Asthma Care Implementation Program for the District of Columbia (ACIP-DC)

 描述（由申请人提供）：哮喘是儿童最常见的慢性疾病，尽管美国国立卫生研究院制定了循证指南，但该疾病的总体发病率仅略有下降。此外，在照料和结果方面仍然存在着令人无法接受的显著差距，不成比例地影响到贫穷、城市和少数民族儿童和青少年。解决这些差异是多个联邦机构、当地社区、父母和患者以及研究人员的核心优先事项。有显著的实例表明，循证干预确实可以降低儿童哮喘发病率和差异.例如，经过验证的IMPACT DC干预措施改善了华盛顿特区儿科哮喘护理和结果的多项指标。然而，儿童哮喘发病率在DC仍然很高，进一步改善儿童哮喘护理和结果在DC和其他地方将需要超越主要的医疗干预模式，并纳入额外的循证干预领域的医疗保健，家庭，家庭和社区。因此，我们提出的项目的总体目标是使用社区驱动的过程，将这些干预措施整合到一个高度以患者和家庭为中心的计划中，准备进行严格的后续验证，作为一种可重复的手段，以改善脆弱的城市青年的哮喘结果。哥伦比亚特区的哮喘护理实施计划（ACIP-DC）将纳入现有的IMPACT DC干预措施，但将通过增加社区哮喘导航（基于社区卫生工作者模型）来协调多个其他正在进行的患者服务，并通过使用电子护理协调平台来整合这些服务，从而对其进行扩展。ACIP-DC提案非常重要，因为它将创建一个新的高度合作的项目，准备在随机试验中进行严格的评估。如果在华盛顿有效，该计划将准备在其他地方传播，作为一种手段，以解决类似社区的儿童哮喘发病率高负担的差异。为了实现我们的总体目标，我们将追求三个具体目标：（1）我们将与我们的儿童健康倡导研究所合作， 进行社区需求评估，重点是通过与当地不同利益相关者的互动过程，了解DC哮喘结局不良的高风险儿童的现有护理网络;（2）根据此需求评估，我们将通过整合医疗保健，家庭，家庭和社区领域的循证干预措施，创建，试点测试和修改ACIP-DC;和（3）我们将计划并试点一项严格方案的要素，用于在前瞻性、随机、单盲临床试验中评估ACIP-DC，并将其与单独的IMPACT DC干预（常规护理）进行比较。为了实现这一目标，经验丰富的研究团队将利用其现有的本地合作者网络，并将聘请新的合作者。ACIP-DC的关键要素将进行试点测试，整个干预将使用高保真检查表编写脚本，准备作为临床试验的基础。 (End摘要）

 DESCRIPTION (Provided By Applicant): Asthma is the most common chronic disease of childhood, and despite evidence-based guidelines from the National Institutes of Health, overall morbidity from the disease has decreased only modestly. In addition, striking and unacceptable disparities in care and outcomes persist that disproportionately affect poor, urban, and minority children and adolescents. Addressing these disparities is a central priority for multiple federal agencies, local communities, parents and patients, and investigators. There are notable examples of evidence- based interventions that do reduce pediatric asthma morbidity and disparities. The validated IMPACT DC intervention, for example, has improved multiple measures of pediatric asthma care and outcomes in Washington, DC. Nevertheless, pediatric asthma morbidity in DC remains high, and further improving pediatric asthma care and outcomes in DC and elsewhere will require moving beyond the largely medical model of interventions and incorporating additional evidence-based interventions from the domains of medical care, family, home, and community. The overall goal of our proposed project is therefore to use a community driven process to integrate such interventions into a highly patient and family-centered program ready for rigorous subsequent validation as a reproducible means to improve asthma outcomes among vulnerable urban youth. The Asthma Care Implementation Program for the District of Columbia (ACIP-DC) will incorporate the existing IMPACT DC intervention, but will expand it by adding a Community Asthma Navigator (based on a Community Health Worker model) to coordinate multiple other ongoing patient services and by using an electronic care coordination platform to integrate those services. The ACIP-DC proposal is highly significant in that it will create a new and highly collaborative program ready for rigorous evaluation in a randomized trial. If efficacious in Washington DC, the program will then be ready for dissemination elsewhere as a means to address disparities in similar communities burdened with high pediatric asthma morbidity. In order to achieve our overall goal, we will pursue three specific aims: (1) we will partner with our Child Health Advocacy Institute to conduct a community needs assessment focused on understanding the existing network of care for DC's children at high risk of poor asthma outcomes through an iterative process of engaging a diverse group of local stakeholders; (2) informed by this needs assessment, we will create, pilot test, and modify ACIP-DC by integrating evidence-based interventions from the domains of medical care, family, home, and community; and (3) we will plan and pilot the elements of a rigorous protocol for the evaluation of ACIP-DC in a prospective, randomized, single-blind clinical trial that compares it to the IMPACT DC intervention alone (usual care). In pursuing this goal, the experienced research team will leverage its existing network of local collaborators, and will engage new ones as well. Key elements of ACIP-DC will be pilot tested, and the entire intervention will be scripted with a high fidelity checklist ready to serve as the basis for a clincal trial. (End of Abstract)