ASTHMA GUIDELINES COMPLIANCE--CLINICAL/COST EFFECTIVENES

本提案旨在为主要研究者（PI）提供机会，使其在由高资质申办者和合作研究者组成的咨询委员会的监督下获得医疗结局、经济学和成本效益评价方面的知识和技能。 PI接受过特殊的临床培训，并在Channing实验室完成了为期两年的呼吸流行病学研究。 此外，她还获得了MS。在哈佛公共卫生学院的临床流行病学。 该奖项与PI的背景相结合，为成功的独立研究事业的发展提供了极好的潜力。 该提案的总体科学目标是确定哮喘管理符合国家哮喘教育和预防计划（NAEPP）哮喘诊断和管理指南中发布的建议的个体是否会改善临床结局，并且相对于管理不符合的个体是否具有成本效益。 我们建议采用一项回顾性队列研究设计，使用哈佛朝圣者医疗中心（HPHC）收集的成人和儿童哮喘患者队列的广泛信息。 我们假设，与管理不符合NAEPP指南的个体相比，接受哮喘药物治疗和非药物管理（门诊随访和专家转诊、哮喘教育、峰值流量利用、环境措施）的个体将降低医疗保健利用率，改善健康相关生活质量（HRQL），并具有成本效益。 这项建议对美国1400多万哮喘患者的护理至关重要。 NAEPP敦促对指南的评估给予“高度优先”，评估不仅要考虑疗效证据，还要考虑提出的治疗建议的有效性、成本和成本效益。

This proposal is designed to provide the opportunity for the Principal Investigator (PI) to gain knowledge and skills in medical outcomes, economics and cost effectiveness evaluation under the supervision of an advisory committee comprising a highly qualified sponsor and co-investigators. The PI has exceptional clinical training and has completed a two-year fellowship in respiratory epidemiology at the Channing Laboratory. In addition she has obtained an M.S. in Clinical Epidemiology at the Harvard School of Public Health. This award in combination with the PI's background provides an excellent potential for development of a successful independent research career. The overall scientific goal of this proposal is to determine whether individuals with asthma management that conforms with recommendations published within the National Asthma Education and Prevention Program (NAEPP) Guidelines for the Diagnosis and Management of Asthma, results in an improved clinical outcome and is cost effective relative to individuals whose management does not conform. We propose to use the extensive information available on a cohort of adult and pediatric asthma patients assembled at Harvard Pilgrim Health Care (HPHC) in a retrospective cohort study design. We hypothesize that individuals with asthma pharmacotherapy and non- pharmacologic management (outpatient follow-up and specialist referral, asthma education, peak flow utilization, environmental measures) that conforms with the NAEPP Guidelines will have decreased health care utilization, improved Health Related Quality of Life (HRQL) and will be cost effective when compared with individuals whose management does not conform. This proposal is vital to the care of more than 14 million asthmatics in the United States. The NAEPP urges that evaluation of the guidelines be given "high priority," and that evaluation should consider not only evidence of efficacy but effectiveness, costs, and cost effectiveness of the therapeutic recommendations put forth.