以哮喘为主的“起点计划”儿童家庭和学校哮喘教育计划的效果：一项随机临床试验。
Effectiveness of a Home- and School-Based Asthma Educational Program for Head Start Children With Asthma: A Randomized Clinical Trial.
机构信息
Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland.
Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston.
出版信息
JAMA Pediatr. 2020 Dec 1;174(12):1191-1198. doi: 10.1001/jamapediatrics.2020.3375.
IMPORTANCE
Asthma is the most common chronic childhood disease, with Black children experiencing worse morbidity and mortality. It is important to evaluate the effectiveness of efficacious interventions in community settings that have the greatest likelihood of serving at-risk families.
OBJECTIVE
To evaluate the effectiveness of a multilevel home- and school (Head Start)-based asthma educational program compared with a Head Start-based asthma educational program alone in improving asthma outcomes in children.
DESIGN, SETTING, AND PARTICIPANT: This randomized clinical trial included 398 children with asthma enrolled in Head Start preschool programs in Baltimore, Maryland, and their primary caregivers. Participants were recruited from April 1, 2011, to November 31, 2016, with final data collection ending December 31, 2017. Data were analyzed from March 18 to August 30, 2018.
INTERVENTIONS
Asthma Basic Care (ABC) family education combined with Head Start asthma education compared with Head Start asthma education alone.
MAIN OUTCOMES AND MEASURES
Asthma control as measured by the Test for Respiratory and Asthma Control in Kids (TRACK) score.
RESULTS
Among the 398 children included in the analysis (247 boys [62.1%]; mean [SD] age, 4.2 [0.7] years), the ABC plus Head Start program improved asthma control (β = 6.26; 95% CI, 1.77 to 10.75; P < .001), reduced courses of oral corticosteroids (β = -0.61; 95% CI, -1.13 to -0.09; P = .02), and reduced hospitalizations (odds ratio, 0.36; 95% CI, 0.21-0.61; P < .001) during a 12-month period.
CONCLUSION AND RELEVANCE
In this randomized clinical trial, combined family and preschool asthma educational interventions improved asthma control and reduced courses of oral corticosteroids and hospitalizations. Multilevel interventions implemented in community settings that serve low-income minority families may be key to reducing disparities in asthma outcomes.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT01519453.
重要性
哮喘是最常见的儿童慢性疾病，黑人儿童的发病率和死亡率更高。评估在最有可能为高危家庭服务的社区环境中实施有效干预措施的效果非常重要。
目的
评估多层次家庭和学校（“提前开端”）为基础的哮喘教育计划与单纯的“提前开端”为基础的哮喘教育计划相比，在改善儿童哮喘结局方面的有效性。
设计、地点和参与者：这项随机临床试验纳入了巴尔的摩“提前开端”学前项目中的 398 名哮喘患儿及其主要照顾者。参与者于 2011 年 4 月 1 日至 2016 年 11 月 31 日期间招募，最终数据收集于 2017 年 12 月 31 日结束。数据分析于 2018 年 3 月 18 日至 8 月 30 日进行。
干预措施
哮喘基本护理（ABC）家庭教育与“提前开端”哮喘教育相结合与单纯的“提前开端”哮喘教育相比。
主要结局和测量指标
通过儿童呼吸和哮喘控制测试（TRACK）评分衡量哮喘控制情况。
结果
在纳入分析的 398 名儿童中（男 247 名[62.1%]；平均[SD]年龄 4.2[0.7]岁），ABC 加“提前开端”方案改善了哮喘控制（β=6.26；95%CI，1.77 至 10.75；P<0.001），减少了口服皮质类固醇疗程（β=-0.61；95%CI，-1.13 至-0.09；P=0.02），并减少了 12 个月期间的住院率（比值比，0.36；95%CI，0.21 至 0.61；P<0.001）。
结论和相关性
在这项随机临床试验中，家庭和学前联合哮喘教育干预措施改善了哮喘控制，并减少了口服皮质类固醇疗程和住院率。在为低收入少数族裔家庭服务的社区环境中实施多层次干预措施可能是减少哮喘结局差异的关键。
试验注册
ClinicalTrials.gov 标识符：NCT01519453。
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