Bryant-Stephens Tyra, Williams Yolanda, Kanagasundaram Janani, Apter Andrea, Kenyon Chén C, Shults Justine
Community Asthma Prevention Program, Sr Director, Center for Health Equity, Associate Professor of Pediatrics, United States.
Children's Hospital of Philadelphia, United States.
Contemp Clin Trials Commun. 2021 Nov 16;24:100864. doi: 10.1016/j.conctc.2021.100864. eCollection 2021 Dec.
Asthma is the most common chronic condition among children, with low-income families living in urban areas experiencing significantly higher rates. Evidence based interventions for asthma are routinely implemented in either the home, school, or primary care setting. However, even when caregivers of poor children are engaged in asthma interventions in one setting, they often have to navigate challenges in another setting, such as an under-resourced home, non-supportive school, or disengaged health care provider. The West Philadelphia Asthma Care Implementation Plan aims to compare the effectiveness of a primary care-based intervention, school-based intervention, and combined primary care and school intervention to usual care for improving asthma control in school-age children to explore if the synergistic effect of Community Health Worker (CHW) support in the home, school, and health care environments will result in improved asthma control. Children ages 5-13 with uncontrolled asthma from four West Philadelphia recruitment sites will be eligible for enrollment. The families of school age children interested in participating will be randomized to receive a primary care CHW or usual care. Those identified as attending a participating school will have a CHW-led school intervention or usual care in school. If proven effective, this care coordination program will assist caregivers in assessing resources, improving self-management skills, and ultimately reducing asthma-related ED visits and hospitalizations as well as provide additional information for healthcare systems and policy makers to inform their decisions about how and where to focus additional resources and investments in childhood asthma care to improve health outcomes.
哮喘是儿童中最常见的慢性疾病，居住在城市地区的低收入家庭患病率显著更高。针对哮喘的循证干预措施通常在家庭、学校或初级保健机构实施。然而，即使贫困儿童的照料者在某一环境中参与了哮喘干预，他们在另一环境中往往仍要应对挑战，比如资源匮乏的家庭、不支持的学校或不积极的医疗服务提供者。西费城哮喘护理实施计划旨在比较基于初级保健的干预措施、基于学校的干预措施以及初级保健与学校相结合的干预措施与常规护理在改善学龄儿童哮喘控制方面的效果，以探讨社区卫生工作者（CHW）在家庭、学校和医疗环境中的支持所产生的协同效应是否会改善哮喘控制情况。来自西费城四个招募地点的5至13岁哮喘未得到控制的儿童将有资格入选。有意参与的学龄儿童家庭将被随机分组，接受初级保健CHW干预或常规护理。那些被确定就读于参与学校的儿童将在学校接受由CHW主导的学校干预或常规护理。如果被证明有效，这个护理协调项目将帮助照料者评估资源、提高自我管理技能，并最终减少与哮喘相关的急诊就诊和住院次数，同时为医疗系统和政策制定者提供更多信息，以便他们决定如何以及在何处集中额外资源和投资于儿童哮喘护理，以改善健康结果。
