Chicago Asthma School-Directed Child-Centered Assessment and Dissemination of Evidence (CASCADE) Program

项目摘要 尽管有现有证据，但儿童哮喘患病率和发病率仍然存在显着的健康差异 基于哮喘指南已被证明可以改善结果。学校是不可或缺的合作伙伴 哮喘管理。先前的文献概述了各种有针对性的基于学校的干预措施，其中包括一些 积极成果；然而，这些计划侧重于指南的各个组成部分并进行 暂时没有融入学校流程以实现可持续性。为了更全面地影响 哮喘护理，学校已制定政策支持基于指南的实践；然而，实施 不足，因此这些政策没有带来有效、系统的实践。因此，我的目标是架起桥梁 通过制定和评估务实、多方面的政策，在哮喘指南和政策的实施方面存在差距 以学校为主导、以儿童为中心的哮喘计划的组成部分，该计划以现有的有针对性的干预措施为基础 并融入学校以促进可持续性。这个创新项目的贡献超出了现有的 通过同时、务实地实施哮喘的多个组成部分来开展以学校为基础的计划 通过全校系统和由非专业卫生工作者领导的简化流程制定指导方针。我已经建立了一个 通过与多校区建立强有力的合作伙伴关系，为这项新颖而重要的研究奠定了坚实的基础 为少数族裔、低收入人口服务的城市学校网络，并进行初步研究 强调了哮喘护理方面的重要差距。在这个提案中，我将开发和评估一个创新的多 两所小学的组成项目（目标 1）。首先，我将试点基于指南的干预 成分并确定可行性和功效 (1A)。然后我将利用这些数据和现有文献 以学校为基础的干预措施，以实施和评估多组成部分的计划 (1B)。主要成果将 关注患者（哮喘控制）、组织（上学）和成本。另外，我会确定 不同利益相关者对计划组成部分和整体计划的看法，作为预 实施评估，为在大型、多元化的城市更广泛的实施和传播做好准备 公立学区（目标2）。结果将用于扩大学校应用的R01研究- 将定向的、以儿童为中心的模型应用于芝加哥大型、多元化的公立学区，比较其有效性 其他以学校为基础的哮喘干预措施，并进行全面的社会成本效益分析。在此期间 职业发展奖，我将与我的导师和由领导者组成的专家咨询委员会密切合作 健康差异、哮喘、社区和学校计划、实施科学以及统计和 成本分析。该奖项将使我能够获得先进研究方法方面额外的必要培训 和数据分析，以及实施和传播研究。拟议的研究和培训 将使我成为一名独立调查员和国家领导人，整合社区- 通过实施科学进行研究，以改善患者的治疗效果并减少哮喘差异。

PROJECT ABSTRACT Significant health disparities persist in childhood asthma prevalence and morbidity despite existing evidence- based asthma guidelines that have been shown to improve outcomes. Schools are an integral partner in asthma management. Prior literature has outlined various targeted school-based interventions with some positive outcomes; however, these programs focus on individual components of the guidelines and take place transiently without integration into school processes for sustainability. To more comprehensively impact asthma care, schools have enacted policies to support guideline-based practices; however, implementation falls short and thus these policies have not led to effective, systemic practices. Therefore, I aim to bridge the gap in the implementation of asthma guidelines and policies by developing and evaluating a pragmatic, multi- component school-directed, child-centered asthma program that builds upon existing targeted interventions and is integrated in the school to foster sustainability. This innovative project contributes beyond existing school-based programs by simultaneously and pragmatically implementing multiple components of the asthma guidelines through school-wide systems and streamlined processes led by lay health workers. I have built a strong foundation for this novel and important research by developing a strong partnership with a multi-campus urban school network that serves a minority, low-income population and conducting preliminary research that highlights the important gaps in asthma care. In this proposal, I will develop and evaluate an innovative multi- component program in two elementary schools (Aim 1). First, I will pilot guideline-based intervention components and determine feasibility and efficacy (1A). I will then utilize this data and existing literature about school-based interventions to implement and evaluate a multi-component program (1B). Key outcomes will focus on the patient (asthma control), organization (school attendance), and cost. In addition, I will determine diverse stakeholder perspectives about the program components and the overall program as part of a pre- implementation assessment to prepare for broader implementation and dissemination in a large, diverse urban public school district (Aim 2).The results will be used for R01 studies that expand the application of the school- directed, child-centered model to the large, diverse public school district in Chicago, compare its effectiveness to other school-based asthma interventions, and conduct a full societal cost-effectiveness analysis. During this career development award, I will work closely with my mentors and an expert advisory committee of leaders in health disparities, asthma, community and school-based programs, implementation science, and statistical and cost analyses. This award will allow me to obtain additional necessary training in advanced research methods and data analysis, as well as implementation and dissemination research. The proposed research and training will position me to become an independent investigator and national leader who integrates community- engaged research with implementation science to advance patient outcomes and reduce asthma disparities.