IMPROVING ASTHMA CARE FOR MINORITY CHILDREN IN HEADSTART

描述(由申请人提供)： 在低收入的非洲裔美国儿童中，与哮喘相关的发病率和死亡率高得不成比例。这一哮喘负担对幼儿及其家庭的影响尤其大，导致急诊科就诊率高、住院率高、生活质量下降，并有发生致命哮喘的风险。我们的研究和其他人的研究表明，导致这种高发病率的因素包括对哮喘初级预防护理的使用不足，次优的医疗管理，以及不适当的哮喘管理行为。尽管对儿童进行早期、定期的哮喘预防护理很重要，但事实证明，这一目标难以实现。Head Start计划为接触高风险、低收入的学龄前儿童和改善哮喘发病率提供了一个理想的场所。我们假设，消除预防哮喘护理的障碍和促进父母和初级保健提供者(PCP)之间的沟通是以最佳方式影响照顾者哮喘管理实践的必要先决条件。我们建议通过使用BreathMobile消除障碍，这是一项基于社区的服务，专门为哮喘筛查和直接向高危社区的家庭和儿童提供特殊咨询而设计。此外，我们将评估护理员/儿科医生沟通干预措施，旨在促进父母和儿科医生之间关于儿童哮喘严重程度和推荐治疗的沟通。拟议的2x2改良析因研究设计将比较呼吸运动干预结合促进哮喘沟通干预(FAI)与单独促进哮喘沟通干预、单独呼吸运动干预或对照组在降低哮喘发病率和改善哮喘管理方面的有效性。我们将招收360名患有有症状的医生诊断为哮喘的3至4岁的Head Start学生。主要的研究结果将以18个月内的无症状天数衡量。次要结果包括缺课、医疗保健利用(急诊科就诊、住院、初级保健就诊)、哮喘药物治疗、父母哮喘相关的生活质量、父母哮喘管理做法和成本效益。我们假设，促进哮喘沟通干预结合呼吸运动干预将在改善父母和儿童哮喘的PCP管理和降低哮喘发病率方面最有效。

DESCRIPTION (provided by applicant): Asthma-related morbidity and mortality are disproportionately high among low-income African-American children. The impact of this asthma burden is particularly great on very young children and their families, resulting in high rates of emergency department care, hospitalization, decreased quality of life, and the risk of fatal asthma. Our research and that of others suggests that the contributing factors to this high morbidity include under-use of asthma primary preventive care, sub-optimal medical management, and inappropriate asthma management behaviors. Despite the importance of early, regular asthma preventive care for children this goal has proved elusive. Head Start programs offer an ideal venue for accessing high-risk, low income pre-school children and improving asthma morbidity. We hypothesize that removing barriers to preventive asthma care and facilitating communication between parents and primary care providers (PCP) are necessary prerequisites to optimally influence caregivers' asthma management practices. We propose to remove barriers by use of the Breathmobile, a community-based service that is specifically designed to deliver asthma screening, and special consultation directly to families and children in high-risk neighborhoods. In addition, we will evaluate a caregiver/PCP communication intervention designed to facilitate communication between parents and PCPs about a child's asthma severity and recommended therapy. The proposed 2x2 modified factorial study design will compare the effectiveness of a Breathmobile Intervention combined with a Facilitated Asthma Communication Intervention (FACI) to a Facilitated Asthma Communication Intervention alone, the Breathmobile Intervention alone, or a Control Group in reducing asthma morbidity and improving asthma management. We will recruit 360 Head Start students aged 3 and 4 years with symptomatic doctor-diagnosed asthma. The primary study outcome measure will by Symptom-Free Days over 18 months. Secondary outcomes include school absences, health care utilization (emergency department visits, hospitalizations, primary care visits), asthma medications, parents' asthma related quality of life, parent asthma management practices, and cost-effectiveness. We hypothesize that a Facilitated Asthma Communication Intervention combined with the Breathmobile Intervention will be most effective in improving parent and PCP management of the child's asthma and reducing asthma morbidity.