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

描述（由申请人提供）：降低哮喘发病率是公共卫生的优先事项。尽管国家指南建议与父母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，并且难以将改善维持护理的有效干预措施传播到办公室实践中。我们以前的NHLBI资助的工作重点是减少低收入城市社区儿童的哮喘相关发病率和医疗保健使用。我们已经证明，非专业哮喘教练可以改善自我管理行为，减少哮喘住院，并可以提高急诊科就诊后PCP的随访率。在这个竞争性的续约申请中，我们将把我们成功的基于理论的辅导模式扩展到普通哮喘人群，并通过电话哮喘辅导计划（TAC）将辅导整合到办公室护理中。我们将进行一项随机对照试验来评估TAC计划。指导干预将在父母层面进行，但为了尽量减少污染，随机化将在医生层面进行。采用分层整群设计，我们将24名社区儿科医生随机分为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）将收到最新的NAEPP指南，患者教育材料和哮喘患者登记的摘要。干预组的医生将参加两个简短的会议，介绍教练和定制实施干预他们的做法。他们照顾的哮喘儿童的父母将被邀请参加TAC计划，并与场外哮喘教练合作，以促进有效的自我管理和与PCP的合作伙伴关系。我们将在社区评估这种务实的干预措施，并为PCP、教练和家长开发教育材料，以促进广泛的计划传播。我们的假设是，通过改善父母和PCP提供的维持护理，干预将降低儿童哮喘发病率，并且这些变化将保持下去。目标人群是5至12岁的哮喘儿童，在过去12个月内有>1次紧急护理事件。所有结果将通过12个月和24个月的家长访谈和图表审计来衡量。测量队列将平均40例患者/PCP（总计1000例患者）。我们将确定干预措施是否：减少哮喘损害，以改善哮喘控制和哮喘相关生活质量衡量;降低目标人群12个月内紧急护理事件的哮喘风险;并提高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计划的发展，并提供了一个机会来评估这种模式，将研究转化为基于办公室的实践。 公共卫生相关性：降低哮喘发病率是公共卫生的优先事项。本项目将评估将哮喘电话辅导计划纳入办公室实践是否会通过改善父母和PCP提供的维护护理来降低儿童哮喘发病率，以及该计划是否具有成本效益。

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.