CHICAGO INNER CITY ASTHMA STUDY

NCICAS的数据表明，多种风险因素相互作用， 增加贫困城市少数民族儿童哮喘的严重程度。 任何 采取干预措施，降低依赖医疗补助人群的发病率 不仅要多方面，而且要价格合理。 因此，我们认为， 芝加哥市中心哮喘研究（CICAS）建议确定一项成本- 有效的干预措施，将减少哮喘发病率在4至12年- 少数民族/低收入城市老年重度/中重度儿童 哮喘 主要结果指标是平均症状天数的减少， 成本效益。 次要指标包括其他发病率指标 （减少住院、计划外急诊就诊，包括 急诊室和缺课）;改善患者/看护人对哮喘的了解 管理、药物和输送装置/峰值流量计的使用; 提高初级保健医生的实践效率和哮喘护理 知识（包括书面哮喘管理计划）;改善 医生和患者/护理人员之间的沟通， 坚持;减少室内过敏原;减少行为 问题 CICAS将评估三种基于HMO的干预措施， 将其与对照组（第I组）进行比较， 在乎 干预小组是根据附加原则设计的。 每个 下一组接受前一组的所有干预 加上一次额外的干预。 八个医生诊所 隶属于伊利诺伊州联合卫生保健（一个HMO，提供大型 芝加哥的医疗补助人口的比例）将被随机分配到 四个组。 将对这些研究中心的儿童/家庭进行筛查 并被招募参与研究。 患者将接受皮肤测试， 肺活量测定，他们/看护人将完成各种书面评估 哮喘风险和哮喘知识。 II-IV组将接受患者 由临床哮喘导师教授的教育，包括正确使用 药物和设备。 这些群体中的初级保健医生将 参加一个以病例为基础的医生教育计划， 强调使用哮喘护理指南和书面管理计划。 一个 督察会探访第三及第四组病人的居所， 环境风险因素。 将采取有针对性的干预措施， 尘螨患者（例如，枕头、床垫套）或蟑螂 （灭绝）敏感的。 第IV组中的选定患者（ 行为或其他棘手的问题）将得到密集的情况下， 管理 在整个干预过程中，将对患者进行监测 双月电话 哮喘导师也将发挥关键作用， 解决每个诊所的问题。 成功的成本效益干预 降低市中心少数民族儿童的发病率， 这对健康有很大的好处，它将为人们提供经济上的救济。 负担过重的城市医疗体系。 CICAS认为， 设计允许确定最有效的干预措施， 也具有成本效益。

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.