Department of Family Medicine, Carolinas HealthCare System, 2001 Vail Avenue, Charlotte, NC 28207, USA.
BMC Health Serv Res. 2011 Aug 16;11:188. doi: 10.1186/1472-6963-11-188.
Asthma is a chronic lung disease that affects more than 23 million people in the United States, including 7 million children. Asthma is a difficult to manage chronic condition associated with disparities in health outcomes, poor medical compliance, and high healthcare costs. The research network coordinating this project includes hospitals, urgent care centers, and outpatient clinics within Carolinas Healthcare System that share a common electronic medical record and billing system allowing for rapid collection of clinical and demographic data. This study investigates the impact of three interventions on clinical outcomes for patients with asthma. Interventions are: an integrated approach to care that incorporates asthma management based on the chronic care model; a shared decision making intervention for asthma patients in underserved or disadvantaged populations; and a school based care approach that examines the efficacy of school-based programs to impact asthma outcomes including effectiveness of linkages between schools and the healthcare providers.
METHODS/DESIGN: This study will include 95 Practices, 171 schools, and over 30,000 asthmatic patients. Five groups (A-E) will be evaluated to determine the effectiveness of three interventions. Group A is the usual care control group without electronic medical record (EMR). Group B practices are a second control group that has an EMR with decision support, asthma action plans, and population reports at baseline. A time delay design during year one converts practices in Group B to group C after receiving the integrated approach to care intervention. Four practices within Group C will receive the shared decision making intervention (and become group D). Group E will receive a school based care intervention through case management within the schools. A centralized database will be created with the goal of facilitating comparative effectiveness research on asthma outcomes specifically for this study. Patient and community level analysis will include results from patient surveys, focus groups, and asthma patient density mapping. Community variables such as income and housing density will be mapped for comparison. Outcomes to be measured are reduced hospitalizations and emergency department visits; improved adherence to medication; improved quality of life; reduced school absenteeism; improved self-efficacy and improved school performance.
Identifying new mechanisms that improve the delivery of asthma care is an important step towards advancing patient outcomes, avoiding preventable Emergency Department visits and hospitalizations, while simultaneously reducing overall healthcare costs.
哮喘是一种影响美国超过 2300 万人（包括 700 万儿童）的慢性肺部疾病。哮喘是一种难以控制的慢性疾病，与健康结果的差异、医疗依从性差和医疗保健费用高有关。协调这个项目的研究网络包括卡罗来纳医疗保健系统内的医院、紧急护理中心和门诊诊所，这些机构拥有共同的电子病历和计费系统，能够快速收集临床和人口统计数据。本研究调查了三种干预措施对哮喘患者临床结果的影响。干预措施包括：基于慢性病管理模式的综合护理方法；为服务不足或处于不利地位的人群中的哮喘患者提供共同决策干预；以及以学校为基础的护理方法，研究学校为基础的项目对哮喘结果的影响，包括学校与医疗保健提供者之间联系的有效性。
方法/设计：这项研究将包括 95 个实践、171 所学校和超过 30000 名哮喘患者。将评估五个组（A-E），以确定三种干预措施的有效性。组 A 是没有电子病历（EMR）的常规护理对照组。组 B 实践是基线时具有电子病历、决策支持、哮喘行动计划和人群报告的第二个对照组。在第一年期间采用时间延迟设计，在收到综合护理方法干预后，将组 B 中的实践转换为组 C。组 C 中的四个实践将接受共同决策干预（成为组 D）。组 E 将通过学校内的病例管理接受基于学校的护理干预。将创建一个集中式数据库，目的是促进针对哮喘结果的比较有效性研究，特别是针对这项研究。患者和社区层面的分析将包括患者调查、焦点小组和哮喘患者密度图的结果。将为比较绘制社区变量，如收入和住房密度。要测量的结果是减少住院和急诊就诊次数；提高药物依从性；提高生活质量；减少学校缺勤率；提高自我效能感和提高学校表现。
确定改善哮喘护理提供的新机制是朝着改善患者结果、避免可预防的急诊就诊和住院治疗、同时降低整体医疗保健成本的重要一步。
