Pediaric asthma community based program(PACBP) Eliminating asthma

小儿哮喘社区计划 (PACBP) 消除哮喘

• 批准号: 8270534
• 负责人: Gloria Canino
• 金额: $ 45万
• 依托单位: UNIVERSITY OF PUERTO RICO MED SCIENCES
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-06-01 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8270534
• 关键词: Accident and Emergency department; Address; Admission activity; Affect; Age; Agonist; Anti-Inflammatory Agents; Anti-inflammatory; Asthma; Breathing; Caring; Centers of Research Excellence; Child; Childhood; Childhood Asthma; Chronic; Clinic; Clinical Trials Design; Communities; Cost Measures; Data; Education; Educational Intervention; Effectiveness; Environment; Ethnic group; Evaluation; Family; Family Policy; Future; Guidelines; Health; Health Policy; Hospitalization; Hospitals; Income; Institute of Medicine (U.S.); Intervention; Intervention Studies; Island; Knowledge; Latino; Low income; Measures; Minority Groups; Modeling; Morbidity - disease rate; Oral; Outpatients; Pharmaceutical Preparations; Pharmacy facility; Physicians; Policies; Practice Management; Prevalence; Prevention program; Provider; Puerto Rican; Puerto Rico; Quality of life; Randomized; Randomized Controlled Trials; Research; Research Design; Risk; Self Efficacy; Services; Severities; Societies; Steroids; Surveys; Symptoms; Testing; Training; Training Programs; United States; Visit; base; cost; cost effectiveness; design; evidence base; experience; family management; functional disability; health disparity; intervention program; novel; payment; primary outcome; programs; secondary outcome; service utilization; skills; success; therapy design

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.

波多黎各儿童哮喘发病率最高的任何etnic组，更有可能 与其他儿童相比，他们死于哮喘。在波多黎各， 与高收入儿童相比，贫困哮喘儿童接受的哮喘护理质量。作为 根据医学研究所的描述，这种健康差异可能是由多层次的障碍造成的， 适当的照顾。根据该调查小组开发的健康差异概念模型， 我们建议评估儿童哮喘社区项目（PACBP）的有效性， 一种新颖的多层次干预，旨在通过干预哮喘患者的 卫生政策、提供者和家庭层面。目标1将使用非实验性前后比较设计， 评估用药政策的历史变化（即，国家承担费用的责任 在波多黎各的一个试点卫生区，我们将使用自动索赔和药房数据 政策变更前一年和政策变更后一年半，以比较处方药的分配情况 控制性药物（ACM）、口服类固醇和β受体激动剂（主要结局），以及 儿童的急诊（艾德）就诊率和住院率（次要结局） 持续性哮喘。为了检查供应商水平变化的影响，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），一个以提供者为中心的教育干预，旨在增加 基于指南的护理。使用索赔数据，我们将比较ACM分发率（主要结局）， 以及β-激动剂和口服类固醇分配。我们还将比较基于指南的护理的图表审计， 和哮喘管理实践的提供者调查。研究家庭变化的影响， 目标3将使用随机对照试验来测试以家庭为基础的哮喘管理干预（FAMI），嵌套在诊所中 收到EBP的试点地区。这项干预措施旨在增加家庭知识、技能 哮喘管理的自我效能。FAMI研究的主要结果变量是无风险的 天次要结局包括ACM使用和生活质量，以及艾德访视和住院 入院、β受体激动剂和口服类固醇的使用以及功能障碍。最后，目标4将评估成本效益 儿童哮喘社区项目（PACBP）的每个级别。拟议 这项研究将是第一个测试文化适应，以社区为基础的干预，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。