Improving Asthma Communication in Minority Families

描述（由申请人提供）：有频繁急诊科（ED）护理和住院史的儿童哮喘发病率增加的风险最大，包括生活质量下降、缺课增加和危及生命的哮喘。治疗儿童哮喘的护理费用很高。父母和孩子准确地向医生传达症状的能力对于最佳的哮喘诊断和治疗至关重要。当与及时和适当的哮喘药物使用相联系时，准确的医生-亲子沟通可能导致哮喘发病率降低。据报道，市中心儿童在平均8岁时开始自行服用吸入性哮喘药物。尽管哮喘自我管理的年龄很小，但很少有研究关注儿童对医疗遭遇的贡献。本研究旨在确定父母和儿童哮喘沟通干预（ACI）是否与目标1（增强父母和儿童的沟通技巧）、目标2（降低哮喘发病率）、目标3（基于药房补充率）增强对哮喘药物的适当依从性)和目标4（与参加标准哮喘教育干预（SAE）的儿童相比，显示成本效益）相关。在18个月的随访中，比较两组（ACI和SAE）哮喘ED就诊、住院天数、急诊和初级保健就诊次数、缺勤、活动受限、症状天数和夜间次数、功能状态、生活质量的差异。马里兰大学医院儿科急诊科、住院病房和社区儿科诊所将作为我们的招聘地点。6-12岁轻度-重度持续性哮喘患儿家庭（N=220）将被纳入研究。数据分析将包括卡方检验、t检验、方差分析和多元线性回归模型。将使用广义估计方程（GEE）来处理重复测量的相关性。将产生成本效益和成本效益比率，以检查各组之间护理成本的差异。研究结果将为哮喘沟通干预对轻度至重度持续性哮喘儿童的影响、干预的相对成本提供重要数据；以及满足轻度至重度哮喘患儿需要的主要成分。研究结果将改善对这一弱势儿童群体以及患有其他慢性疾病的儿童的临床护理，并将对卫生保健提供者、研究人员、保险公司和决策者具有重要的用途，并将具有重大的公共卫生适用性。

DESCRIPTION (provided by applicant): Children with a history of frequent emergency department (ED) care and hospitalizations are at the greatest risk for increased asthma morbidity including decreased quality of life, increased school absences and life threatening asthma. Cost of care in treating pediatric asthma is high. Parental and child ability to accurately communicate symptoms to the physician is critical for optimal asthma diagnosis and treatment. When linked to timely and appropriate asthma medication use, accurate physician-parent-child communication may result in decreased asthma morbidity. Early self-administration of inhaled asthma medications was reported at a mean age of 8 years for inner-city children. Despite this early age of asthma self-management, little research focuses on the child's contribution to the medical encounter. This study is designed to determine if a parent and child asthma communication intervention (ACI) will be associated with AIM 1:enhanced communication skills of the parent and child, AIM 2:reduced asthma morbidity, AIM 3: enhanced appropriate adherence to asthma medication based on pharmacy refill rates and AIM 4: demonstrate cost effectiveness as compared to children enrolled in a standard asthma education intervention (SAE). Differences in ED visits for asthma, hospital days, number of urgent and primary care visits, school absences, restricted activity, number of symptom days and nights, functional status, quality of life over the 18 month follow-up will be compared between the two groups (ACI and SAE). The University of Maryland Hospital Pediatric ED, inpatient unit and Community pediatric clinics will serve as our recruitment sites. Families of children with mild-severe persistent asthma ages 6-12 years (N=220) will be enrolled. Data analysis will include chi-square, t-tests, ANOVA and multivariate linear regression models. The Generalized Estimating Equation (GEE) will be used to address the correlation of repeated measures. Cost-effectiveness and cost benefit ratios will be generated to examine for differences in cost of care between groups. Study outcomes will provide important data on the effects of an asthma communication intervention for children with mild to severe persistent asthma, the relative cost of the intervention; and the major components required to meet the needs of children with mild to severe asthma. Study findings will improve clinical care to this vulnerable population of children as well as children with other chronic illness and will be of significant use to health care providers, researchers, insurers and policy makers and will have significant public health applicability.