ASTHMA SCHOOL INITIATIVE: EVALUATING 3 MODELS OF CARE

虽然哮喘是一种可以控制的疾病，可以接受初级保健，但它已经成为市中心儿童住院的一个越来越常见的原因。包括难以获得医疗保健在内的因素是导致高住院率的原因。虽然报告了许多干预措施，但它们并没有在贫困社区得到广泛采用或评估。Montefiore医疗中心学校健康计划运营着11个以学校为基础的健康中心(SBHC)，为纽约布朗克斯区的10,000名弱势公立学校学生提供服务。SBHC克服了许多准入障碍，为儿童提供了适当使用门诊服务的机会。它们还为引入和评估旨在降低发病率和成本的哮喘干预措施提供了理想的环境。这项为期三年的研究的目标是：1)确定在学校环境下的传统初级保健模式中增加积极主动的外展部分是否会对哮喘儿童的健康状况和学校表现产生可衡量的影响；以及2)研究在SBHC实施这种主动的哮喘护理模式的经济影响。该项目将涉及六所布朗克斯小学--两所没有SBHC的学校，以及四所由Montefiore医疗中心学校健康计划运营的SBHC的学校。其中两所设有母婴健康院的学校将被指定为主动或干预地点。结果将根据三种学校健康模式进行比较：(1)控制模式，对于没有SBHC的学校；(2)传统模式，对于有SBHC的学校，治疗在场的儿童；以及，(3)主动模式，对于有SBHC和积极的外展计划的学校。将以基线和定期间隔收集人口和社会经济特征，以调整人口之间的差异，并比较三年期间感兴趣的结果。此外，将收集相关过程数据，以记录干预的成功要素，以促进与常规临床实践的整合。

Although asthma is a manageable disease, amenable to primary care, it has become an increasingly common cause of hospital admissions among inner-city children. Factors including poor access to health care contribute to high hospitalization rates. Though numerous interventions have been reported, they have not been widely adopted or evaluated in poor communities. The Montefiore Medical Center School Health Program operates 11 school-based health centers (SBHCs) serving 10,000 disadvantaged public school students in the Bronx, New York. SBHCs overcome many access barriers and provide an opportunity to engage children in the appropriate use of outpatient services. They also offer an ideal setting for the introduction and evaluation of an asthma intervention designed to reduce morbidity and costs. The goals of this three-year study are: 1) to determine whether the addition of a pro-active outreach component to the traditional model of primary care in a school setting will have a measurable effect on the health status and school performance of children with asthma; and, 2) to examine the economic implications of implementing this pro-active model of asthma care in SBHCs. This project will involve six Bronx elementary schools--two schools that do not have SBHCs, and four that have SBHCs run by the Montefiore Medical Center School Health Program. Two of the schools with SBHCs will be designated as pro-active or intervention sites. Outcomes will be compared according to three models of school health: (1) the control model, for schools without SBHCs; (2) the traditional model, for schools with SBHCs treating children who present for care; and, (3) the pro-active model for schools with SBHCs and aggressive outreach programs. Demographic and socioeconomic characteristics will be collected at baseline and at regular intervals to adjust for variation between the populations, and outcomes of interest compared over a three year period. In addition, relevant process data will be gathered to document successful elements of the intervention to facilitate integration with routine clinical practice.