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）

基本信息

批准号：
7862499
负责人：
Jane M Garbutt
金额：
$ 65.23万
依托单位：
WASHINGTON UNIVERSITY
依托单位国家：
美国
项目类别：
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/7862499
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

项目摘要

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）：降低哮喘发病率是公共卫生的优先事项。尽管国家准则建议与父母合作以进行有效的哮喘护理，但大多数初级保健提供者（PCP）不提供自我管理教育或支持，并且很难将其改善维护护理的有效干预措施分发到办公室实践中。我们以前由NHLBI资助的工作着重于减少低收入城市社区儿童中与哮喘相关的发病率和医疗保健的使用。我们已经证明，哮喘教练可以改善自我管理行为并减少哮喘住院，并在急诊室访问后可以提高PCP的随访率。在此竞争激烈的续签应用中，我们将将成功的基于理论的教练模型扩展到普通哮喘人群中，并将教练与电话哮喘教练计划（TAC）相结合到基于办公室的护理中。我们将进行一项随机对照试验以评估TAC计划。教练干预将发生在父母的水平上，但为了最大程度地减少污染，随机分组将在医师的水平上发生。使用分层的集群设计，我们将将24位社区儿科医生随机为干预或通常的护理对照组。所有参与的医生（干预和对照组）将收到最新的NAEPP指南，患者教育材料和哮喘患者的注册表。干预小组的医师将参加两次简短的会议，以介绍教练并将干预措施量身定制为实践。他们关心的哮喘儿童的父母将被邀请参加TAC计划，并与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务实的干预措施，并为PCP，教练和父母开发教育材料，以促进广泛的计划传播。我们的假设是，干预措施将通过改善父母和PCP提供的维护护理来减少儿童的哮喘发病率，并且将维持这些变化。目标人群是5至12岁的哮喘儿童，在前12个月中患有> 1个紧急护理发作。所有结果将通过父母访谈和12个月的图表审核来衡量。测量队列平均为40名患者/PCP（总1000名患者）。我们将确定干预措施是否减少哮喘障碍，以改善哮喘控制和与哮喘相关的生活质量；在12个月的目标人群中，通过紧急护理事件衡量的哮喘风险降低；并提高了PCP遵守国家哮喘护理指南。我们将从付款人和社会的角度评估成本效益。基于社区的哮喘护理中的主要参与者之间的合作导致了TAC计划的发展，并提供了一个评估该模型以将研究转化为基于办公室的实践的机会。公共卫生相关性：降低哮喘发病率是公共卫生的优先事项。该项目将通过改善父母和PCP提供的维护护理以及该计划具有成本效益，来评估将电话哮喘教练计划纳入办公室实践中是否会降低儿童哮喘发病率。