CHICAGO INNER CITY ASTHMA STUDY

来自NCICAS的数据表明，多种风险因素相互作用， 增加贫困的城市少数民族儿童哮喘的严重程度。任何 干预措施以减少依赖医疗补助的人群的发病率 不仅应该是多方面的，而且价格也应该合理。因此， 芝加哥内城哮喘研究(CICAS)建议确定成本- 有效的干预措施将在4至12年内降低哮喘发病率- 患有重度/中度重度的老年少数民族/低收入城市儿童 哮喘。主要结果衡量标准是平均症状天数减少和 成本效益。次要措施包括其他发病率措施 (住院人数减少，计划外急诊减少，包括 呃，缺课)；提高患者/照顾者对哮喘的了解 输液装置/峰值流量计的管理、用药和使用； 提高初级保健医生的执业效率和哮喘护理 知识(包括书面哮喘管理计划)；改进 医生与患者/照顾者之间的沟通导致更大的 坚持；室内过敏原的减少；行为的减少 有问题。CICAS将评估三种基于HMO的干预措施和 将它们与对照组(组I)进行比较，在对照组中，患者接受常规的 关心。干预小组是根据附加原则设计的。每个人 后继组接受前一组的所有干预(S) 外加一项额外的干预措施。八个医生-提供者诊所站点 隶属于伊利诺伊州联合医疗保健(HMO)，为大型 芝加哥医疗补助人口的比例)将被随机分配到 这四个组。来自这些网站的儿童/家庭将接受筛查 并被招募参加这项研究。患者将接受皮肤测试和 肺活量测定，他们/护理员将完成各种书面评估 了解哮喘风险和哮喘知识。II-IV组将接待患者 由临床哮喘导师传授的教育，包括正确使用 药物和设备。这些群体中的初级保健医生将 参加以病例为基础的医生教育计划，该计划还将 强调使用哮喘护理指南和书面管理计划。一个 检查人员将走访第三组和第四组患者的家，以评估 环境风险因素。将提供有针对性的干预措施 有尘螨(如枕头、床垫)或蟑螂的病人 (灭绝)敏感的。第IV组中选定的患者(有 行为或其他难以解决的问题)将收到密集病例 管理层。在整个干预过程中，将对患者进行监测 电话每两个月一次。哮喘导师还将在 在每个诊所解决问题。成本效益高的成功干预措施 减少市中心少数民族儿童的发病率将是一个 对健康有显著的好处，并将为 负担过重的城市医疗体系。CICAS认为它的研究 设计允许确定最有效的干预措施 也是性价比高的。

Data from NCICAS indicate that a multiplicity of risk factors interact to increase the severity of asthma in poor, urban minority children. Any intervention to reduce morbidity in this Medicaid-dependent population should not only be multifaceted but also reasonably priced. Therefore, the Chicago Inner-City Asthma Study (CICAS) proposes to identify a cost- effective intervention that will reduce asthma morbidity in 4- to 12-year- old minority/low-income urban children with severe/moderately severe asthma. Primary outcome measures are reduction in mean symptom days and cost-effectiveness. Secondary measures include other morbidity measures (reductions in hospitalization, unscheduled acute-care visits including to ER, and school absences); improved patient/caretaker knowledge of asthma management, medications, and use of delivery devices/peak flow meters; increased primary-care physicians' practice effectiveness and asthma-care knowledge (including written asthma management plans); improved communication between physician and patient/caretaker leading to greater adherence; decrease in indoor allergens; and a reduction in behavior problems. The CICAS will evaluate three HMO-based interventions and compare them to a control group (Group I) in which patients receive usual care. The intervention groups are designed on an add-on principle. Each succeeding group receives all the interventions of the previous group(s) plus one additional intervention. Eight physician-provider clinic sites affiliated with United Health Care of Illinois (an HMO that serves a large proportion of Chicago's Medicaid population) will be randomized to one of the four groups. Children/families from these sites will be screened and recruited for the study. Patients will receive skin testing and spirometry, and they/caretakers will complete various written assessments of asthma risk and asthma knowledge. Groups II-IV will receive patient education taught by a clinic-based asthma mentor, including the proper use of medications and devices. Primary-care physicians in these groups will participate in a case-based physician education program that will also stress use of asthma-care guidelines and written management plans. An inspector will visit homes of patients in Groups III and IV to assess environmental risk factors. Targeted interventions will be provided for patients who are dust-mite (e.g., pillow, mattress covers) or cockroach (extermination) sensitive. Selected patients in Group IV (those with behavioral or other intractable problems) will receive intensive case management. Throughout the interventions, patients will be monitored bimonthly by telephone. The asthma mentor will also play a key role in problem-solving in each clinic. A successful cost-effective intervention that reduces morbidity among inner-city minority children would be a significant health benefit, and it would provide economic relief to the overburdened urban healthcare system. The CICAS believes that its study design permits the determination of the most effective intervention that is also cost-effective.