MULTIDIMENSIONAL APPROACH TO INNER CITY PEDIATRIC ASTHMA

描述（改编自申请人的摘要）：哮喘发病率和 死亡率，包括住院率和急诊率 在过去的十年里，美国的访问量急剧上升， 特别是在少数民族，得不到充分服务的人群中。 申请人的建议 研究将评估两个组成部分的有效性，一个双语哮喘 教育干预和环境干预， 相关的可避免的空气过敏原在家里，对哮喘相关的 发病率 该计划将针对市中心的哮喘儿童 (ages 4-12），谁有中度至重度疾病，和他们的家人。 符合条件的儿童将从急诊科招募， 儿童医疗中心（CMC）的住院服务以及 帕克兰纪念医院（PMH）的住院服务， 相邻的有940个床位的县医院 孩子们将随机 分配到接受初级护理或“常规护理”的群体 (no其他干预措施），而那些接受初级保健的人将 根据皮试结果进行二次随机化，以避免 空气过敏原 随着初级保健的建立，皮肤 测试阴性的孩子将被随机分配到一组， 或者不接受教育干预。 皮试阳性 儿童将被随机分配到四个组之一：初级保健 单独，初级保健和教育干预，初级保健和 环境干预或初级保健以及两种干预措施。 初级 护理最初将在CMC建立，并将由 根据国家哮喘教育对儿科住院医师进行教育 NAEP哮喘管理指南。 其次，初级保健 将被转移到一个公园附属的社区导向 初级保健（COPC）诊所靠近患者的家。 结果将是 评估将包括医疗设施利用率，肺功能， 功能状态、与哮喘相关的行为和自我管理 实践 虽然调查人员预计， 对于那些单独接受初级保健的儿童，研究人员预计， 改善那些既接受教育， 环境干预。 申请人还打算解决社会问题， 心理和经济因素，以及卫生保健的提供和管理 在这个过程中，与哮喘相关的发病率相关的问题 人口

DESCRIPTION (adapted from applicant's Abstract): Asthma morbidity and mortality, including rates of hospitalizations and emergency room (ER) visits have been rising dramatically in the U.S. over the last decade, particularly in minority, underserved populations. The applicants' proposed study will assess the effectiveness of two components, a bilingual asthma education intervention and an environmental intervention aimed at reducing pertinent avoidable aeroallergens in the home, on asthma-associated morbidity. The program will be targeted to inner-city asthmatic children (ages 4-12), who have moderate to severe disease, and their families. Eligible children will be recruited from the emergency department and inpatient services at Children's Medical Center (CMC) as well as from the inpatient services of Parkland Memorial Hospital (PMH), a physically-adjacent, 940-bed, county hospital. Children will be randomly assigned to a group that is to receive either primary care or "usual care" (no additional intervention), and those who are to receive primary care will undergo a secondary randomization based upon skin test results to avoidable aeroallergens. Following the establishment of primary care, skin test-negative children will be randomly assigned to a group that either does or does not receive the educational intervention. Skin test-positive children will be randomly assigned to one of four groups: primary care alone, primary care and an educational intervention, primary care and an environmental intervention, or primary care and both interventions. Primary care initially will be established at the CMC and will be provided by pediatric residents educated according to the National Asthma Education Program (NAEP) Asthma Management Guidelines. Subsequently, primary care will be transferred to one of the Parkland-affiliated Community Oriented Primary Care (COPC) Clinics near the patient's home. Outcomes to be assessed will include medical facility utilization, lung function, functional status, behavior as it relates to asthma, and self-management practices. While the investigators expect a modest degree of improvement in the children who receive primary care alone, the investigators expect marked improvement in those children who receive both the educational and environmental interventions. The applicants also intend to address social, psychological and economic factors, and health care delivery and management issues that contribute to the morbidity associated with asthma in this population.