Parents, Pediatricians and Telephone Coaches Partner to Improve Control (PARTNER)

TAC摘要 减少哮喘发病率是公共卫生的优先事项。尽管国家指南建议 与父母合作进行有效的哮喘护理，大多数初级保健提供者(PCP)不提供- 进行自我管理教育或支持，以及有效的干预措施，以改善维护护理 很难推广到办公室实践中。我们之前由NHLBI资助的工作重点是减少与哮喘相关的 低收入城市社区儿童的发病率和医疗保健使用情况。我们已经证明了一个 开设哮喘教练可以改善自我管理行为，减少哮喘住院，并可以 提高急诊科就诊后PCP的随访率。在这场竞争性的更新中 我们将把我们成功的以理论为基础的教练模式推广到普通哮喘人群中， 并将指导与电话哮喘指导计划(TAC)整合到基于办公室的护理中。 我们将进行一项随机对照试验来评估TAC计划。教练干预 将发生在父级级别，但为了最大限度地减少污染，随机化将发生在 医生。使用分层整群设计，我们将随机选择24名社区儿科医生参加干预或 常规护理对照组。所有参与的医生(干预组和对照组)将收到一份摘要 最新的NAEPP指南、患者教育材料和哮喘患者登记。 干预组的医生将参加两个简短的会议，介绍指导和量身定做 对他们的实践实施干预。他们照顾的哮喘儿童的父母将被邀请到 参与TAC计划，并与非现场哮喘教练合作，促进有效的自我管理 以及与PCP的合作伙伴关系。 我们将评估这一社区中的务实干预，并为以下方面开发教育材料 PCP、教练和家长，以促进广泛的计划传播。我们的假设是 干预措施将通过改善由儿童基金会提供的维持护理来减少儿童哮喘发病率 父项和PCP，这些更改将被保留。目标人群是哮喘儿童，他们 年龄在5至12岁之间，在过去12个月内有过1次紧急护理。所有结果都将由 在12个月和24个月时与父母面谈和图表审计。测量队列将平均为40 患者/初级保健医生(共1000名患者)。我们将确定是否干预：减少测量的哮喘损害 改善哮喘控制和哮喘相关生活质量；通过紧急护理降低哮喘风险 在12个月内在目标人群中发作；并改进对以下方面国家指导方针的遵守 儿科医生对哮喘的护理。我们将从付款人和社会的角度来评估成本效益。 社区哮喘护理的主要参与者之间的合作导致了TAC的发展 计划，并为评估这一模式提供了机会，以将研究转化为基于办公室的实践。期末项目叙述。 减少哮喘发病率是公共卫生的优先事项。该项目将评估是否有电话哮喘辅导 整合到办公室实践中的计划将通过改善以下方面减少儿童哮喘发病率 由父母和PCP提供的维护护理，以及该计划是否具有成本效益。

TAC ABSTRACT Reducing asthma morbidity is a public health priority. Despite National guidelines that recommend collaboration with the parent for effective asthma care, most primary care providers (PCPs) do not provide on- going self-management education or support, and effective interventions to improve maintenance care are difficult to disseminate into office practice. Our prior NHLBI-funded work focused on reducing asthma-related morbidity and healthcare use in children from low-income, urban neighborhoods. We have demonstrated that a lay asthma coach can improve self-management behaviors and reduce asthma hospitalizations, and can improve rates of follow-up with a PCP after an emergency department visit. In this competitive renewal application we will extend our successful theory-based coaching model into the general asthma population, and integrate coaching into office-based care with the Telephone Asthma Coaching program (TAC). We will conduct a randomized controlled trial to evaluate the TAC program. The coaching intervention will occur at the level of the parent, but to minimize contamination, randomization will occur at the level of the physician. Using a stratified cluster design, we will randomize 24 community pediatricians to the intervention or usual care control group. All participating physicians (intervention and control groups) will receive a summary of the most recent NAEPP guidelines, patient education materials and a registry of their asthma patients. Physicians in the intervention group will participate in two brief meetings to introduce coaching and to tailor implementation of the intervention to their practice. Parents of asthmatic children they care for will be invited to participate in the TAC program and work with an off site asthma coach to facilitate effective self-management and a collaborative partnership with the PCP. We will evaluate this pragmatic intervention in the community, and develop educational materials for PCPs, coaches and parents to facilitate widespread program dissemination. Our hypothesis is that the intervention will reduce asthma morbidity among children by improving maintenance care provided by the parent and the PCP, and these changes will be maintained. The target population is asthmatic children who are 5 to 12 years old and had >1 urgent care episode in the prior 12 months. All outcomes will be measured by parent interviews and chart audits at 12 and 24 months. The measurement cohort will average 40 patients/PCP (total 1000 patients). We will determine if the intervention: reduces asthma impairment measured as improved asthma control and asthma-related quality of life; reduces asthma risk measured by urgent care episodes among the target population in 12-months; and improves adherence to National guidelines for asthma care by the PCP. We will assess cost effectiveness from the perspective of the payor and society. Collaboration between key players in community-based asthma care resulted in development of the TAC program, and affords an opportunity to evaluate this model to translate research into office-based practice. Final Project Narrative. Reducing asthma morbidity is a public health priority. This project will evaluate if a telephone asthma coaching program that is integrated into office practice will reduce asthma morbidity among children by improving maintenance care provided by the parent and the PCP, and if the program is cost-effective.