IMPROVING ASTHMA CARE FOR MINORITY CHILDREN IN HEADSTART

描述（由申请人提供）： 低收入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。 这种哮喘负担对非常年幼的儿童及其家庭的影响特别大，导致急诊室护理，住院率高，生活质量下降，以及致命性哮喘的风险。 我们和其他人的研究表明，导致发病率如此高的因素包括哮喘初级预防护理的使用不足、医疗管理不佳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，但这一目标已被证明是难以实现的。 先声夺人计划为接触高风险、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，消除预防性哮喘护理的障碍，促进父母和初级保健提供者（PCP）之间的沟通是必要的先决条件，以最佳地影响照顾者的哮喘管理实践。 我们建议通过使用Breathmobile来消除障碍，Breathmobile是一种基于社区的服务，专门用于提供哮喘筛查，并直接向高风险社区的家庭和儿童提供特别咨询。 此外，我们将评估护理人员/PCP沟通干预措施，旨在促进父母和PCP之间就儿童哮喘严重程度和推荐治疗进行沟通。 拟定的2x2改良析因研究设计将比较呼吸机干预联合易化哮喘沟通干预（FACI）与单独易化哮喘沟通干预、单独呼吸机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。 我们将招募360名3岁和4岁的有症状的医生诊断为哮喘的学生。 主要研究结局指标为18个月内的无症状天数。 次要结果包括缺课、卫生保健利用（急诊室就诊、住院、初级保健就诊）、哮喘药物、父母哮喘相关生活质量、父母哮喘管理实践和成本效益。 我们假设，促进哮喘沟通干预结合呼吸机干预将是最有效的改善家长和PCP管理儿童的哮喘和降低哮喘发病率。

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.