Healthy Homes II: Environmental/Clinical Asthma Control

描述（由申请人提供）： 这项提案的总体目标是更好地了解如何减少哮喘 低收入、不同种族的发病率和医疗保健利用率 3-13岁的儿童。 特别是，关于家庭护理的有效性的证据 干预措施，强调控制环境触发因素， 需要临床干预。 一半的参与者将 接受以诊所为基础的哮喘教育，自我管理支持（哮喘 行动计划和自我监测），哮喘控制资源（过敏 控制寝具罩、峰值流量计和药物间隔器）和护理 哮喘护士的一年协调（1级干预）。 的 另一半将获得这些服务和家庭环境评估， 基于评估数据、教育和 社会支持，鼓励行为改变，物质减少 暴露（床罩、吸尘器、门垫、清洁套件和HEPA） 过滤器）和哮喘自我管理支持一年， 卫生工作者（二级干预）。 第二个目标是学习如何适应 这些干预措施，使他们在文化上适合种族多样性 人口。 第三个目标是减少其他家庭健康风险 风险，如铅，灰尘，石棉，杀虫剂，其他有毒的家庭 化学品和伤害的风险。 第四个目标是开发更好的工具 用于评估社区环境中的室内环境。 最终 目标是将这些活动纳入当地哮喘工作 联盟。 研究人员将对360名受试者进行随机对照试验 使用平行干预组和等待列表对照组进行比较 第1级和第2级干预措施相互之间的有效性， 对照组 主要结果指标将包括哮喘相关健康 生活状况和质量、医疗保健利用和室内暴露 哮喘诱因（螨虫、蟑螂、霉菌、烟草烟雾和宠物）。 二次 措施包括了解哮喘，控制环境触发因素， 医疗管理;自我效能;和哮喘控制相关行为。 他们将评估两个层次的干预措施的成本， 一个健康服务支付者的视角。 研究人员希望这项研究 将产生一个可复制和可持续的模式， 健康保险公司和医疗保健提供组织，并整合到一个 全面、协调的地方哮喘控制系统。 该项目的 该组织的基础是儿童的父母之间的伙伴关系， 哮喘、社区组织、公共卫生机构和学术界， 并将遵循以社区为基础的合作研究原则。 是 由金郡哮喘论坛赞助，这是一个当地的哮喘联盟， 哮喘患者及其家人的社区参与，34 机构，包括公共卫生-西雅图和国王县，美国肺 华盛顿哮喘和过敏基金会， 学区、社区卫生中心、医院、西雅图大学，以及 华盛顿大学。

DESCRIPTION (provided by applicant): The overall goal of this proposal is to understand better how to reduce asthma morbidity and health care utilization among low-income, ethnically diverse children age 3-13. In particular, evidence about the effectiveness of in-home interventions, emphasizing control of environmental triggers relative to clinic-based interventions, is needed. One-half of the participants will receive clinic-based asthma education, self-management support (an asthma action plan and self-monitoring), resources for asthma control (allergy control bedding covers, a peak flow meter, and a medication spacer) and care coordination for one year from an asthma nurse (level 1 intervention). The other half will receive these services plus in-home environmental assessment, an individualized home action plan based on assessment data, education, and social support, encouragement of behavior changes, materials to reduce exposures (bedding covers, vacuums, door mats, cleaning kits, and a HEPA filter), and asthma self-management support for one year from a community health worker (level 2 intervention). A second goal is to learn how to adapt these interventions so they are culturally appropriate for ethnically diverse populations. A third goal is to reduce exposures to other household health risks such as lead, dust, asbestos, pesticides, other toxic household chemicals, and risks for injuries. A fourth goal is to develop better tools for assessing the indoor environment in community-based settings. A final goal is to integrate these activities into the work of the local asthma coalition. The investigators will conduct a randomized controlled trial with 360 subjects using parallel intervention groups and a wait-list control group to compare the effectiveness of the level 1 and 2 interventions with each other and the control group. Primary outcome measures will include asthma-related health status and quality of life, medical care utilization, and exposure to indoor asthma triggers (mites, roaches, mold, tobacco smoke, and pets). Secondary measures include knowledge of asthma, control of environmental triggers, and medical management; self-efficacy; and behaviors related to asthma control. They will assess the costs of the two levels of intervention from the perspective of a health services payer. The investigators hope this research will result in a replicable and sustainable model which can be adopted by health insurers and health care delivery organizations and integrated into a comprehensive, coordinated local asthma control system. The project's organization is based upon partnerships between parents of children with asthma, community-based organizations, public health agencies, and academia, and will follow principles of community-based collaborative research. It is sponsored by the King County Asthma Forum, a local asthma coalition with broad community participation from people with asthma, their families, and 34 agencies, including Public Health - Seattle & King County, the American Lung Association of Washington, the Asthma and Allergy Foundation of American, school districts, community health centers, hospitals, Seattle University, and the University of Washington.