Asthma Express: Bridging Emergency to Primary Care in Underserved Children

描述（由申请人提供）：哮喘是儿童时期主要的慢性疾病，是幼儿去儿科急诊 (ED) 就诊的首要原因，并对医疗费用产生重大影响。急诊科通常是低收入儿童的接触点，许多家庭将急诊科视为哮喘护理的主要来源。贫困儿童和少数民族儿童的哮喘发病率最高，最不可能接受足够的预防治疗或特殊护理，并且比非贫困儿童更频繁地接触环境诱因。然而，包括我们的试点在内的先前研究表明，经常就诊哮喘的儿童将前往急诊科进行一次性随访诊所进行哮喘“检查”和教育。这项随机对照试验的目的是测试一种药物的功效 多方面的急诊初级保健提供者 (PCP) 和家庭干预 Asthma Express (AEx)，针对每年 2 次以上哮喘急诊就诊或 1 次住院治疗的儿童，提供基于指南的定制哮喘护理。在急诊室就诊期间收集的过敏和可替宁生物标志物用于针对干预措施的家庭环境控制部分。将 AEx 干预 (n=132) 与注意力控制 (CON) 组 (n=132) 进行比较，以实现以下具体目标：(1) 降低哮喘发病率（增加无症状日数和夜间数），减少急诊就诊和住院次数，提高哮喘控制和护理人员的生活质量，(2) 根据儿童药房补充记录改善适当预防性抗炎药物的使用，(3) 比较该干预措施的经济成本和效果。过去 12 个月内 2 次哮喘急诊就诊或 1 次住院且当前因哮喘就诊的 3-12 岁儿童将从约翰霍普金斯大学儿科急诊科招募，并进行 12 个月的随访。将在基线、6 个月和 12 个月收集症状频率、医疗保健利用率、护理人员生活质量和可替宁测量值，并在基线和 12 个月收集药房数据。数据分析包括按组对健康结果进行初步交叉制表（AEx 与 CON）和多元广义线性回归模型，以研究 AEx 治疗对平均无症状日/夜、重复急诊就诊、住院和护理人员生活质量评分以及抗炎药物补充的影响。将比较各组（AEx 和 CON）之间的 ED、PCP 就诊、住院天数和药物费用的平均总费用，以进行经济分析。 AEx 模型的设计易于使用、基于指南、易于复制并纳入急诊室护理。如果成功，这项研究将填补急诊科向预防性哮喘干预研究过渡的关键空白。

DESCRIPTION (provided by applicant): Asthma, the leading chronic disorder in childhood, is the number one cause of pediatric emergency department (ED) visits in young children and is responsible for a substantial impact on healthcare costs.The ED is often the point of contact for low-income children and many families view the ED as their primary source of asthma care. Poor and minority children have the highest asthma morbidity, are the least likely to receive adequate preventive therapy or specialty care and more frequently exposed to environmental triggers than non-poor children. However, prior studies, including our pilot, indicate that childre with frequent asthma ED visits will attend a one-time ED-based follow-up clinic for an asthma "check-up" and education. The goal of this randomized controlled trial is to test the efficacy of a multifaceted, ED + primary care provider (PCP) and home-based intervention, Asthma Express (AEx), for children with > 2 asthma ED visits or 1 hospitalization/year that provides tailored guideline based asthma care. Allergy and cotinine biomarkers, collected during the ED visit, are used to target the home environmental control component of the intervention. The AEx intervention (n=132) will be compared to an attention control (CON) group (n=132) for the specific aims: (1) to reduce asthma morbidity (increase symptom free days and nights) and decrease ED visits and hospitalizations and increase asthma control and caregiver quality of life, (2) to improve the use of appropriate preventive anti-inflammatory medication based on child pharmacy refill records and (3) to compare the economic cost and effects of this intervention. Children aged 3-12 years with > 2 asthma ED visits or 1 hospitalization within the past 12 months and a current ED visit for asthma will be recruited from the Johns Hopkins Pediatric-ED and followed for 12 months. Symptom frequency, health care utilization, caregiver quality of life and cotinine measures will be collected at baseline, 6 and 12 months and pharmacy data collected at baseline and 12 months. Data analysis includes initial cross tabulations of health outcomes by group (AEx vs. CON) and multivariate generalized linear regression models to study the effects of the AEx treatment on mean symptom free days/nights, repeat ED visits, hospitalizations and caregiver quality of life scores and anti-inflammatory medication refills. Mean total costs of ED, PCP visits, hospital days and medication costs will be compared between groups (AEx and CON) for the economic analysis. The AEx model is designed to be accessible, guideline-based, easily replicated and incorporated into ED care. If successful, this study will fill critical gaps in the ED transition to preventive care asthma interventional research.