MULTIDIMENSIONAL APPROACH TO INNER CITY PEDIATRIC ASTHMA

描述(摘自申请者摘要)：哮喘发病率和 死亡率，包括住院率和急诊室(ER) 在过去的十年里，美国的游客数量一直在急剧上升， 特别是在服务不足的少数群体中。申请人的建议 研究将评估两种成分的疗效，一种双语哮喘 教育干预和环境干预旨在减少 家庭中与哮喘相关的可避免的空气过敏原 发病率。该计划将针对市中心患有哮喘的儿童 (4-12岁)，患有中重度疾病的儿童及其家人。 符合条件的儿童将从急诊科招募，并 儿童医学中心(CMC)的住院服务以及 柏克兰纪念医院(玛嘉烈)的住院服务 毗邻，有940个床位，县医院。孩子们将被随机 分配给接受初级护理或“常规护理”的群体 (无需额外干预)，那些将接受初级保健的人将 根据皮肤测试结果进行二次随机化，以避免 空气过敏原。在建立初级保健之后，皮肤 测试阴性的儿童将被随机分配到一组， 或未接受教育干预。皮肤测试呈阳性 儿童将被随机分配到四组中的一组：初级护理 单独、初级保健和教育干预、初级保健和 环境干预，或初级保健和两种干预措施。主要 护理最初将在CMC建立，并将由 根据全国哮喘教育对儿科住院医师进行教育 项目(NAEP)哮喘管理指南。随后，初级保健 将被转移到一家以公园为导向的附属社区 患者住所附近的初级保健(COPC)诊所。结果将是 评估将包括医疗设施利用率、肺功能、 与哮喘相关的功能状态、行为和自我管理 练习。虽然调查人员预计在以下方面会有适度的改善 调查人员预计，单独接受初级护理的儿童 同时接受教育和教育的儿童的情况有所改善 环境干预。申请者还打算解决社会问题， 心理和经济因素，以及卫生保健的提供和管理 导致本地区与哮喘相关的发病率的问题 人口。

DESCRIPTION (adapted from applicant's Abstract): Asthma morbidity and mortality, including rates of hospitalizations and emergency room (ER) visits have been rising dramatically in the U.S. over the last decade, particularly in minority, underserved populations. The applicants' proposed study will assess the effectiveness of two components, a bilingual asthma education intervention and an environmental intervention aimed at reducing pertinent avoidable aeroallergens in the home, on asthma-associated morbidity. The program will be targeted to inner-city asthmatic children (ages 4-12), who have moderate to severe disease, and their families. Eligible children will be recruited from the emergency department and inpatient services at Children's Medical Center (CMC) as well as from the inpatient services of Parkland Memorial Hospital (PMH), a physically-adjacent, 940-bed, county hospital. Children will be randomly assigned to a group that is to receive either primary care or "usual care" (no additional intervention), and those who are to receive primary care will undergo a secondary randomization based upon skin test results to avoidable aeroallergens. Following the establishment of primary care, skin test-negative children will be randomly assigned to a group that either does or does not receive the educational intervention. Skin test-positive children will be randomly assigned to one of four groups: primary care alone, primary care and an educational intervention, primary care and an environmental intervention, or primary care and both interventions. Primary care initially will be established at the CMC and will be provided by pediatric residents educated according to the National Asthma Education Program (NAEP) Asthma Management Guidelines. Subsequently, primary care will be transferred to one of the Parkland-affiliated Community Oriented Primary Care (COPC) Clinics near the patient's home. Outcomes to be assessed will include medical facility utilization, lung function, functional status, behavior as it relates to asthma, and self-management practices. While the investigators expect a modest degree of improvement in the children who receive primary care alone, the investigators expect marked improvement in those children who receive both the educational and environmental interventions. The applicants also intend to address social, psychological and economic factors, and health care delivery and management issues that contribute to the morbidity associated with asthma in this population.