DISEASE MANAGEMENT FOR ASTHMATICS IN MEDICAID HMOS

这项建议的核心假设是， (DM)该计划将提高成人哮喘患者的护理质量， 医疗保健组织。 为了验证这一假设，一项随机对照试验 将评估DM的临床有效性和经济影响 在门诊实践中。 主要临床指标将是 急诊科（艾德）就诊、住院、 限制活动日、无激素日和使用口服类固醇。 主要经济指标将是总量、平均数、增量 第一年按方案和保健费用衡量的费用 节目的年份。 我们还将计算标准经济比率 例如每一增量成果增量成本。 主要成果 这项研究将是DM计划对限制活动日的影响， 无病天数、健康状况和生活质量。 本研究的具体目的是：1）使用随机对照 初级保健实践的临床试验，以评估对 成人哮喘患者DM项目的临床结局; 2）评估 DM项目对患者报告的健康状况和质量的影响 探讨糖尿病项目对医疗服务的影响 使用，包括处方药的使用;以及4）进行 DM计划的计划性和按患者经济分析。 这项研究的结果将增加我们对糖尿病如何 基于初级保健实践的计划，可以影响临床结果， 健康状况和成人哮喘的费用。本研究将提供 为卫生保健组织、规划、 通过提醒决策者有效的计划 资源的开发和利用。 它将扩展其他DM的发现 研究通过：（i）使用严格的对照试验方法来评估 （二）实施干预措施， 由于临床严重程度和SES状态而处于高风险的患者， 以及（iii）评估两个方面的结果， 和健康相关的结果。

The central hypothesis of this proposal is that a disease management (DM) program will improve the quality of care to adults with asthma in Medicaid HMOs. To test this hypothesis, a randomized controlled trial will evaluate the clinical effectiveness and economic impact of a DM program in ambulatory practices. The main clinical indicators will be numbers of emergency department (ED) visits, hospitalizations, restricted activity-days, symptom-free days, and use of oral steroids. The main economic indicators will be the total, average, and incremental costs as measured by programmatic and health care costs in the first year of the program. We will also calculate standard economic ratios such as incremental cost per incremental outcome. The main outcomes in this study will be the DM program's effect on restricted activity-days, symptom-free days, health status, and quality of life. The specific aims of this study are to: 1) use a randomized controlled clinical trial of primary care practices to assess the effect on clinical outcomes of a DM program for adults with asthma; 2) assess the effects of the DM program on patient-reported health status and quality of life; 3) explore the effects of the DM program on medical service utilization, including prescription drug use; and 4) conduct a programmatic and per patient economic analysis of the DM program. The results of this study will increase our understanding of how a DM program, based in primary care practices, can affect clinical outcomes, health status, and costs in adult asthma. This study will provide relevant and timely information for health care organization, planning, and delivery by alerting decision makers to effective program development and use of resources. It will extend findings of other DM studies by: (i) using a rigorous controlled trial methodology to assess programmatic and economic results; (ii) applying the intervention to patients at high risk because of their clinical severity and SES status, and (iii) evaluating outcomes in terms of both health care utilization and health-related outcomes.