NEBULIZER INTERVENTION IN MINORITY CHILDREN WITH ASTHMA

描述：低收入少数民族哮喘儿童不成比例地 急诊科（艾德）和医院护理的使用率较高， 其他孩子早期准确识别哮喘症状 及时和适当的哮喘药物使用与降低 艾德来访。在幼儿中，适当的药物使用包括准确的 症状感知和雾化器使用。在对低收入少数群体的试点研究中， 对有症状的哮喘儿童，我们观察到过度使用家用雾化器（48 %）、带垫片的定量吸入器（MDI）使用不足（2.7%）以及 峰值流量计（17%）。本研究旨在确定是否存在 强化家庭雾化器教育干预（NEI）将与 目的1：降低哮喘发病率，目的2：改善父母和子女的哮喘症状 目标3：增强适当的雾化器用药依从性， 目标4：证明与参加一个 标准哮喘教育干预（SAE）。艾德访视差异 哮喘、住院天数、急诊和初级保健就诊次数、学校 缺勤、活动受限、夜间症状、功能状态、质量 随访18个月，比较两组的生存时间（NEI SAE）。约翰霍普金斯艾德将作为我们的招聘网站。家属 中重度哮喘儿童，年龄2-8岁（N = 220）， 在过去12个月内，急诊室就诊或哮喘护理住院 并且目前正在使用雾化器的患者将被纳入研究。数据分析将包括 卡方检验、t检验、ANOVA和多元线性回归模型。的 将使用广义估计方程（GEE）来解决相关性 重复的措施。成本效益和成本效益比率将 以检查各组之间护理成本的差异。研究 结果将提供关于NEI干预效果的重要数据， 中度至重度哮喘儿童，干预的相对成本， 以及满足中度残疾儿童需要所需的主要组成部分， 严重哮喘。研究结果将改善对这种脆弱人群的临床护理 儿童人口，如果对卫生保健提供者有重大意义， 研究人员、保险公司和政策制定者。

DESCRIPTION: Low-income minority children with asthma have disproportionately high utilization rates o f emergency department (ED) and hospital care compared to other children. Early and accurate identification of asthma symptoms linked with timely and appropriate asthma medication use is associated with decreased ED visits. In young children appropriate medication use includes accurate symptom perception and nebulizer use. In a pilot study of low-income minority children with symptomatic asthma we observed overuse of home nebulizer (48 percent), underuse of metered dose inhaler (MDI) with spacers (2.7 percent) and peak flow meter (17 percent). This study is designed to determine if an intensive home Nebulizer Education Intervention (NEI) will be associated with Aim 1: reduced asthma morbidity, Aim 2 improved parent and child asthma symptom identification; Aim 3: enhanced appropriate nebulizer medication adherence and Aim 4: demonstrate cost effectiveness as compared to children enrolled in a standard asthma education intervention (SAE). Difference in ED visits for asthma, hospital days, number of urgent and primary care visits, school absences, restricted activity, nighttime symptoms, functional status, quality of life over 18 month follow-up will be compared between the two groups (NEI and SAE). The Johns Hopkins ED will serve as our recruitment site. Families of children with moderate-severe asthma, ages 2-8 years (N = 220) with > 1 emergency room visit or a hospitalization for asthma care in the past 12 months and currently using a nebulizer will be enrolled. Data analysis will include chi square test, t-tests, ANOVA, and multivariate linear regression models. The Generalized Estimating Equation (GEE) will be used to address the correlation of repeated measures. Cost-effectiveness and cost benefit ratios will be generated to examine for differences in cost of care between groups. Study outcomes will provide important data on the effects of a NEI intervention for children with moderate to severe asthma, the relative cost of the intervention, and the major components required to meet the needs of children with moderate to severe asthma. Study findings will improve clinical care to this vulnerable population of children and will be if significant use to health care providers, researchers, insurers and policy makers.