PRIMARY INSTEAD OF EMERGENCY CARE FOR CHILDHOOD ASTHMA

该应用程序是四个合作研究提案之一， 来自哈莱姆医院中心和哥伦比亚长老会医院的调查人员 医疗中心（CPMC）。在本提案中，CPMC的三个部门，即， 肺，过敏，和普通儿科，已经联合起来研究 如何最好地改善少数民族儿童的健康状况， 经常到急诊室（艾德）进行哮喘护理。同相 本研究将对300名儿童进行病例对照研究 了解为什么有些哮喘患者的家庭经常去艾德急诊室， 哮喘我们将比较三次或三次以上艾德就诊的儿童， 哮喘与儿童谁作出艾德访问其他条件，但 不是为了检验频繁使用艾德服务 哮喘护理与（1）缺乏持续的关系有关 与初级保健提供者;（2）哮喘的严重程度;（3）缺乏足够的 在家中控制哮喘的药物治疗或使用它的知识 正确;（4）在家中暴露于过敏原和刺激物;（5）社会 或家庭的人口特征;以及（6）社会混乱或 照顾孩子的人所经历的压力。在第二阶段，我们将开发一个 减少少数民族儿童哮喘发病率的模式， 进行试点研究，以确定最佳的招生和留用方法 子女经常到艾德门诊继续接受小学教育的家庭 由门诊护理网络公司提供的护理关系 （ACNC），CPMC的儿科教师实践。在第三阶段，我们将 一项对150名儿童的对照研究， 通常的艾德护理和转诊实践与一个实验组， 接受病例管理员/健康教育者的干预以登记， 让儿童继续接受ACNC的初级保健。我们假设 实验组的孩子和他们的家人更有可能 与对照组相比，（1）登记并保持持续护理关系， 和（2）改善健康状况和生活质量，如通过 减少症状和艾德就诊频率，改善峰值流速， 提高自我管理技能，减少对家庭生活的干扰。

This application is one of four collaborative research proposals by investigators from Harlem Hospital Center and Columbia Presbyterian Medical Center (CPMC). In this proposal, three divisions of CPMC, i.e., Pulmonary, Allergy, and General Pediatrics, have joined together to study how best to improve the health status of minority children who make frequent visits to the emergency department (ED) for asthma care. In Phase 1 of the research we will conduct a case-control study of 300 children with asthma to learn why some families make frequent visits to the ED for asthma. We will compare children who make three or more ED visits for asthma per year with children who made ED visits for other conditions, but not for asthma to test the hypotheses that frequent use of ED services for asthma care is associated with (1) absence of a continuing relationship with a primary care provider; (2) severity of asthma; (3) lack of adequate medical therapy to control asthma at home or the knowledge to use it correctly; (4) exposure to allergens and irritants in the home; (5) social or demographic characteristics of the family; and (6) social disruption or stress experienced by the child's caretaker. In Phase 2 we will develop a model for reducing asthma morbidity in minority children by conducting pilot studies to determine the best method for enrolling and retaining families whose children make frequent ED visits into continuing primary care relationships delivered by the Ambulatory Care Network Corporation (ACNC), a pediatric faculty practice at CPMC. In Phase 3 we will undertake a controlled study of 150 children comparing a control group that receives usual ED care and referral practices with an experimental group that receives an intervention by a case manager/health educator to enroll and retain children in continuing primary care with ACNC. We hypothesize that children and their families in the experimental group will be more likely than controls to (1) enroll and remain in continuing care relationships, and (2) have improved health status and quality of life, as measured by reduced frequency of symptoms and ED visits, improved peak flow rates, improved self-management skill, and reduced disruption of family life.