Project ASTHMA - Aligning with Schools to Help Manage Asthma and Decrease Health Inequities

项目摘要/摘要 在以学校为基础的卫生中心(SBHC)提供的多种干预措施有可能 减少来自健康不平等社区的儿童的哮喘发病率。哮喘是最多的 儿童常见的慢性病。来自低社会经济社区的黑人和西班牙裔儿童 占哮喘恶化、急诊科(ED)就诊的比例过高，以及 住院治疗。这些儿童通常不接受以指南为基础的哮喘治疗，并坚持每天 预防哮喘的药物很差。接受医疗服务的传统医疗服务提供模式 医生办公室在改善脆弱人群的哮喘结果方面取得的成功有限。这是 可归因于多种影响健康的社会决定因素，这些因素中断了一致的全面护理，包括 卫生服务有限，缺乏交通，照顾者的就业需求。结果, 这些儿童往往接受危机驱动的护理，而不是预防驱动的护理。SBHC可以作为一种安全措施 为生活在贫困社区的儿童提供网络服务，并改善健康状况。SBHC的工作人员是高级 可以评估和管理疾病的实践提供者(应用程序)。因此，将成本降至最低 将哮喘管理计划整合到现有的医疗保健提供模式中。 哮喘项目(与学校结盟以帮助管理哮喘)是一个具有前瞻性的阶梯式楔形集群 基于一项成功的试点研究的随机试验，旨在评估SBHC的有效性作为成本 有效的医疗保健提供模式，以减少哮喘症状、恶化、急诊和住院 适用于生活在健康不平等社区的哮喘失控儿童。干预将需要 安置在位于10所布法罗公立学校的SBHC。SBHC的应用程序被随机分配到哮喘项目 该年将接受培训和支持，以提供以指南为基础的慢性哮喘护理。注册的学生 哮喘项目将接受来自应用程序的哮喘评估和预防性药物管理， 从学校护士那里直接观察他们的预防哮喘药物的治疗，以支持坚持治疗，以及 自我管理支持，以提高对家庭剂量哮喘药物的依从性。注册的学生在 当年被随机分配到对照组的SBHC将被纳入强化常规护理组，他们将接受 由研究小组对哮喘进行评估，然后转介给他们的初级保健提供者进行评估 和药物管理。SBHC是一种在财务和临床上可持续的医疗保健提供模式， 并有可能大幅减少哮喘发病率的不平等现象。如果传播，项目 哮喘有可能改善全国高贫困学校儿童的健康。 这些改进对州和县卫生部门来说可能是划算的，因为 在美国的数百个社区中，已经有2500家SBHC。通过我们的 研究结果可以帮助公共卫生政策制定者确定优先事项并将资源分配给SBHC。

PROJECT SUMMARY/ABSTRACT Multicomponent interventions delivered in school-based health centers (SBHCs) have the potential to decrease asthma morbidity in children from communities that experience health inequities. Asthma is the most common chronic disease in children. Black and Hispanic children from low-socioeconomic communities account for a disproportionate percentage of asthma exacerbations, emergency department (ED) visits, and hospitalizations. These children often do not receive guideline-based asthma care, and adherence to daily preventive asthma medication is poor. Traditional health service delivery models where care is received in physicians’ offices have limited success in improving asthma outcomes in vulnerable populations. This is attributable to multiple social determinants of health that interrupt consistent comprehensive care, including limited availability of health services, lack of transportation, and caregiver employment demands. As a result, these children often receive crisis-driven care rather than prevention-driven care. SBHCs can serve as a safety net for children living in poor communities and improve health outcomes. SBHCs are staffed by advanced practice providers (APPs) who can assess and manage diseases. There are therefore minimal costs to integrating an asthma management program within this existing health care delivery model. Project ASTHMA (Aligning with Schools To Help Manage Asthma) is a prospective, stepped wedge cluster randomized trial based on a successful pilot study, that aims to assess the effectiveness of SBHCs as a cost effective health care delivery model to reduce asthma symptoms, exacerbations, ED visits, and hospitalizations in children with uncontrolled asthma who live in communities with health inequities. The intervention will take place in SBHCs located in 10 Buffalo Public Schools. The APPs at the SBHCs randomized to Project ASTHMA that year will be trained and supported to deliver guideline-based chronic asthma care. Students enrolled in Project ASTHMA will receive asthma assessments and preventive medication management from the APPs, directly observed therapy of their preventive asthma medication from school nurses to support adherence, and self-management support to improve adherence to home doses of asthma medication. Students enrolled at the SBHCs randomized to the control that year will be in an enhanced usual care group who will receive an asthma assessment by the research team and then be referred to their primary care provider for assessment and medication management. SBHCs are a financially and clinically sustainable health care delivery model, and have the potential to substantially decrease inequities in asthma morbidity. If disseminated, Project ASTHMA has the potential to improve the health of children in high-poverty schools throughout the country. These improvements are likely to be cost-effective for state and county health departments because over 2,500 SBHCs already exist in hundreds of communities in the United States. Evidence generated through our findings can assist public health policymakers in determining priorities and allocating resources to SBHCs.