CHILDHOOD ASTHMA PROGRAM IN NYC HEALTH DEPT CLINICS

我们建议证明纽约市儿童卫生局 卫生诊所可以改善黑人和西班牙裔儿童的健康状况 通过为他们提供全面的连续性系统来治疗哮喘 包括药物治疗、家庭健康教育和 社区外展。为了发展这个全面的护理系统，我们将 为卫生部门的医生和护士提供最新的培训 诊断哮喘的方法，并提供临床护理和健康 作为一系列常规20分钟节目的一部分，对患者和家属进行教育 探望病人。护士和公共卫生助理也将接受培训，以 通过教授我们的Open Airways自我管理计划来补充这一点 成群的家庭。为家庭提供24小时电话咨询服务 哮喘患者将配备训练有素的卫生部门医生。 干预将基于社会认知理论，特别是 自律。在第一阶段，卫生署医护人员 工作人员将由哥伦比亚大学教职员工授课，并由 卫生局内科医生和护士主管。自律将是 通过使用哮喘就诊记录在医生中培养，在家庭中通过 哮喘日记的使用。七对配对诊所将被随机分配 被控制或接受干预。我们将测试以下内容 假设：一个全面的连续性护理系统，包括 医疗保健、家庭健康教育和社区外展服务(1) 增强员工诊断和治疗儿童哮喘的信心；(2) 吸引和留住有哮喘孩子的家庭继续 卫生署诊所的护理关系；及。(3)改善 患者的健康状况及其家属的生活质量。阶段 Ii将测试这一综合系统是否能够自我维持 在卫生部内，由医生和护士监督 参加了第一阶段向员工讲授第二套 匹配的诊所。这项计划有可能惠及5000名少数民族。 患有哮喘的儿童。如果成功，它可以推广到其他健康领域。 国家各部门。

We propose to demonstrate that the New York City Department of Health Child Health Clinics can improve the health status of Black and Hispanic children with asthma by providing them with a comprehensive system of continuity of care that includes pharmacologic treatment, family health education and community outreach. To develop this comprehensive care system, we will provide training for Health Department physicians and nurses in up-to-date methods of diagnosing asthma, and providing clinical care and health education to patients and families as part of a series of regular 20 minute patient visits. Nurses and public health assistants will also be trained to supplement this by teaching our Open Airways self-management program to groups of families. A 24-hour telephone advice service for families of asthma patients will be staffed by trained Health Department physicians. The intervention will be based on social cognitive theory, especially self-regulation. In Phase I, the Health Department medical and nursing staff will be taught by Columbia University faculty with reinforcement by Health Department physician and nurse supervisors. Self-regulation will be fostered in physicians by use of an Asthma Visit Record and in families by use of an Asthma Diary. Seven pairs of matched clinics will be randomized to be controls or receive the intervention. We will test the following hypotheses: that a comprehensive system of continuity of care, including medical care, family health education and community outreach will (1) increase staff confidence to diagnose and treat childhood asthma; (2) attract and retain families who have children with asthma in continuing care relationships in the Health Department clinics; and (3) improve the health status of patients and the quality of life of their families. Phase II will test whether this comprehensive system can be made self-sustaining within the Health Department by having physician and nurse super-visors who took part in Phase I teach the program to staff from a second set of matched clinics. This program has the potential to reach > 5000 minority children with asthma. If successful it could be generalized to other health departments in the country.