An Innovative Approach to Improving Asthma Control for World Trade Center Rescue and Recovery Workers through Telehealth Enriched Asthma Management (WTC-TEAM)

项目总结 哮喘在世贸中心(WTC)救援和恢复工作人员(响应者)中很常见。 此外，这一人群表现出疾病控制不力，医疗保健利用成本高， 特别是在受精神健康状况影响的应答者中。来自普通民众的证据 支持哮喘自我管理方案可以改善哮喘结果，包括哮喘控制 和卫生保健利用率。然而，哮喘自我管理目前不是WTC健康计划的一部分 项目(WTCHP)。老年人的哮喘发病率和死亡率比年轻人高 成年人对老龄化的WTC队列尤为突出，强调了哮喘的潜在自我 管理计划将成为满足这一人群独特需求的关键。 为了满足这种需求，我们开发了一种优化哮喘护理的创新方法： 远程健康丰富的哮喘管理(团队)计划。这一干预将利用现有的 WTCHP的临床基础设施，包括与WTC精神健康计划合作，以提供 哮喘自我管理，以加强目前的哮喘护理。团队计划还将利用 最近在WTCHP中增强了远程保健能力(为应对SARS-CoV-2而实施 通过提供一系列虚拟访问来提供哮喘自我管理教育。在这个范围内 强大的远程医疗和临床基础设施，团队将提供与其他组件协调的护理 WTCHP-治疗计划、精神健康计划、戒烟服务和社会工作- 通过多因素的方法，将促进吸收和遵守。团队的具体目标 计划是：1)开发一种干预措施，扩大远程医疗能力，改善哮喘护理；2) 收集和分析各种主观和客观的哮喘预后指标，以评估 团队干预的有效性；3)评估目前远程医疗平台利用的障碍 了解如何改进WTCHP远程医疗服务。 我们的建议是以证据为基础的，并回应了那些最重要的人的具体需求 受世贸中心灾难的影响。我们预计这项计划将改善对这些弱势群体的哮喘护理 人口，同时优化可针对其他健康状况实施的远程保健功能 影响世贸中心的应答者。

PROJECT SUMMARY Asthma is prevalent among World Trade Center (WTC) rescue and recovery workers (responders). Moreover, this population exhibits poorly controlled disease with high health care utilization costs, particularly among responders affected by mental health conditions. Evidence from the general population supports that asthma self-management programs can improve asthma outcomes, including asthma control and health care utilization. However, asthma self- management is not currently part of the WTC Health Program (WTCHP). That asthma morbidity and mortality are higher in older adults compared to younger adults is particularly salient for the aging WTC cohort, underscoring the potential for asthma self- management programs to become vital to meeting the unique needs of this population. To address this need, we developed an innovative approach to optimizing asthma care: the Telehealth Enriched Asthma Management (TEAM) program. This intervention will utilize the existing clinical infrastructure of the WTCHP, including partnering with the WTC Mental Health Program, to provide asthma self-management to enhance current asthma care. The TEAM program will also leverage the recently augmented telehealth capabilities in the WTCHP (implemented in response to the SARS-CoV-2 pandemic) by delivering a series of virtual visits to provide asthma self-management education. Within this robust telehealth and clinical infrastructure, TEAM will provide care coordinated with other components of the WTCHP— Treatment Program, Mental Health Program, smoking cessation services, and social work— via a multifactorial approach that will promote uptake and adherence. The specific aims of the TEAM program are to: 1) develop an intervention that will expand telehealth capabilities to improve asthma care; 2) collect and analyze a variety of subjective and objective asthma outcome measures to evaluate the effectiveness of the TEAM intervention; 3) evaluate current barriers to telehealth platform utililzation as well as satisfaction with virtual encounters to understand how to improve WTCHP telehealth delivery. Our proposal is evidence-based and responds to the specific needs of those most significantly impacted by the WTC disaster. We anticipate that this program will improve asthma care for this vulnerable population, while optimizing telehealth capabilities that can be implemented for other health conditions affecting WTC responders.