Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA; Bradley-Hasbro Children's Research Center, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA.
Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA; Bradley-Hasbro Children's Research Center, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA; Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Contemp Clin Trials. 2023 Jun;129:107204. doi: 10.1016/j.cct.2023.107204. Epub 2023 Apr 23.
Pediatric asthma is among the most common health conditions and disproportionately impacts Black and Latino children. Gaps in asthma care exist and may contribute to racial and ethnic inequities. The Rhode Island Asthma Integrated Response (RI-AIR) program was developed to address current limitations in care. The aims of the RI-AIR Hybrid Type II effectiveness-implementation trial were to: a) simultaneously evaluate the effectiveness of RI-AIR on individual-level and community-level outcomes; b) evaluate implementation strategies used to increase uptake of RI-AIR. In this manuscript, we outline the design and methods used to implement RI-AIR.
School-based areas (polygons) with the highest asthma-related urgent healthcare utilization in Greater Providence, R.I., were identified using geospatial mapping. Families with eligible children (2-12 years) living in one of the polygons received evidence-based school- and/or home-based asthma management interventions, based on asthma control level. School-based interventions included child and caregiver education programs and school staff trainings. Home-based interventions included individualized asthma education, home-environmental assessments, and strategies and supplies for trigger remediation. Implementation strategies included engaging school nurse teachers as champions, tailoring interventions to school preferences, and engaging families for input.
A total of 6420 children were screened throughout the study period, 811 were identified as eligible, and 433 children were enrolled between November 2018 and December 2021.
Effective implementation of pediatric asthma interventions is essential to decrease health inequities and improve asthma management. The RI-AIR study serves as an example of a multi-level intervention to improve outcomes and reduce disparities in pediatric chronic disease.
NCT03583814.
儿科哮喘是最常见的健康问题之一， disproportionately 影响黑人和拉丁裔儿童。哮喘护理存在差距，可能导致种族和族裔不平等。罗德岛哮喘综合反应（RI-AIR）计划旨在解决当前护理方面的局限性。RI-AIR 混合 II 型有效性实施试验的目的是：a）同时评估 RI-AIR 对个体和社区层面结果的有效性；b）评估用于增加 RI-AIR 采用的实施策略。在本手稿中，我们概述了实施 RI-AIR 所使用的设计和方法。
使用地理空间映射确定罗得岛州普罗维登斯大都市区内与哮喘相关的紧急医疗保健利用率最高的基于学校的区域（多边形）。居住在一个多边形内、符合条件的儿童（2-12 岁）的家庭根据哮喘控制水平接受基于学校和/或家庭的哮喘管理干预措施。学校干预措施包括儿童和照顾者教育计划以及学校工作人员培训。家庭干预措施包括个体化哮喘教育、家庭环境评估以及针对触发因素的补救策略和用品。实施策略包括让学校护士教师担任拥护者、根据学校偏好调整干预措施以及让家庭参与提供意见。
在整个研究期间共筛查了 6420 名儿童，确定了 811 名符合条件的儿童，在 2018 年 11 月至 2021 年 12 月期间，有 433 名儿童入组。
有效实施儿科哮喘干预措施对于减少健康不平等和改善哮喘管理至关重要。RI-AIR 研究是一个多层面干预措施的范例，可以改善儿科慢性病的结果并减少差异。
NCT03583814。
