Multisystemic therapy to reduce health disparities in adolescents with asthma

描述（由申请人提供）：哮喘是儿童除感染外最常见的住院原因。2000年保健人员减少哮喘住院的倡议没有实现。城市内的少数民族儿童，特别是青少年，似乎最容易出现高发病率和死亡率。不良的疾病管理被认为是哮喘发病率和死亡率的主要驱动因素。然而，很少有针对市中心青少年哮喘患者的随机对照试验。由于哮喘管理的复杂性和相关障碍，需要密集的多成分干预措施来改善高危人群的预后。研究人员采用了多系统治疗（MST），这是一种创新的家庭和社区心理治疗，成功地改善了城市儿科医疗人群的治疗依从性和结果。本研究的目的是利用MST改善哮喘管理，并减少患有中度至重度持续性哮喘的高风险非裔美国青少年（12-16岁）的医疗保健利用率（急诊科就诊和住院）。高风险定义为在12个月内>=2次急诊就诊或>= 1次住院)。其他目标是确定MST效果在12个月内的稳定性，并确定干预措施的成本效益。家庭将从密歇根州底特律市唯一的大学附属医疗中心招募。在美国各大城市中，底特律的非裔美国人比例最高。本研究的实验设计是一项随机对照试验，纳入170名患有中度至重度持续性哮喘的高风险非裔美国青少年，其中85人接受标准的多学科专科治疗（对照条件），85人接受该治疗加MST。家庭将完成初始数据收集会议（基线），7个月的后测试，旨在与治疗完成同时进行，并在基线后12个月进行后续后测试。如果成功，这一干预措施将为易受哮喘影响的弱势人群提供即时援助，并可能降低对这一高危人群的护理成本。虽然哮喘是儿童住院治疗的第二大常见原因，但少数民族和市中心的青少年患该病并发症的风险增加。我们正在测试使用多系统治疗对市中心非裔美国青少年哮喘干预的有效性，多系统治疗是一种强化的，家庭和社区心理治疗。如果成功，这一干预措施将改善哮喘管理和整体健康，并降低这一易受哮喘影响人群的医疗成本。

DESCRIPTION (provided by applicant): Asthma is the most common cause of hospitalization in children other than infections. The Health People 2000 initiative to reduce asthma hospitalizations was NOT met. Minority, inner city children, particularly adolescents, appear to be most at risk for high morbidity and mortality. Poor illness management is thought to be a primary driver of asthma morbidity and mortality. Yet, there are very few randomized controlled trials with inner city adolescents with asthma. Because of the complexity of asthma management and the associated barriers, intensive, multi-component interventions are needed to improve outcomes among those at highest risk. The investigators have adapted Multisystemic Therapy (MST), an innovative home- and community-based psychotherapy, to successfully improve treatment adherence and outcomes in urban pediatric medical populations. The objective of the present study is to utilize MST to improve asthma management and to reduce health care utilization (emergency department visits and hospitalizations) among high risk African American adolescents (ages 12-16) with moderate to severe persistent asthma. High risk is defined as having >=2 emergency department visits or >= 1 hospitalizations in 12 months). Additional aims are to determine the stability of MST's effects over a 12 month interval and to determine cost-effectiveness of the intervention. Families will be recruited from the only university-affiliated medical center in Detroit, Michigan. Detroit has the highest percentage of African Americans of any major city in the United States. The experimental design for the proposed study is a randomized controlled trial with 170 high risk African American adolescents with moderate to severe persistent asthma, 85 of whom will receive standard multidisciplinary specialty care (control condition) and 85 of whom will receive this care plus MST. Families will complete an initial data collection session (baseline), a 7-month post-test designed to coincide with treatment completion, and a subsequent post-test at 12 months after baseline. If successful, this intervention will provide immediate assistance to a vulnerable population disproportionately affected by asthma and may reduce costs of care for this high risk population. While asthma is the second most common cause of hospitalization in children, minority, inner city teens are at increased risk for complications from the disease. We are testing the effectiveness of an intervention for inner city African American teens with asthma using Multisystemic Therapy an intensive, home- and community-based psychotherapy. If successful, this intervention will improve asthma management and overall health, as well as reduce healthcare costs for this vulnerable population disproportionately affected by asthma.