Navigating Together for Equitable Asthma Management (Nav-TEAM) for Children in Families who Communicate in Languages other than English

为使用英语以外语言交流的家庭中的儿童共同导航公平哮喘管理 (Nav-TEAM)

• 批准号: 10831713
• 负责人: Lisa Ross DeCamp
• 金额: $ 49.97万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10831713
• 关键词: Navigating; Together; Equitable; Asthma; Management

PROJECT SUMMARY/ABSTRACT Children in families with healthcare communication in a language other than English (LOE) are at increased risk of worse asthma care and outcomes compared to those without a language barrier. There is a gap in knowledge about effectiveness and implementation outcomes of interventions to address asthma disparities for children in LOE families. Asthma navigators play a key role in asthma education and care coordination, resulting in improved asthma outcomes. Our local model of asthma navigation and care coordination to support meeting social determinants of health needs using a lay health worker model has improved asthma outcomes among urban racial/ethnic minority children but has not focused on children in LOE families. To address this gap, we propose, the Navigating Toward Equitable Asthma Management Program (Nav-TEAM) intervention, an adaptation of evidence-based asthma navigation specifically for children in families who communicate in LOE. As with existing asthma navigation programs at our health system, Nav-TEAM will align with EXHALE, the Centers for Disease Control and Prevention National Asthma Control Program compilation of asthma management strategies that have been proven to reduce asthma-related healthcare utilization and costs. The overall scientific goals of this community-engaged study are to: evaluate the effectiveness of Nav-TEAM on pediatric asthma outcomes for 280 children whose families communicate in LOE, evaluate implementation outcomes and application of implementation strategies, and assess cost and contextual factors to support sustained implementation, scale up and scale out. The study will be implemented in a large primary care clinic serving primarily Medicaid-insured children and in subspecialty pediatric pulmonary clinics using the Practical, Robust Implementation and Sustainability Model (PRISM) - inclusive of RE-AIM (Reach, Effectiveness, Adoption, Implementation Maintenance outcomes with an equity lens – as the guiding Dissemination & Implementation Science framework. We will use community-engaged processes to tailor asthma navigation for LOE families in primary and subspecialty pediatric pulmonary care settings at Children’s Hospital of Colorado, a large academic children’s health system serving urban and rural patients. Subsequently, we will conduct a hybrid type 2 effectiveness-implementation trial to simultaneously evaluate the effectiveness of Nav-TEAM at reducing asthma-related emergency department use among children with asthma age 4-14 years using a pragmatic randomized controlled trial as well as a mixed methods assessment of implementation using PRISM/RE-AIM focusing on equity. We will then assess cost, sustainability and contextual domains to understand factors that enable implementation, sustainability, and scale-out of Nav-TEAM. Results from this study will provide information on the effectiveness and implementation of evidence-based asthma navigation adapted specifically for families who communicate in LOE, and will offer lessons that we will capture in an implementation and sustainability guide to promote scaling to other clinical settings.

项目总结/摘要 使用英语以外的语言进行医疗保健沟通的家庭中的儿童数量有所增加 与没有语言障碍的人相比，哮喘护理和结果更差的风险。有差距 了解干预措施的有效性和实施结果，以解决 LOE家庭的孩子们。哮喘导航员在哮喘教育和护理协调中发挥着关键作用， 从而改善哮喘的结果。我们当地的哮喘导航和护理协调模式， 使用非专业卫生工作者模式满足健康需求的社会决定因素改善了哮喘的结局 在城市种族/少数民族儿童中，没有关注LOE家庭的儿童。为了解决这个 差距，我们建议，导航走向公平哮喘管理计划（Nav-TEAM）干预， 一个适应的循证哮喘导航专门为儿童的家庭谁沟通， LOE。与我们卫生系统现有的哮喘导航计划一样，Nav-TEAM将与EXHALE保持一致， 疾病控制和预防中心国家哮喘控制计划哮喘汇编 管理策略，已被证明可以减少哮喘相关的医疗保健利用和成本。的 这项社区参与研究的总体科学目标是：评估Nav-TEAM在以下方面的有效性： 280名家庭在LOE中沟通的儿童的儿科哮喘结局，评价实施情况 执行战略的成果和应用，并评估成本和背景因素，以支持 持续实施、扩大规模和向外扩展。该研究将在一家大型初级保健诊所实施 主要服务于医疗补助保险的儿童和使用实用， 稳健的实施和可持续性模型（PRISM）-包括RE-AIM（覆盖范围，有效性， 采用、执行以公平透镜为指导， 实施科学框架。我们将使用社区参与的过程来定制哮喘导航， 在科罗拉多儿童医院的初级和专科儿科肺部护理机构中的LOE家庭， 一个为城市和农村患者服务的大型学术儿童卫生系统。随后，我们将进行 混合2型有效性-实施试验，同时评估Nav-TEAM的有效性， 减少4-14岁哮喘儿童的哮喘相关急诊使用， 实用的随机对照试验以及混合方法评估的实施， PRISM/RE-AIM注重公平。然后，我们将评估成本、可持续性和相关领域， 了解Nav-TEAM的实施、可持续性和扩展的因素。结果从这个 一项研究将提供有关循证哮喘导航的有效性和实施情况的信息 特别适合在LOE中沟通的家庭，并将提供我们将在 实施和可持续性指南，以促进扩展到其他临床环境。