NATIONAL COOPERATIVE INNER-CITY ASTHMA STUDY

描述（改编自申请人的摘要）：哮喘是最常见的 儿童慢性病，这是一个负担不成比例地分担， 贫民区的非裔美国儿童 可能降低哮喘的因素 高质量的全面医疗护理，文化敏感， 外展，强调自我管理技能，环境和 行为矫正，以及更协调的护理提供方法。 申请人提出了一项前瞻性随机对照试验， 评估文化敏感的协调方法的有效性 对患有中度或重度哮喘的市中心儿童进行哮喘护理。 将儿童随机分为三组：（1）加强常规护理 （I组）;（2）协调护理（II组）;和（3）协调护理加 环境改造（第三组），每项为期24个月。 所有群体的提供者将接受国家心肺和血液培训 研究所（NHLBI）哮喘管理指南，并将有几个 加强教育和管理。 第二组将每两个月收到一次 哮喘病人家访 外展工作人员和学校护士每周评估。 的 照顾这些儿童的儿科医生将在治疗期间使用这些信息。 定期门诊访视，包括哮喘教育课程。 第三组将接受协调护理干预， 旨在尽量减少儿童接触尘螨的干预措施， 环境烟草烟雾（ETS）。 将评估第二组和第三组干预措施的影响 根据以下四个领域：（1）生理测量 （乙酰甲胆碱激发，一秒用力呼气量（FEV-1）， 呼气峰流速;（2）卫生保健用途（哮喘住院和 急症诊所及急症室）;及（3）环保措施 （家庭尘螨浓度、二氧化氮（N 02）和细颗粒物） 颗粒物浓度、尿可替宁水平和家庭 湿）;和（4）功能状态测量（药物使用， 生活，家庭功能）。

DESCRIPTION (adapted from applicant's Abstract): Asthma is the most common chronic illness of childhood, a burden disproportionately shared by inner-city, African-American children. Factors that may decrease asthma morbidity are high-quality comprehensive medical care, culturally-sensitive outreach which emphasizes self-management skills, environmental and behavioral modification, and a more coordinated approach to care delivery. The applicants propose a prospective, randomized controlled trial to evaluate the effectiveness of a culturally-sensitive, coordinated approach to asthma care in inner-city children with moderate or severe asthma. Children will be randomized into three groups: (1) augmented usual care (Group I); (2) coordinated care (Group II); and (3) coordinated care plus environmental modification (Group III), each of 24-months duration. Providers for all groups will be trained in National Heart Lung and Blood Institute (NHLBI) asthma management guidelines and will have several educational and management enhancements. Group II will receive bi-monthly home visits by a lay asthma outreach worker and weekly assessments by the school nurse. The pediatricians caring for these children will use this information during scheduled clinic visits, which will include an asthma education curriculum. Group III will receive the coordinated care intervention plus specific interventions designed to minimize the child's exposure to dust mites and environmental tobacco smoke (ETS). The impact of the interventions in Groups II and III will be assessed according to the following four domains: (1) physiologic measures (methacholine challenge, forced expiratory volume in one second (FEV-1), peak expiratory flow rate; (2) health care use (asthma hospitalizations and acute visits to clinics and emergency rooms); and (3) environmental measures (household dust mite concentrations, nitrogen dioxide (N02) and fine particulate matter concentrations, urinary cotinine levels, and household dampness); and (4) functional status measures (medication use, quality of life, and family function).