青少年哮喘控制计划(CAMP AIR)的初步影响 为患有无法控制的哮喘的青少年提供个性化的电子健康干预。目标：我们的目标：(1) 系统评估Camp Air在370名城市青少年哮喘患者中的疗效；(2)评估其 成本效益；以及(3)确定与成功实施Camp Air有关的多层面因素 为其未来的扩大提供信息。假设：相对于控制组，一年以上的空中训练营参与者将拥有 哮喘控制显著改善，表现为：(A)哮喘控制测试(ACT)得分较高；(B) 较少与哮喘相关的紧急护理就诊(主要结果)。空中夏令营的参与者也将拥有显著的 更好的(A)哮喘自我护理技能，(B)控制性用药，(C)肺功能(通过肺活量测量)， 和(D)生活质量；以及显著降低(E)类固醇爆发率，(F)白天症状，(G)夜间醒来， (H)活动限制，和(I)缺课。我们假设，与控制组相比，Air营将 具有有利的价值(增量成本效益比&lt；100,000美元/质量调整寿命年[QALY])。 方法：我们将从纽约市19所高中招收370名患有未控制哮喘的9-11年级学生。我们 将参与者随机安排到空气营或哮喘教育控制干预中，并对他们进行12年的跟踪 治疗后几个月。使用决策分析马尔科夫模型，我们将估计Camp Air的增量成本 从社会和支付者的角度来看，每QALY收益和每症状无症状天数的成本。对于 建立在RE-AIM和实施研究综合框架基础上的过程评估 (CFIR)模型，我们将从学生、照顾者和学校收集定性和定量数据 管理员。我们将与利益相关者一起制定广泛实施cAMP的战略。 AIR，了解我们的临床疗效、成本效益和实施结果。意义：这项研究 具有很高的公共卫生意义，因为它(1)针对受到严重影响的未充分研究的人群 哮喘，(2)利用健康不同人群中的技术来促进自我护理，(3)评估CAMP 空气的经济价值，使用QALY和无症状天数，以及(4)弥合研究和 通过确定实施因素，为广泛实施“空中营地”的战略提供信息。

PROJECT SUMMARY / ABSTRACT Background and Rationale: Asthma has high prevalence and morbidity among minority adolescents. Yet, few interventions are tested in adolescents, with only one being web-based. Given asthma's significant impact on this group, and the important role technology plays in their lives, this oversight is a significant public health concern. There is a dearth of cost-effectiveness analyses and implementation studies in asthma intervention research. This study addresses these treatment and methodological gaps. We developed and established the preliminary impact of the Controlling Asthma Program for Adolescents (CAMP Air), a seven-module personalized, e-health intervention for adolescents with uncontrolled asthma. Objective: We aim to: (1) systematically evaluate CAMP Air's efficacy in 370 urban adolescents with uncontrolled asthma; (2) assess its cost-effectiveness; and (3) identify multi-level factors associated with successful implementation of CAMP Air to inform its future scale-up. Hypotheses: Relative to controls, over 1-year CAMP Air participants will have significantly better asthma control as indicated by (a) higher scores on the Asthma Control Test (ACT) and (b) fewer asthma-related urgent care visits (primary outcomes). CAMP Air participants will also have significantly better (a) asthma self-care skills, (b) controller medication use, (c) lung function (measured by spirometry), and (d) quality of life; and significantly lower rates of (e) steroid bursts, (f) symptoms days, (g) nights woken, (h) activity limitations, and (i) school absences. We hypothesize that compared to the control, CAMP Air will have favorable value (incremental cost-effectiveness ratio<$100,000/ quality adjusted life years [QALYs]). Methods: We will enroll 370 9th – 11th graders with uncontrolled asthma from up to 19 NYC high schools. We will randomize participants to CAMP Air or an asthma education control intervention and follow them for 12 months post-treatment. Using a decision-analytic Markov model, we will estimate CAMP Air's incremental cost per QALY gained and cost per symptom free days, from both the societal and payer perspectives. For the process evaluation, which is built on the RE-AIM and Consolidated Framework for Implementation Research (CFIR) models, we will collect qualitative and quantitative data from students, caregivers, and school administrators. Together with stakeholders we will develop strategies for widespread implementation of CAMP Air, informed by our clinical efficacy, cost-effectiveness, and implementation results. Significance: The study has high public health significance because it (1) targets an understudied population impacted greatly by asthma, (2) leverages technology in a health disparate population to promote self-care, (3) assesses CAMP Air's economic value using QALYs and symptom-free days, and (4) bridges a gap between research and practice by identifying implementation factors to inform strategies for widespread implementation of CAMP Air.