Pediaric asthma community based program(PACBP) Eliminating asthma

波多黎各儿童的哮喘发病率是所有耳鼻喉科人群中最高的，更有可能 与其他孩子相比，他们死于哮喘。在波多黎各，存在着严重的差距 与高收入儿童相比，贫困哮喘儿童接受哮喘护理的质量。AS 根据医学研究所的描述，这种健康差距可能是由多个层次的障碍造成的 适当的照顾。根据该调查小组开发的健康差距概念模型， 我们建议评估儿童哮喘社区计划(PACBP)的有效性，一个 新的、多层次的干预旨在通过干预在治疗中消除哮喘差异 卫生政策、医疗服务提供者和家庭层面。目标1将使用非试验性的事前比较设计 评估药物政策的历史性变化(即，承担医疗费用的国家 药物)在波多黎各的一个试点卫生区。我们将使用自动理赔和药房数据一 政策改变前一年和政策改变后一年半比较药房处方的抗炎作用 控制性药物(ACM)、口服类固醇和β-激动剂(主要结果)，以及 儿童的急诊科就诊率和住院率(次要结果) 持续哮喘。为了在提供者级别检查更改的影响，Aim 2将使用随机 对照试验(RCT)设计嵌套在试点地区，以研究文化适应版本的影响 轻松呼吸计划(EBP)，这是一个以提供者为重点的教育干预措施，旨在增加 以指导方针为基础的护理。使用索赔数据，我们将比较ACM配药率(主要结果)，如 以及β-激动剂和口服类固醇配药。我们还将比较以指南为基础的护理的图表审计， 以及对哮喘管理做法的提供者调查。研究变化对家庭的影响 水平，Aim 3将使用随机对照试验测试嵌套在诊所的基于家庭的哮喘管理干预(FAMI) 收到EBP的试点地区的名单。这种干预旨在增加家庭知识、技能 哮喘管理的自我效能感。FAMI研究的主要结果变量是无症状 几天。次要结果包括ACM的使用和生活质量，以及急诊和住院 入院，β-激动剂和口服类固醇的使用，以及功能残疾。最后，目标4将评估成本效益 儿童哮喘社区计划(PACBP)的每一级。建议数 这项研究将第一次测试一种适应文化的、以社区为基础的干预措施，以解决 通过在提供者、家庭和卫生政策层面进行干预，消除健康差距。

Puerto Rican children have the highest rates of asthma morbidity of any etnic group and are more likely to die because of their asthma as compared with other children. In Puerto Rico gross disparities exist in the quality of asthma care received by poor asthmatic children compared to higher income children. As described by the Institute of Medicine, such health disparities likely result from multi-level barriers to appropriate care. Based on a conceptual model of health disparities developed by this investigative group, we propose to evaluate the effectiveness of the Pediatric Asthma Community- Based Program (PACBP), a novel, multi-level intervention designed to eliminate asthma disparities in treatment by intervening at the health policy, provider, and family level. Aim 1 will use a non-experimental pre-post comparison design to assess a historic change in medication policy (i.e., the state assuming responsibility for the cost of medication) in a pilot health region in Puerto Rico. We will use automated claims and pharmacy data one year prior to and one-and-a-half years post policy change to compare pharmacy dispensing of antiinflammatory controller medications (ACMs), oral steroids and beta agonists (primary outcome), as well as rates of Emergency Department (ED) visits and hospital admissions (secondary outcomes) in children with persistent asthma.To examine the impact of change at the provider level, Aim 2 will use a randomized control trial (RCT) design nested within the pilot region to study the impact of a culturally-adapted version of the Easy Breather Program ( EBP), a provider-focused educational intervention designed to increase guideline-based care. Using claims data, we will compare rates of ACM dispensing (primary outcome), as well as beta-agonist and oral steroid dispensing. We will also compare chart audits of guideline-based care, and provider surveys of asthma management practices. To examine the impact of change at the family level, Aim 3 will use a RCT to test a family-based asthma management intervention (FAMI), nested in clinics of the Pilot region that received the EBP. This intervention is designed to increase family knowledge, skills and self-efficacy for asthma management. The primary outcome variable for the FAMI study is symptomfree days. Secondary outcomes include ACM use and quality of life, as well ED visits and hospital admissions, beta agonist and oral steroids use, and functional disability. Finally, Aim 4 will evaluate the costeffectiveness of each level of the Pediatric Asthma Community-Based Program (PACBP). The proposed study will be the first to test a culturally-adapted, community-based intervention that addresses the elimination of health disparities by intervening at the provider, family and health policy level.