Telecommunications Enhanced Asthma Management (TEAM)

描述（由申请人提供）：我们提议开展一项实用的随机临床试验，以测试健康沟通干预措施的影响，该干预措施旨在提高科罗拉多州凯撒医疗机构 (KPCO)（该州最大的健康维护组织）3-12 岁哮喘儿童的吸入性哮喘控制药物依从性。电信增强依从性管理 (TEAM) 干预措施旨在通过使用自动化电信技术来加强与儿科患者及其父母的沟通和支持，以：1) 让父母更容易联系护理人员，2) 提供立即请求补充和询问孩子症状的机会，3) 提供有关儿童日常哮喘药物重要性的教育和激励信息。这种健康沟通干预将通过最先进的语音识别（SR）技术来提供。 SR 技术的进步使计算机生成的对话变得更容易、更容易被受访者接受，并允许正确解释父母的口头回答，从而产生一系列适当的 SR 回答。调查团队在使用自动化电信技术促进促进健康的行为改变方面拥有丰富的经验。利益-风险模型和社会营销理论继续指导干预的目标和过程。前景理论对这些进行了补充，并将指导 SR 干预中包含的激励信息的发展。这将是一项实用临床试验，针对所有接受吸入皮质类固醇 (ICS) 治疗哮喘的儿童的 KPCO 父母。预计 12 个月的 TEAM 干预将提高 ICS 补充持续性和药物依从性（主要结果），足以使哮喘相关健康结果相对于常规护理对照组产生显着改善，如紧急护理就诊频率、泼尼松使用、β2 激动剂使用以及家长报告的症状控制和生活质量（次要结果）。一项子研究将在参与 TEAM 干预之前和之后对 200 个家庭进行随机抽样，以收集有关可能调节干预效果的变量的信息，包括种族、社会经济地位、疾病严重程度、家庭结构和利益风险认知。处方补充是依从性的准确衡量标准的假设将在第二个子研究中进行测试，该研究将使用电子设备跟踪 ICS 依从性。这种基于系统的干预措施是使用 RE-AIM 框架设计的，因此它应该具有较高的覆盖范围，并以适中的成本持续实施，如果有效，它可以在 KPCO 内维护，也可以轻松导出到其他临床医疗保健机构

DESCRIPTION (provided by applicant): We propose a practical, randomized clinical trial to test the impact of a health communication intervention designed to improve inhaled asthma controller medication adherence in 3-12 year old children with asthma in Kaiser Permanente of Colorado (KPCO), the largest health maintenance organization in the state. The Telecommunication Enhanced Adherence Management (TEAM) intervention is designed to increase communication with and support of pediatric patients and their parents by using automated telecommunication technology to: 1) allow parents more easy access to caregivers, 2) provide an immediate opportunity to request refills and inquire about their child's symptoms, and 3) provide educational and motivating messages about the importance of the child's daily asthma medication. This health- communication intervention will be delivered through state-of-the-art speech recognition (SR) technology. Advances in SR technology have made computer-generated conversation easier and more acceptable to respondents, and allow for correct interpretation of parents' spoken responses that in turn can lead to a range of appropriate SR responses. The investigative team has extensive experience using automated telecommunication technology to promote health-enhancing behavior change. The Benefit-Risk Model and Social Marketing Theory continue to guide both the objective and process of the intervention. Prospect Theory complements these and will guide development of the motivating messages to be contained in the SR intervention. This will be a Practical Clinical Trial aimed at the entire population of KPCO parents of a child receiving an inhaled corticosteroid (ICS) for asthma. It is expected that the 12-month TEAM intervention will increase ICS refill persistence and medication adherence (primary outcome) sufficient to produce significant improvement, relative to the usual-care control group, in asthma-related health outcomes as reflected in frequency of urgent care visits, prednisone use, beta2agonist use, and parent-reported symptom control and quality of life (secondary outcomes). A sub-study will randomly sample 200 families, both before and after participation in the TEAM intervention, to gather information about variables that may moderate the effectiveness of the intervention including race, socioeconomic status, illness severity, family structure, and benefit-risk perception. The presumption that prescription refilling is an accurate measure of adherence will be tested in a second sub-study that will use electronic devices to track ICS adherence. This system- based intervention has been designed using the RE-AIM framework so that it should have high reach and be consistently implemented at modest cost, and if effective, it can be maintained within KPCO as well as readily exported to other clinical healthcare settings