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首页> 外文期刊>Disease Management >The Breathmobile™ Program: Structure, Implementation, and Evolution of a Large-Scale, Urban, Pediatric Asthma Disease Management Program
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The Breathmobile™ Program: Structure, Implementation, and Evolution of a Large-Scale, Urban, Pediatric Asthma Disease Management Program

机译：Breathmobile™计划：大规模，城市，小儿哮喘病管理计划的结构，实施和演变

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Despite more than a decade of education and research-oriented intervention programs, inner city children with asthma continue to engage in episodic "rescue" patterns of healthcare and experience a disproportionate level of morbidity. The aim of this study was to establish and evaluate a sustainable community-wide pediatric asthma disease management program designed to shift inner city children in Los Angeles from acute episodic care to regular preventive care in accordance with national standards. In 1995 the Southern California Chapter of the Asthma and Allergy Foundation of America (AAFA), the Los Angeles County Department of Health Services (LAC DHS), and the Los Angeles Unified School District (LAUSD) established an agreement to initiate and sustain the Breathmobile™ Program. This program includes automated case identification, mobile school-based clinics, and highly structured clinical encounters supported by an advanced information technology solution. Interdisciplinary teams of asthma care specialists provide regular and ongoing care to children at school and county clinic sites over a wide geographic area of urban Los Angeles. Each team operates in a specially equipped mobile clinic (Breathmobile™), efficiently moving a structured healthcare process to school and county clinic sites with large numbers of children. Demographic, clinical, and participation data is tracked carefully in an electronic medical record system. Program operations, clinical oversight, and patient tracking are centralized at a care coordination center. Clinical operations and methods have been replicated in fixed specialty clinic sites at the Los Angeles County + University of Southern California Medical Center. Clinical and process measures are regularly evaluated to assure quality, plan iterative improvement, and support evidence-based care. Four Breathmobiles™ deliver ongoing care at more than 90 school sites. The program has engaged over five thousand patients and their families in a continuity care model that has demonstrated efficacy over usual episodic care. More than 90% of patients in all asthma severity categories achieved clinical control of asthma with significant reductions in inpatient (IP) and emergency department (ED) use. On February 14, 2002, the program became the first program in the United States to receive the award of dis- ease-specific care certification by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Proper design and resource allocation can sustain a school-based community-wide pediatric asthma disease management program and shift a population of inner city children from acute episodic care to routine preventive care in accordance with national standards. An evidence-based approach to evaluating and maintaining quality, coupled with stratified care delivery, can assure the efficient use of safety net healthcare resources.
机译：尽管有十多年的教育和研究导向型干预计划，但内城区哮喘儿童仍继续采取突发性的“营救”医疗保健模式，并患病率不成比例。这项研究的目的是建立和评估一项可持续的社区范围内的小儿哮喘疾病管理计划，该计划旨在按照国家标准将洛杉矶市内的城市儿童从急性发作性护理转移到常规预防性护理。 1995年，美国哮喘和过敏基金会南加州分会（AAFA），洛杉矶县卫生服务部（LAC DHS）和洛杉矶联合学区（LAUSD）达成了一项协议，以启动和维持呼吸车™程序。该计划包括自动病例识别，以学校为基地的移动诊所以及由高级信息技术解决方案支持的高度结构化的临床交流。哮喘护理专家跨学科团队在洛杉矶市区的广泛地理区域内，为学校和县诊所的儿童提供定期和持续的护理。每个团队都在专门配备的移动诊所（Breathmobile™）中运作，将结构化的医疗流程有效地转移到有大量儿童的学校和县诊所现场。在电子病历系统中会仔细跟踪人口统计，临床和参与数据。计划操作，临床监督和患者跟踪均集中在护理协调中心。临床操作和方法已在洛杉矶县+南加州大学医学中心的固定专业诊所现场复制。定期评估临床和过程措施，以确保质量，计划迭代改进并支持循证护理。四台Breathmobiles™在90多个学校现场提供持续护理。该计划已使超过五千名患者及其家人参与了连续性护理模型，该模型已证明比常规的间歇性护理有效。在所有哮喘严重程度类别中，超过90％的患者实现了哮喘的临床控制，住院患者（IP）和急诊科（ED）的使用显着减少。 2002年2月14日，该计划成为美国首个获得医疗组织认可联合委员会（JCAHO）颁发的针对疾病的护理证书奖的计划。适当的设计和资源分配可以维持学校为基础的社区性小儿哮喘疾病管理计划，并根据国家标准，将内城区儿童从急性发作护理转变为常规预防保健。基于证据的评估和保持质量的方法，再加上分层的护理服务，可以确保安全网医疗资源的有效利用。

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