哮喘联盟

   摘要
   评估社区哮喘管理方案的挑战在于如何在建立社区执行和监管循证医学治疗方案的同时保证健康产出。对乔治亚州哮喘患儿管理方案（一项由乔治亚州医疗保健基金会资助，倡导多样化哮喘治疗方案的项目）的评估为如何解决以上问题提供了较好的方法学示范。他们采用了一种“发展性评估”的方法，混合使用定量和定性的数据收集和分析方法，评估在社区建设过程中社区哮喘预防方案的进展。
   评估内容包括：社区建设从何开始，社区水平系统的改变，以及如何使社区的哮喘预防方案朝着更循证、更基于结局指标的方向前进。初步的评估结果显示，社区资产大部分被用于哮喘儿童的管理。但是，却很少去评估系统改变与健康产出，并且缺乏基于逻辑模型的研究方案以评估循证医学实践与临床转归的关联。随着不断发展的技术支持以及评估工作的开展，所有的研究都采用逻辑回归模型，将临床实践-转归与数据收集过程相结合，评估达到目标健康结局的进展。
   该新发展的研究方法适合于不同的临床研究和不同的社区，连同对健康产出的基准点分析法的质量改进，使重点集中于健康状况转归的改善。特别要指出的是，该研究方法强调改进社区确定、实施并监控循证医学哮喘治疗方案的能力，且该方法可用于任何一种社区环境。
 

（杨冬 审校）
Popul Health Manag. 2015 Feb 6. [Epub ahead of print]


 

Evaluation of Diverse Community Asthma Interventions: Balancing Health Outcomes with Developing Community Capacity for Evidence-Based Program Measurement.
 

Woodhouse LD1, Livingood WC, Toal R, Keene D, Hines RB, Tedders S, Charles SM, Lawrence RH, Gunn LH, Williams N, Kellum A.
 

ABSTRACT
The challenge of evaluating community asthma management programs is complicated by balancing the emphasis on health outcomes with the need to build community process capacity for conducting and monitoring evidence-based programs. The evaluation of a Georgia Childhood Asthma Management Program, a Healthcare Georgia Foundation-supported initiative for multiple diverse programs and settings, provides an example of an approach and the results that address this challenge. A "developmental evaluation" approach was applied, using mixed methods of quantitative and qualitative data collection and analysis, to assess the progress of community asthma prevention programs in building community within the context of: where the community is starting, community-level systems changes, and the community's progress toward becoming more outcome measurement oriented and evidence based. Initial evaluation efforts revealed extensive mobilization of community assets to manage childhood asthma. However, there were minimal planned efforts to assess health outcomes and systems changes, and the lack of a logic model-based program design linking evidence-based practices to outcomes. Following developmental technical assistance within evaluation efforts, all programs developed logic models, linking practices to outcomes with data collection processes to assess progress toward achieving the selected outcomes. This developmental approach across diverse projects and communities, along with a quality improvement benchmarking approach to outcomes, created a focus on health status outcome improvement. Specifically, this approach complemented an emphasis on an improved community process capacity to identify, implement, and monitor evidence-based asthma practices that could be used within each community setting.
 

Popul Health Manag. 2015 Feb 6. [Epub ahead of print]