Medicaid Asthma Home Visit Project- Improving Health and Reducing Costs of Health

描述（由申请人提供）：西雅图-金县健康之家是控制低收入儿童哮喘的循证方法。我们建议的第一个目标是将基于研究的模型转化为实践，评估翻译对原始模型评估中包含的哮喘相关结果的影响，并描述翻译过程。我们的第二个目标是评估翻译模型的成本效益和投资回报率。我们希望证明，健康之家是一个可复制的、具有成本效益的模式，可以提供给所有受医疗补助保险的哮喘不受控制的儿童。背景：哮喘仍然是儿童最常见的慢性疾病，影响9.1%的美国儿童。自1980年以来，哮喘发病率翻了一番，并保持在历史高位。哮喘教育在降低哮喘发病率和紧急卫生服务利用率方面是有效的。美国国立卫生研究院已将其确定为哮喘控制的核心策略。然而，由于准入障碍，许多哮喘儿童及其看护人没有参与哮喘教育。在家里提供教育可能会增加参与率。最近的研究表明，通过家访提供哮喘教育可以减少哮喘症状和紧急医疗保健的利用。疾控中心社区预防服务指南最近推荐家访作为一种有效的干预措施。更广泛地实施家访方法的一个主要障碍是卫生保健支付者缺乏对这项服务的报销，他们需要这种干预的投资回报率的证据。干预措施：一名社区卫生工作者（CHW）将在一年多的时间里到200名参加医疗补助的哮喘不受控制的儿童家中进行访问。CHW是一名同伴教育者，提供量身定制的、适合文化的哮喘教育。她将评估目前的哮喘控制状况、自我管理做法和家中哮喘诱因的存在，并帮助儿童及其看护人更有效地使用药物，预防和管理病情恶化，促进获得卫生服务和与提供者沟通，并减少接触哮喘诱因。他们将为参与者提供减少接触触发器的工具（例如真空）。另一个重要作用是提供工具、信息和情感支持。评估：我们将使用RE-AIM框架和基于社区的参与性研究方法来评估翻译过程。我们将完成一项准实验研究，利用行政索赔和自我报告的哮喘控制数据来评估干预的成本效益和投资回报率。

DESCRIPTION (provided by applicant): Seattle-King County Healthy Homes is an evidence-based approach for controlling asthma among low-income children. The first aim of our proposal is to translate the research-based model into practice, assess the impact of translation on the asthma-related outcomes included in evaluation of the original model, and describe the translation process. Our second aim is to assess the cost-effectiveness and return on investment (ROI) of the translated model. We hope to demonstrate that Healthy Homes is a replicable and cost-effective model that can be provided to all children with uncontrolled asthma insured by Medicaid. Background: Asthma remains the most common chronic condition of childhood, affecting 9.1% of all American children. The rate of asthma has doubled since 1980 and remains at historically high levels. Asthma education is effective in reducing asthma morbidity and urgent health services utilization. The National Institutes of Health has identified it as a core asthma control strategy. However, many children with asthma and their caretakers do not participate in asthma education because of access barriers. Offering education in the home may increase participation. Recent research shows that providing asthma education through home visits results in reductions in asthma symptoms and urgent health care utilization. The CDC Guide to Community Preventive Services recently recommended home visits as an effective intervention. A major barrier to wider implementation of the home visit approach is lack of reimbursement for this service by health care payers, who need evidence of the ROI of this intervention. Intervention: A community health workers (CHW) will visit 200 Medicaid-insured children with uncontrolled asthma in their homes over a year. A CHW is a peer educator who provides tailored, culturally-appropriate asthma education. She will assess current asthma control status, self-management practices and the presence of asthma triggers in the home and help children and their caretakers use medications more effectively, prevent and manage exacerbations, facilitate access health services and communication with providers, and reduce exposure to asthma triggers. They will provide participants with tools to reduce exposure to triggers (e.g. a vacuum). Another important role will be provision of instrumental, informational and emotional support. Evaluation: We will use the RE-AIM framework and community-based participatory research methods to assess the translation process. We will complete a quasi-experimental study to assess the cost-effectiveness and ROI of the intervention using administrative claims and self-reported asthma control data. PUBLIC HEALTH RELEVANCE: Information on the cost-effectiveness of CHW home visits for asthma will enable policy makers to assess the health and economic benefits of providing this service to all children with uncontrolled asthma who are insured by Medicaid. Home visits have the potential not only to improve children's health but also to reduce Medicaid expenditures.