Asthma Express: Bridging Emergency to Primary Care in Underserved Children

描述（由申请人提供）：哮喘是儿童期的主要慢性疾病，是幼儿急诊科（艾德）就诊的头号原因，对医疗费用有重大影响。艾德通常是低收入儿童的接触点，许多家庭将艾德视为其哮喘护理的主要来源。贫困和少数民族儿童的哮喘发病率最高，最不可能得到充分的预防治疗或专业护理，并且比非贫困儿童更经常地暴露于环境触发因素。然而，先前的研究，包括我们的试点，表明儿童与频繁的哮喘艾德访问将参加一个一次性的ED为基础的后续门诊哮喘“检查”和教育。这项随机对照试验的目的是测试 多方面的艾德+初级保健提供者（PCP）和家庭干预，哮喘快车（AEx），为每年有2次以上哮喘艾德就诊或1次住院的儿童提供定制的基于指南的哮喘护理。在艾德访视期间收集的过敏和可替宁生物标志物用于针对干预的家庭环境控制部分。将AEx干预（n=132）与注意力控制（CON）组（n=132）进行比较，以达到以下特定目的：（1）降低哮喘发病率（增加无症状的天数和夜晚），减少艾德就诊和住院，提高哮喘控制和护理人员的生活质量，（2）根据儿童药房再填充记录，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。在过去12个月内有> 2次哮喘艾德访视或1次住院治疗和当前哮喘艾德访视的3-12岁儿童将从约翰霍普金斯儿科-艾德招募并随访12个月。将在基线、6个月和12个月时收集症状频率、医疗保健利用、护理人员生活质量和可替宁指标，并在基线和12个月时收集药房数据。数据分析包括按组（AEx vs. CON）和多变量广义线性回归模型列出的健康结局的初始交叉表，以研究AEx治疗对平均无症状日/夜、重复艾德访视、住院和护理人员生活质量评分以及抗炎药物补充的影响。将比较两组（AEx和CON）之间的艾德、PCP就诊、住院天数和药物费用的平均总费用，以进行经济分析。AEx模式的设计是可访问的，基于指南的，易于复制和纳入艾德护理。如果成功的话，这项研究将填补艾德向预防性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.