Findley Sally, Rosenthal Michael, Bryant-Stephens Tyra, Damitz Maureen, Lara Marielena, Mansfield Carol, Matiz Adriana, Nourani Vesall, Peretz Patricia, Persky Victoria W, Valencia Gilberto Ramos, Uyeda Kimberly, Viswanathan Meera
Columbia University, New York, NY, USA.
Health Promot Pract. 2011 Nov;12(6 Suppl 1):52S-62S. doi: 10.1177/1524839911404231.
Care coordination programs have been used to address chronic illnesses, including childhood asthma, but primarily via practice-based models. An alternative approach employs community-based care coordinators who bridge gaps between families, health care providers, and support services. Merck Childhood Asthma Network, Inc. (MCAN) sites developed community-based care coordination approaches for childhood asthma. Using a community-based care coordination logic model, programs at each site are described along with program operational statistics. Four sites used three to four community health workers (CHWs) to provide care coordination, whereas one site used five school-based asthma nurses. This school-based site had the highest caseload (82.5 per year), but program duration was 3 months with 4 calls or visits. Other sites averaged fewer cases (35 to 61 per CHW per year), but families received more (7 to 17) calls or visits over a year. Retention was 43% to 93% at 6 months and 24% to 75% at 12 months. Pre-post cross-site data document changes in asthma management behaviors and outcomes. After program participation, 93% to 100% of caregivers had confidence in controlling their child's asthma, 85% to 92% had taken steps to reduce triggers, 69% to 100% had obtained an asthma action plan, and 46% to 100% of those with moderate to severe asthma reported appropriate use of controller medication. Emergency department visits for asthma decreased by 36% to 63%, and asthma-related hospitalizations declined by 26% to 78%. More than three fourths had fewer school absences. In conclusion, MCAN community-based care coordination programs improved management behaviors and decreased morbidity across all sites.
护理协调项目已被用于应对包括儿童哮喘在内的慢性疾病，但主要是通过基于实践的模式。另一种方法是采用社区护理协调员，他们能够弥合家庭、医疗服务提供者和支持服务之间的差距。默克儿童哮喘网络公司（MCAN）的各站点开发了针对儿童哮喘的基于社区的护理协调方法。利用基于社区的护理协调逻辑模型，介绍了每个站点的项目以及项目运营统计数据。四个站点使用三到四名社区卫生工作者（CHW）提供护理协调，而一个站点使用五名学校哮喘护士。这个以学校为基础的站点病例量最高（每年82.5例），但项目持续时间为3个月，有4次电话或家访。其他站点平均病例较少（每名CHW每年35至61例），但家庭在一年中接受了更多（7至17次）电话或家访。6个月时的留存率为43%至93%，12个月时为24%至75%。跨站点前后数据记录了哮喘管理行为和结果的变化。参与项目后，93%至100%的护理人员有信心控制孩子的哮喘，85%至92%采取了措施减少诱发因素，69%至100%获得了哮喘行动计划，46%至100%的中重度哮喘患者报告正确使用了控制药物。哮喘急诊就诊次数减少了36%至63%，与哮喘相关的住院率下降了26%至78%。超过四分之三的人缺课次数减少。总之，MCAN基于社区的护理协调项目改善了所有站点的管理行为并降低了发病率。
