Asthma Express: Bridging Emergency to Primary Care in Underserved Children

简介(申请人提供)：哮喘是儿童时期的主要慢性疾病，是幼儿去儿科急诊科就诊的头号原因，并对医疗费用造成重大影响。急诊科通常是低收入儿童的接触点，许多家庭认为急诊科是他们照顾哮喘的主要来源。与非贫困儿童相比，贫困儿童和少数族裔儿童的哮喘发病率最高，接受适当预防治疗或特殊护理的可能性最小，更经常受到环境因素的影响。然而，先前的研究，包括我们的试验，表明哮喘儿童经常去急诊科就诊，会到一次性的以急诊科为基础的后续诊所进行哮喘“检查”和教育。这项随机对照试验的目标是测试一种 多方面的，ED+初级保健提供者(PCP)和基于家庭的干预，哮喘快速(AEX)，为哮喘儿童提供2次急诊或1次住院/年，提供量身定制的基于指南的哮喘护理。在ED访问期间收集的过敏和可替宁生物标记物被用于针对干预的家庭环境控制部分。AEX干预(n=132)将与注意力控制(CON)组(n=132)进行比较，以达到特定目的：(1)减少哮喘发病率(增加无症状日夜)，减少急诊室就诊和住院，提高哮喘控制和照顾者的生活质量，(2)根据儿童药房的再灌装记录改善适当预防性抗炎药物的使用，(3)比较这种干预的经济成本和效果。3-12岁的哮喘儿童在过去12个月内有2次急诊或1次住院，目前因哮喘就诊的儿童将从约翰·霍普金斯儿科教育中心招募并跟踪观察12个月。将在基线、6个月和12个月收集症状频率、卫生保健利用情况、照顾者生活质量和可替宁测量，并在基线和12个月收集药房数据。数据分析包括按组划分的初始健康结果交叉表(AEX与CON)和多变量广义线性回归模型，以研究AEX治疗对平均无症状日数/夜晚、重复急诊、住院和照顾者生活质量评分以及消炎药物补充的影响。为了进行经济分析，将比较急诊、初级保健医生就诊、住院天数和药物费用的平均总费用(AEX和CON)。AEX模式设计为可访问、基于指南、易于复制并纳入急诊护理。如果成功，这项研究将填补ED向预防护理哮喘干预研究过渡的关键空白。

DESCRIPTION (provided by applicant): Asthma, the leading chronic disorder in childhood, is the number one cause of pediatric emergency department (ED) visits in young children and is responsible for a substantial impact on healthcare costs.The ED is often the point of contact for low-income children and many families view the ED as their primary source of asthma care. Poor and minority children have the highest asthma morbidity, are the least likely to receive adequate preventive therapy or specialty care and more frequently exposed to environmental triggers than non-poor children. However, prior studies, including our pilot, indicate that childre with frequent asthma ED visits will attend a one-time ED-based follow-up clinic for an asthma "check-up" and education. The goal of this randomized controlled trial is to test the efficacy of a multifaceted, ED + primary care provider (PCP) and home-based intervention, Asthma Express (AEx), for children with > 2 asthma ED visits or 1 hospitalization/year that provides tailored guideline based asthma care. Allergy and cotinine biomarkers, collected during the ED visit, are used to target the home environmental control component of the intervention. The AEx intervention (n=132) will be compared to an attention control (CON) group (n=132) for the specific aims: (1) to reduce asthma morbidity (increase symptom free days and nights) and decrease ED visits and hospitalizations and increase asthma control and caregiver quality of life, (2) to improve the use of appropriate preventive anti-inflammatory medication based on child pharmacy refill records and (3) to compare the economic cost and effects of this intervention. Children aged 3-12 years with > 2 asthma ED visits or 1 hospitalization within the past 12 months and a current ED visit for asthma will be recruited from the Johns Hopkins Pediatric-ED and followed for 12 months. Symptom frequency, health care utilization, caregiver quality of life and cotinine measures will be collected at baseline, 6 and 12 months and pharmacy data collected at baseline and 12 months. Data analysis includes initial cross tabulations of health outcomes by group (AEx vs. CON) and multivariate generalized linear regression models to study the effects of the AEx treatment on mean symptom free days/nights, repeat ED visits, hospitalizations and caregiver quality of life scores and anti-inflammatory medication refills. Mean total costs of ED, PCP visits, hospital days and medication costs will be compared between groups (AEx and CON) for the economic analysis. The AEx model is designed to be accessible, guideline-based, easily replicated and incorporated into ED care. If successful, this study will fill critical gaps in the ED transition to preventive care asthma interventional research.