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

项目摘要 哮喘在世界贸易中心（WTC）救援和恢复工作人员（响应者）中很普遍。 此外，这一人群的疾病控制不佳，医疗保健使用成本高， 特别是在受心理健康状况影响的响应者中。来自普通人群的证据 支持哮喘自我管理计划可以改善哮喘的结果，包括哮喘控制 和卫生保健利用率。然而，哮喘自我管理目前还不是世贸中心健康的一部分 WTCHP计划。老年人的哮喘发病率和死亡率高于年轻人， 在老年WTC队列中，成年人尤其突出，强调了哮喘自身的可能性， 管理计划成为满足这一人口的独特需求至关重要。 为了满足这一需求，我们开发了一种创新的方法来优化哮喘护理： 远程健康强化哮喘管理（TEAM）计划。本次活动将利用现有的 WTCHP的临床基础设施，包括与WTC心理健康计划合作， 哮喘自我管理，以加强目前的哮喘护理。团队计划还将利用 WTCHP最近增强了远程医疗能力（为应对SARS-CoV-2而实施 大流行），提供一系列的虚拟访问，提供哮喘自我管理教育。在这 强大的远程医疗和临床基础设施，团队将提供与其他组成部分协调的护理， WTCHP-治疗方案、心理健康方案、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。工作队的具体目标 该计划的目的是：1）开发一种干预措施，扩大远程医疗能力，以改善哮喘护理; 2） 收集和分析各种主观和客观哮喘结果指标， TEAM干预的有效性; 3）评估远程医疗平台利用的当前障碍 作为满意的虚拟遭遇，以了解如何改善WTCHP远程保健服务。 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。 受世贸中心灾难影响。我们预计，这一计划将改善哮喘护理， 人口，同时优化可用于其他健康状况的远程保健能力 影响到世贸中心的救援人员

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.