摘要
背景：哮喘是儿童住院、急诊和缺课的主要原因。我们以学校为基础的哮喘干预措施减少了丹佛大都会区健康不平等儿童的哮喘恶化，部分原因是解决了哮喘护理协调和健康的社会决定因素 (SDOH)，如获得医疗保健和药物的机会。在科罗拉多州的其他大城市和农村地区，以学校为基础的哮喘项目在科罗拉多州其他大都市和农村地区的推广有限。我们在科罗拉多州不同的社会经济地区成立了社区咨询委员会，并与之合作，制定了两套实施策略，以提供我们以学校为基础的哮喘干预措施——现在被称为“更好的儿童哮喘控制(BACK)”。-根据地区的优先事项、需要和资源进行调整。
方法：在这个建议的2型混合实施-有效性试验中，主要目标是公平地惠及家庭以减少哮喘差异，我们将比较两种不同的实施策略包，以在科罗拉多州的四个地区提供BACK。要比较的两套实施策略是 1)一套标准的实施策略，包括“因地制宜”（Tailor and Adapt to context）、“促进”（Facilitation）和“培训”（Training），称为“BACK-标准”（BACK-S）；2)BACK-S加上增强型实施策略，其中包括与社区合作伙伴编织网络和消费者参与学校家庭，称为“BACK-增强”（BACK-E）。我们的评估将以“覆盖面、有效性、采用、实施和维护”（RE-AIM）框架为指导，包括其“务实、稳健的实施可持续性模型”（PRISM）的实施结果决定因素。我们的核心假设是，BACK-E实施策略对符合条件的儿童/家庭的覆盖范围将明显大于BACK-S（主要结果），与常规护理相比，BACK-E组和BACK-S组的哮喘恶化率（“发作”）将明显降低，哮喘控制率也将得到改善。
结论：我们期望BACK-S和BACK-E策略包将加速我们的BACK计划在全州的传播——BACK-S和BACK- E对覆盖面和其他RE-AIM结果的比较影响可能会为缩减BACK和其他有效的学校项目的策略选择提供信息，以解决慢性病的差异。
Reducing asthma attacks in disadvantaged school children with asthma: study protocol for a type 2 hybrid implementation-effectiveness trial (Better Asthma Control for Kids, BACK)
Amy G Huebschmann, Nicole M Wagner, Melanie Gleason, et al.
Abstract
BACKGRUND:Asthma is a leading cause of children's hospitalizations, emergency department visits, and missed school days. Our school-based asthma intervention has reduced asthma exacerbations for children experiencing health disparities in the Denver Metropolitan Area, due partly to addressing care coordination for asthma and social determinants of health (SDOH), such as access to healthcare and medications. Limited dissemination of school-based asthma programs has occurred in other metropolitan and rural areas of Colorado. We formed and engaged community advisory boards in socioeconomically diverse regions of Colorado to develop two implementation strategy packages for delivering our school-based asthma intervention-now termed "Better Asthma Control for Kids (BACK)" - with tailoring to regional priorities, needs and resources.
METHODS: In this proposed type 2 hybrid implementation-effectiveness trial, where the primary goal is equitable reach to families to reduce asthma disparities, we will compare two different packages of implementation strategies to deliver BACK across four Colorado regions. The two implementation packages to be compared are: 1) standard set of implementation strategies including Tailor and Adapt to context, Facilitation and Training termed, BACK-Standard (BACK-S); 2) BACK-S plus an enhanced implementation strategy, that incorporates network weaving with community partners and consumer engagement with school families, termed BACK-Enhanced (BACK-E). Our evaluation will be guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, including its Pragmatic Robust Implementation Sustainability Model (PRISM) determinants of implementation outcomes. Our central hypothesis is that our BACK-E implementation strategy will have significantly greater reach to eligible children/families than BACK-S (primary outcome) and that both BACK-E and BACK-S groups will have significantly reduced asthma exacerbation rates ("attacks") and improved asthma control as compared to usual care.
CONCLUSION: We expect both the BACK-S and BACK-E strategy packages will accelerate dissemination of our BACK program across the state - the comparative impact of BACK-S vs. BACK-E on reach and other RE-AIM outcomes may inform strategy selection for scaling BACK and other effective school-based programs to address chronic illness disparities.
背景：哮喘是儿童住院、急诊和缺课的主要原因。我们以学校为基础的哮喘干预措施减少了丹佛大都会区健康不平等儿童的哮喘恶化，部分原因是解决了哮喘护理协调和健康的社会决定因素 (SDOH)，如获得医疗保健和药物的机会。在科罗拉多州的其他大城市和农村地区，以学校为基础的哮喘项目在科罗拉多州其他大都市和农村地区的推广有限。我们在科罗拉多州不同的社会经济地区成立了社区咨询委员会，并与之合作，制定了两套实施策略，以提供我们以学校为基础的哮喘干预措施——现在被称为“更好的儿童哮喘控制(BACK)”。-根据地区的优先事项、需要和资源进行调整。
方法：在这个建议的2型混合实施-有效性试验中，主要目标是公平地惠及家庭以减少哮喘差异，我们将比较两种不同的实施策略包，以在科罗拉多州的四个地区提供BACK。要比较的两套实施策略是 1)一套标准的实施策略，包括“因地制宜”（Tailor and Adapt to context）、“促进”（Facilitation）和“培训”（Training），称为“BACK-标准”（BACK-S）；2)BACK-S加上增强型实施策略，其中包括与社区合作伙伴编织网络和消费者参与学校家庭，称为“BACK-增强”（BACK-E）。我们的评估将以“覆盖面、有效性、采用、实施和维护”（RE-AIM）框架为指导，包括其“务实、稳健的实施可持续性模型”（PRISM）的实施结果决定因素。我们的核心假设是，BACK-E实施策略对符合条件的儿童/家庭的覆盖范围将明显大于BACK-S（主要结果），与常规护理相比，BACK-E组和BACK-S组的哮喘恶化率（“发作”）将明显降低，哮喘控制率也将得到改善。
结论：我们期望BACK-S和BACK-E策略包将加速我们的BACK计划在全州的传播——BACK-S和BACK- E对覆盖面和其他RE-AIM结果的比较影响可能会为缩减BACK和其他有效的学校项目的策略选择提供信息，以解决慢性病的差异。
（中日友好医院呼吸与危重症医学科 李春晓 摘译 林江涛 审校）
（Implement Sci. 2024 Aug 15;19(1):60.DOI: 10.1186/s13012-024-01387-3.）
（Implement Sci. 2024 Aug 15;19(1):60.DOI: 10.1186/s13012-024-01387-3.）
Reducing asthma attacks in disadvantaged school children with asthma: study protocol for a type 2 hybrid implementation-effectiveness trial (Better Asthma Control for Kids, BACK)
Amy G Huebschmann, Nicole M Wagner, Melanie Gleason, et al.
Abstract
BACKGRUND:Asthma is a leading cause of children's hospitalizations, emergency department visits, and missed school days. Our school-based asthma intervention has reduced asthma exacerbations for children experiencing health disparities in the Denver Metropolitan Area, due partly to addressing care coordination for asthma and social determinants of health (SDOH), such as access to healthcare and medications. Limited dissemination of school-based asthma programs has occurred in other metropolitan and rural areas of Colorado. We formed and engaged community advisory boards in socioeconomically diverse regions of Colorado to develop two implementation strategy packages for delivering our school-based asthma intervention-now termed "Better Asthma Control for Kids (BACK)" - with tailoring to regional priorities, needs and resources.
METHODS: In this proposed type 2 hybrid implementation-effectiveness trial, where the primary goal is equitable reach to families to reduce asthma disparities, we will compare two different packages of implementation strategies to deliver BACK across four Colorado regions. The two implementation packages to be compared are: 1) standard set of implementation strategies including Tailor and Adapt to context, Facilitation and Training termed, BACK-Standard (BACK-S); 2) BACK-S plus an enhanced implementation strategy, that incorporates network weaving with community partners and consumer engagement with school families, termed BACK-Enhanced (BACK-E). Our evaluation will be guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, including its Pragmatic Robust Implementation Sustainability Model (PRISM) determinants of implementation outcomes. Our central hypothesis is that our BACK-E implementation strategy will have significantly greater reach to eligible children/families than BACK-S (primary outcome) and that both BACK-E and BACK-S groups will have significantly reduced asthma exacerbation rates ("attacks") and improved asthma control as compared to usual care.
CONCLUSION: We expect both the BACK-S and BACK-E strategy packages will accelerate dissemination of our BACK program across the state - the comparative impact of BACK-S vs. BACK-E on reach and other RE-AIM outcomes may inform strategy selection for scaling BACK and other effective school-based programs to address chronic illness disparities.
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