Parents, Pediatricians and Telephone Coaches Partner to Improve Control (PARTNER)

家长、儿科医生和电话教练合作改善控制（合作伙伴）

• 批准号: 7664585
• 负责人: Jane M Garbutt
• 金额: $ 71.51万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-06-05 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7664585
• 关键词: 12 year old; Absenteeism at work; Accident and Emergency department; Adherence; Asthma; Behavior; Caregivers; Caring; Child; Child Care; Childhood Asthma; Clinical Research; Collaborations; Communication; Communities; Continuity of Patient Care; Control Groups; Costs and Benefits; Development; Education; Educational Materials; Effectiveness of Interventions; Event; Expenditure; Family; Frequencies; Funding; Goals; Guidelines; Healthcare; Hospitalization; Impairment; Influenza vaccination; Insurance Carriers; Intervention; Interview; Juniper; Life; Literature; Low income; Maintenance; Measurement; Measures; Modeling; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Neighborhoods; Outcome; Parents; Patient Education; Patients; Pharmaceutical Preparations; Pharmacotherapy; Physicians; Population; Primary Care Physician; Primary Health Care; Principal Investigator; Process; Provider; Quality of life; Questionnaires; Randomized; Randomized Controlled Trials; Recommendation; Registries; Research; Research Personnel; Risk; Schools; Self Management; Services; Site; Societies; Symptoms; Target Populations; Telephone; Training Programs; Translating; Triage; Universities; Visit; Washington; Work; base; behavior change; care delivery; care episode; clinical practice; cohort; cost; cost effectiveness; design; effective intervention; expectation; experience; follow-up; group intervention; high risk parents; improved; intervention program; medical schools; meetings; pediatrician; practice-based research network; primary care setting; programs; public health priorities; public health relevance; theories; treatment as usual; trial comparing

DESCRIPTION (provided by applicant): Reducing asthma morbidity is a public health priority. Despite National guidelines that recommend collaboration with the parent for effective asthma care, most primary care providers (PCPs) do not provide on- going self-management education or support, and effective interventions to improve maintenance care are difficult to disseminate into office practice. Our prior NHLBI-funded work focused on reducing asthma-related morbidity and healthcare use in children from low-income, urban neighborhoods. We have demonstrated that a lay asthma coach can improve self-management behaviors and reduce asthma hospitalizations, and can improve rates of follow-up with a PCP after an emergency department visit. In this competitive renewal application we will extend our successful theory-based coaching model into the general asthma population, and integrate coaching into office-based care with the Telephone Asthma Coaching program (TAC). We will conduct a randomized controlled trial to evaluate the TAC program. The coaching intervention will occur at the level of the parent, but to minimize contamination, randomization will occur at the level of the physician. Using a stratified cluster design, we will randomize 24 community pediatricians to the intervention or usual care control group. All participating physicians (intervention and control groups) will receive a summary of the most recent NAEPP guidelines, patient education materials and a registry of their asthma patients. Physicians in the intervention group will participate in two brief meetings to introduce coaching and to tailor implementation of the intervention to their practice. Parents of asthmatic children they care for will be invited to participate in the TAC program and work with an off site asthma coach to facilitate effective self-management and a collaborative partnership with the PCP. We will evaluate this pragmatic intervention in the community, and develop educational materials for PCPs, coaches and parents to facilitate widespread program dissemination. Our hypothesis is that the intervention will reduce asthma morbidity among children by improving maintenance care provided by the parent and the PCP, and these changes will be maintained. The target population is asthmatic children who are 5 to 12 years old and had >1 urgent care episode in the prior 12 months. All outcomes will be measured by parent interviews and chart audits at 12 and 24 months. The measurement cohort will average 40 patients/PCP (total 1000 patients). We will determine if the intervention: reduces asthma impairment measured as improved asthma control and asthma-related quality of life; reduces asthma risk measured by urgent care episodes among the target population in 12-months; and improves adherence to National guidelines for asthma care by the PCP. We will assess cost effectiveness from the perspective of the payor and society. Collaboration between key players in community-based asthma care resulted in development of the TAC program, and affords an opportunity to evaluate this model to translate research into office-based practice. PUBLIC HEALTH RELEVANCE: Reducing asthma morbidity is a public health priority. This project will evaluate if a telephone asthma coaching program that is integrated into office practice will reduce asthma morbidity among children by improving maintenance care provided by the parent and the PCP, and if the program is cost-effective.

描述（由申请人提供）：降低哮喘发病率是一项公共卫生优先事项。尽管国家指南建议与家长合作进行有效的哮喘护理，但大多数初级保健提供者（pcp）不提供持续的自我管理教育或支持，而且改善维持护理的有效干预措施很难传播到办公室实践中。我们之前nhlbi资助的工作重点是减少低收入城市社区儿童哮喘相关发病率和医疗保健使用。我们已经证明，一个普通的哮喘教练可以改善自我管理行为，减少哮喘住院治疗，并可以提高急诊就诊后PCP的随访率。在这个竞争性的更新申请中，我们将把我们成功的基于理论的指导模式扩展到普通哮喘人群，并通过电话哮喘指导计划（TAC）将指导整合到基于办公室的护理中。我们将进行一项随机对照试验来评估TAC项目。指导干预将在家长层面进行，但为了尽量减少污染，将在医生层面进行随机化。采用分层聚类设计，我们将24名社区儿科医生随机分配到干预组或常规护理对照组。所有参与的医生（干预组和对照组）将收到最新NAEPP指南的摘要、患者教育材料和哮喘患者的登记。干预组的医生将参加两次简短的会议，介绍指导并根据他们的实践量身定制干预的实施。他们所照顾的哮喘儿童的父母将被邀请参加TAC项目，并与一名非现场哮喘教练一起工作，以促进有效的自我管理和与PCP的合作伙伴关系。我们将在社区中评估这种实用的干预措施，并为pcp、教练和家长编写教育材料，以促进项目的广泛传播。我们的假设是，干预将通过改善父母和PCP提供的维持护理来降低儿童哮喘发病率，并且这些变化将保持不变。目标人群是5至12岁的哮喘儿童，并在过去12个月内有过1次紧急护理。所有结果将在12个月和24个月时通过家长访谈和图表审计来衡量。测量队列平均为40例/PCP（总计1000例）。我们将确定干预是否：通过改善哮喘控制和哮喘相关生活质量来减少哮喘损害；降低目标人群在12个月内通过急诊发作来衡量的哮喘风险；并提高了PCP对国家哮喘护理指南的依从性。我们将从付款人和社会的角度评估成本效益。社区哮喘护理的主要参与者之间的合作导致了TAC项目的发展，并提供了一个机会来评估这一模式，将研究转化为基于办公室的实践。