Healthy Homes II: Environmental/Clinical Asthma Control

描述(由申请人提供)： 这项建议的总体目标是更好地了解如何减少哮喘 不同种族低收入人群的发病率和卫生保健利用情况 3-13岁的儿童。特别是，关于居家锻炼有效性的证据 干预措施，强调控制与以下有关的环境触发因素 需要以临床为基础的干预措施。一半的参与者将 接受以临床为基础的哮喘教育、自我管理支持(哮喘 行动计划和自我监测)，哮喘控制资源(过敏 控制床上用品盖、峰值流量计和药物隔离器)和护理 由哮喘护士进行一年的协调(一级干预)。这个 另一半人将接受这些服务和室内环境评估， 基于评估数据、教育和 社会支持、鼓励行为改变、物质减少 暴露(床罩、吸尘器、门垫、清洁工具包和HEPA) 过滤器)，以及来自社区的为期一年的哮喘自我管理支持 卫生工作者(二级干预)。第二个目标是学习如何适应 这些干预措施使它们在文化上适合不同种族 人口。第三个目标是减少对其他家庭健康的暴露 风险，如铅、粉尘、石棉、杀虫剂、其他有毒家庭 化学品，以及受伤的风险。第四个目标是开发更好的工具 用于评估社区环境中的室内环境。决赛 目标是将这些活动整合到当地哮喘的工作中 联盟。 研究人员将对360名受试者进行随机对照试验 使用平行干预组和等待名单对照组进行比较 1级和2级相互干预的有效性以及 对照组。主要结果衡量标准将包括与哮喘相关的健康状况 生活状况和质量、医疗服务利用和暴露于室内 哮喘的诱因(螨虫、蟑螂、霉菌、烟草烟雾和宠物)。次要的 措施包括哮喘知识，控制环境诱因，以及 医疗管理；自我效能；与哮喘控制相关的行为。 他们将评估这两种干预水平的成本 卫生服务支付者的视角。调查人员希望这项研究 将产生一个可复制和可持续的模式，可供 医疗保险公司和医疗保健提供组织，并集成到 全面、协调的地方哮喘控制体系。该项目的 组织的基础是儿童的父母之间的伙伴关系 哮喘、社区组织、公共卫生机构和学术界， 并将遵循以社区为基础的合作研究原则。它是 由金县哮喘论坛主办，当地哮喘联盟与BREADS 哮喘患者、他们的家人和34个人的社区参与 机构，包括公共卫生-西雅图和金县，美国肺脏 华盛顿协会、美国哮喘和过敏症基金会 学区、社区卫生中心、医院、西雅图大学和 华盛顿大学。

DESCRIPTION (provided by applicant): The overall goal of this proposal is to understand better how to reduce asthma morbidity and health care utilization among low-income, ethnically diverse children age 3-13. In particular, evidence about the effectiveness of in-home interventions, emphasizing control of environmental triggers relative to clinic-based interventions, is needed. One-half of the participants will receive clinic-based asthma education, self-management support (an asthma action plan and self-monitoring), resources for asthma control (allergy control bedding covers, a peak flow meter, and a medication spacer) and care coordination for one year from an asthma nurse (level 1 intervention). The other half will receive these services plus in-home environmental assessment, an individualized home action plan based on assessment data, education, and social support, encouragement of behavior changes, materials to reduce exposures (bedding covers, vacuums, door mats, cleaning kits, and a HEPA filter), and asthma self-management support for one year from a community health worker (level 2 intervention). A second goal is to learn how to adapt these interventions so they are culturally appropriate for ethnically diverse populations. A third goal is to reduce exposures to other household health risks such as lead, dust, asbestos, pesticides, other toxic household chemicals, and risks for injuries. A fourth goal is to develop better tools for assessing the indoor environment in community-based settings. A final goal is to integrate these activities into the work of the local asthma coalition. The investigators will conduct a randomized controlled trial with 360 subjects using parallel intervention groups and a wait-list control group to compare the effectiveness of the level 1 and 2 interventions with each other and the control group. Primary outcome measures will include asthma-related health status and quality of life, medical care utilization, and exposure to indoor asthma triggers (mites, roaches, mold, tobacco smoke, and pets). Secondary measures include knowledge of asthma, control of environmental triggers, and medical management; self-efficacy; and behaviors related to asthma control. They will assess the costs of the two levels of intervention from the perspective of a health services payer. The investigators hope this research will result in a replicable and sustainable model which can be adopted by health insurers and health care delivery organizations and integrated into a comprehensive, coordinated local asthma control system. The project's organization is based upon partnerships between parents of children with asthma, community-based organizations, public health agencies, and academia, and will follow principles of community-based collaborative research. It is sponsored by the King County Asthma Forum, a local asthma coalition with broad community participation from people with asthma, their families, and 34 agencies, including Public Health - Seattle & King County, the American Lung Association of Washington, the Asthma and Allergy Foundation of American, school districts, community health centers, hospitals, Seattle University, and the University of Washington.