@Article{信息:doi 10.2196 / / jmir。1964年，作者=“Gustafson, David和Wise, Meg和Bhattacharya, Abhik和pam, Alice和Shanovich, Kathleen和Phillips, Brenda和Lehman, Erik和Chinchilli, Vernon和Hawkins, Robert和Kim, ji - seon”，标题=“基于web的电子健康与电话护士病例管理相结合对儿科哮喘控制的影响:随机对照试验”，期刊=“J Med Internet Res”，年=“2012”，月=“7月”，日=“26”，卷=“14”，数=“4”，页=“e101”，关键词=“哮喘;哮喘信息;儿童疾病;病例管理;病人教育;电子健康;背景:哮喘是美国最常见的儿科疾病，给低收入和少数族裔家庭造成了不成比例的负担，并导致了高昂的医疗费用。基于临床的哮喘教育和电话病例管理在哮喘控制方面效果好坏参半，电子健康项目和在线游戏也是如此。目的:测试(1)CHESS+CM(一种针对4- 12岁哮喘控制不佳的父母和儿童的系统)对哮喘控制和药物依从性的影响，以及(2)能力、自我效能和社会支持作为介质的影响。 CHESS+CM included a fully automated eHealth component (Comprehensive Health Enhancement Support System [CHESS]) plus monthly nurse case management (CM) via phone. CHESS, based on self-determination theory, was designed to improve competence, social support, and intrinsic motivation of parents and children. Methods: We identified eligible parent--child dyads from files of managed care organizations in Madison and Milwaukee, Wisconsin, USA, sent them recruitment letters, and randomly assigned them (unblinded) to a control group of treatment as usual plus asthma information or to CHESS+CM. Asthma control was measured by the Asthma Control Questionnaire (ACQ) and self-reported symptom-free days. Medication adherence was a composite of pharmacy refill data and medication taking. Social support, information competence, and self-efficacy were self-assessed in questionnaires. All data were collected at 0, 3, 6, 9, and 12 months. Asthma diaries kept during a 3-week run-in period before randomization provided baseline data. Results: Of 305 parent--child dyads enrolled, 301 were randomly assigned, 153 to the control group and 148 to CHESS+CM. Most parents were female (283/301, 94{\%}), African American (150/301, 49.8{\%}), and had a low income as indicated by child's Medicaid status (154/301, 51.2{\%}); 146 (48.5{\%}) were single and 96 of 301 (31.9{\%}) had a high school education or less. Completion rates were 127 of 153 control group dyads (83.0{\%}) and 132 of 148 CHESS+CM group dyads (89.2{\%}). CHESS+CM group children had significantly better asthma control on the ACQ (d = --0.31, 95{\%} confidence limits [CL] --0.56, --0.06, P = .011), but not as measured by symptom-free days (d = 0.18, 95{\%} CL --0.88, 1.60, P = 1.00). The composite adherence scores did not differ significantly between groups (d = 1.48{\%}, 95{\%} CL --8.15, 11.11, P = .76). Social support was a significant mediator for CHESS+CM's effect on asthma control (alpha = .200, P = .01; beta = .210, P = .03). Self-efficacy was not significant (alpha = .080, P = .14; beta = .476, P = .01); neither was information competence (alpha = .079, P = .09; beta = .063, P = .64). Conclusions: Integrating telephone case management with eHealth benefited pediatric asthma control, though not medication adherence. Improved methods of measuring medication adherence are needed. Social support appears to be more effective than information in improving pediatric asthma control. Trial Registration: Clinicaltrials.gov NCT00214383; http://clinicaltrials.gov/ct2/show/NCT00214383 (Archived by WebCite at http://www.webcitation.org/68OVwqMPz) ", issn="1438-8871", doi="10.2196/jmir.1964", url="//www.mybigtv.com/2012/4/e101/", url="https://doi.org/10.2196/jmir.1964", url="http://www.ncbi.nlm.nih.gov/pubmed/22835804" }