RAND Corporation, 1776 Main St, PO Box 2138, Santa Monica, CA 90407-2138, USA.
Pediatrics. 2013 Mar;131 Suppl 1:S26-37. doi: 10.1542/peds.2012-1427d.
Although children living in Puerto Rico have the highest asthma prevalence of all US children, little is known regarding the quality-of-care disparities they experience nor the adaptability of existing asthma evidence-based interventions to reduce these disparities. The objective of this study was to describe our experience in reducing quality-of-care disparities among Puerto Rican children with asthma by adapting 2 existing evidence-based asthma interventions.
We describe our experience in adapting and implementing 2 previously tested asthma evidence-based interventions: the Yes We Can program and the Inner-City Asthma Study intervention. We assessed the feasibility of combining key components of the 2 interventions to reduce asthma symptoms and estimated the potential cost savings associated with reductions in asthma-related hospitalizations and emergency department visits. A total of 117 children with moderate and severe asthma participated in the 12-month intervention in 2 housing projects in San Juan, Puerto Rico. A community-academic team with the necessary technical and cultural competences adapted and implemented the intervention.
Our case study revealed the feasibility of implementing the combined intervention, henceforth referred to as La Red intervention, in the selected Puerto Rican communities experiencing a disproportionately high level of asthma burden. After 1-year follow-up, La Red intervention significantly reduced asthma symptoms and exceeded reductions of the original interventions. Asthma-related hospitalizations and emergency department use, and their associated high costs, were also significantly reduced.
Asthma evidence-based interventions can be adapted to improve quality of care for children with asthma in a different cultural community setting.
尽管波多黎各的儿童哮喘患病率是全美所有儿童中最高的，但对于他们所经历的医疗服务质量差异，以及现有基于证据的哮喘干预措施在缩小这些差异方面的适应性，人们知之甚少。本研究的目的是描述我们通过调整 2 种现有的基于证据的哮喘干预措施来减少波多黎各哮喘儿童医疗服务质量差异的经验。
我们描述了调整和实施 2 种先前经过测试的基于证据的哮喘干预措施的经验：Yes We Can 计划和内城哮喘研究干预措施。我们评估了将这 2 种干预措施的关键组成部分结合起来以减轻哮喘症状的可行性，并估计了与减少哮喘相关住院和急诊就诊相关的潜在成本节约。共有 117 名患有中重度哮喘的儿童参与了在波多黎各圣胡安的 2 个住房项目中进行的为期 12 个月的干预。一个具有必要技术和文化能力的社区学术团队对干预措施进行了调整和实施。
我们的案例研究表明，在经历不成比例高哮喘负担的选定波多黎各社区中，实施联合干预措施（简称 La Red 干预）是可行的。在 1 年的随访后，La Red 干预显著减轻了哮喘症状，并超过了原始干预措施的减轻程度。哮喘相关住院和急诊就诊及其相关的高成本也显著减少。
哮喘基于证据的干预措施可以进行调整，以改善不同文化社区中哮喘儿童的医疗服务质量。
