MCO USE OF A PEDIATRIC ASTHMA MANAGEMENT PROGRAM

哮喘是一种慢性呼吸道炎症性疾病，发病率和死亡率呈上升趋势。尽管有治疗指南，初级保健提供者仍未充分使用抗炎疗法。轻松呼吸是一个针对康涅狄格州哈特福德市中心儿童的哮喘管理项目。轻松呼吸以NHLBI：NAEPP指南为基础，使用经过验证的调查工具、基于哮喘严重性和NHLBI哮喘指南的标准化治疗菜单和标准化治疗计划。根据处方数据，遵守初级保健提供者在轻松呼吸方面的指南的比例为94%。然而，目前尚不清楚在轻松呼吸中获得的结果是否可以在其他社区和其他环境中重现。该项目的目标是：1.确定项目在有保险的、私人诊所、城市/郊区环境中实施时，轻松呼吸的重现性；2.确定与管理保健组织(MCO)合作传播和实施轻松呼吸是否是能够自我维持的有效策略；3.研究初级保健提供者在私人诊所环境中遵守指南对住院率、急诊室就诊、处方使用、患者/家庭满意度、生活质量和提供者满意度的有效性；4.计算哮喘的成本负担以及在MCO中轻松呼吸对该负担的影响。在一项随机研究中，轻松呼吸II将在哈特福德地区的18个社区实施，66个提供者照顾14,756名儿童，由一个MCO管理。在第二年，将为控制点提供二级轻松呼吸服务。结果衡量标准将包括：遵守指南、抗炎处方率和使用率、住院率和急诊室就诊率、患者/家人/提供者满意度以及患者/护理者的适应性感知和生活质量。此外，还将计算MCO管理哮喘的成本、哮喘患者实施轻松呼吸前后的总医疗成本以及轻松呼吸的成本。预计轻松呼吸将改善对指南的遵守，降低医疗成本，并提高提供者、患者和护理人员的满意度。

Asthma is a chronic, inflammatory disease of the airways with increasing morbidity and mortality. Despite the availability of treatment guidelines, primary care providers continue to under- use anti-inflammatory therapy. Easy Breathing is an asthma management program for inner city children in Hartford, CT. Easy Breathing is based upon the NHLBI: NAEPP guidelines and utilizes a validated survey instrument, a standardized treatment menu based upon asthma severity and NHLBI asthma guidelines and a standardized treatment plan. Adherence to guidelines for primary care providers in Easy Breathing, based upon prescribing data, is 94 percent. It is not known, however, whether the results obtained in Easy Breathing are reproducible in other communities and in other settings. The goals of this project are: 1. To determine the reproducibility of Easy Breathing when the program is implemented in an insured, private practice, urban/suburban setting; 2. To determine whether partnering with a managed care organization (MCO) to disseminate and implement Easy Breathing is an effective strategy that is capable of being self-sustained; 3. To study the effectiveness of adherence to guidelines by primary care providers in a private practice setting on hospitalization rates, emergency room visits, prescription utilization, patient/family satisfaction and quality of life and provider satisfaction; and 4. To calculate the cost burden of asthma and the effect of Easy Breathing in an MCO on that burden. In a randomized study, Easy Breathing II will be implemented in 18 communities in the Hartford area, with 66 providers who care for 14,756 children who are managed by a single MCO. Control sites will be offered Easy Breathing II during the second year. Outcome measures will include: adherence to guidelines, anti-inflammatory prescription rates and utilization rates, rates of hospitalization and emergency room visits, patient/family/provider satisfaction and patient/caregiver adaptive perceptions and quality of life. Additionally, the cost to the MCO to manage asthma, the total medical costs of the population with asthma before and after implementing Easy Breathing and the cost of Easy Breathing will be calculated. It is anticipated that Easy Breathing will result in improved adherence to guidelines, decreased medical costs and enhanced satisfaction by providers, patients, and caregivers.