Reducing Asthma Attacks in Disadvantaged School Children with Asthma

减少患有哮喘的弱势学童的哮喘发作

基本信息

批准号：
10470434
负责人：
Lisa Cicutto
金额：
$ 6.94万
依托单位：
UNIVERSITY OF COLORADO DENVER
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-10 至 2023-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10470434
关键词：
Address Adoption Age Area Asthma Attention Behavior Caregivers Caring Child Child Care Childhood Asthma Cities Clinic Colorado Communication Communities Data Disadvantaged Dissemination and Implementation Elements Emergency department visit Ensure Evaluation Evidence based program Exploration, Preparation, Implementation, and Sustainment Family Funding Future Grant Guidelines Health Health Care Quality Indicators Hospitalization Hot Spot Intervention Investments Low income Maintenance Measures Methods Morbidity - disease rate Multimedia National Heart, Lung, and Blood Institute Outcome Patients Performance Phase Practical, Robust Implementation and Sustainability Model Primary Health Care Process Public Health Quality of life Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Research Design Research Personnel Resources Risk Rural School Nursing Schools Site Symptoms System Testing Training Work asthma exacerbation base community burden community engaged research cost design disadvantaged population dissemination trial effectiveness implementation study effectiveness outcome ethnic minority population evidence base experience health disparity health inequalities high risk population implementation framework implementation outcomes implementation research implementation strategy improved improved outcome lower income families member metropolitan minority student population health primary outcome programs racial and ethnic response school district school health screening secondary outcome skills social health determinants success sustainability framework trial design

项目摘要

PROJECT SUMMARY/ABSTRACT Our re-submission proposal, “Reducing Asthma Attacks in Disadvantaged School Children with Asthma,” seeks broad-scale implementation of our effective school-based approach to improve asthma disparities for children in low-income communities (ages 5 to 12 years). Using community-based participatory methods with high risk populations and communities, we will contextualize dissemination and implementation (D&I) of our Colorado school-based asthma program (Col-SBAP) that reduces asthma exacerbations and missed school days, while also addressing social determinants of health (SDOH) which our pilot identified as major drivers of asthma disparities. We will evaluate key metrics identified by diverse stakeholders during a dissemination trial in rural and small metropolitan areas of Colorado. Our dissemination trial will include two interventions: our evidence-based Col-SBAP and an evidence-based assessment and management approach to key SDOH. Our pilot data show both interventions are critical to improve asthma disparities for children from low income families. This two-step level of intervention, called Stop Asthma Attacks (SAA), will be designed for sustainable delivery by school asthma navigators and school nurses who coordinate with primary care and community resources. In partnership with our community stakeholders, the Exploration, Preparation, Implementation, Sustainment (EPIS) D&I framework will be applied during the UG3 planning phase to iteratively adapt our current implementation guide to tailored implementation plans that meet local community and site-specific needs, resources and priorities (EPIS Phases 1 & 2). We will then conduct a UH3 dissemination trial with a randomized stepped-wedge study design in asthma “hot spot” school systems across five Colorado regions to evaluate implementation strategies across asthma “hot spot” school systems (EPIS phase 3, UH3 trial) and to apply the work from EPIS phases 1-3 to develop a “dissemination playbook” to guide future program adoption by other school systems (EPIS Phase 4). The central hypothesis is that SAA will have broad and equitable Reach (primary outcome), and yield important benefits in reducing asthma attacks and symptoms, as compared to schools that have not yet implemented SAA. The SAA playbook will be designed to promote the sustainable adoption of SAA, including training materials and a calculation of return on investment. Our proposal is responsive to and addresses key elements of NHLBI HL-20-003 by “testing late-stage (T4) implementation research strategies” and “promoting and improving population health in high- burden communities” by using a public health approach to target “hot spot” schools with high levels of uncontrolled asthma and asthma associated burden. This proposal will both include a rigorous stakeholder engagement process to ensure SAA is disseminated to diverse geopolitical areas of Colorado with attention to sustainability. Collectively, this evaluation and playbook will accelerate dissemination of SAA nationally to communities experiencing health inequities in pediatric asthma care.

项目概要/摘要我们重新提交的提案“减少患有哮喘的弱势学童的哮喘发作” 哮喘”寻求广泛实施我们有效的基于学校的方法来改善哮喘低收入社区（5 至 12 岁）儿童的差异采用基于社区的参与方式。针对高风险人群和社区的方法，我们将结合具体情况进行传播和实施我们科罗拉多州校本哮喘计划 (Col-SBAP) 的 (D&I)，可减少哮喘恶化，缺课，同时还解决健康的社会决定因素 (SDOH)，我们的试点确定为我们将评估不同利益相关者在评估期间确定的关键指标。在科罗拉多州的农村和小都市地区进行的传播试验将包括两项。干预措施：我们基于证据的 Col-SBAP 以及基于证据的评估和管理方法我们的试点数据显示，这两种干预措施对于改善 20 岁以下儿童的哮喘差异至关重要。这种名为“停止哮喘发作”(SAA) 的两步干预措施将针对低收入家庭。由学校哮喘导航员和学校护士协调初级保健和与我们的社区利益相关者合作，探索、准备、实施、维持 (EPIS) D&I 框架将在 UG3 规划阶段应用，以不断调整我们当前的实施指南，以适应适合当地社区的定制实施计划然后，我们将进行 UH3。在哮喘“热点”学校系统中进行随机阶梯楔形研究设计的传播试验科罗拉多州的五个地区评估哮喘“热点”学校系统的策略实施情况（EPIS 第 3 阶段，UH3 试验）并应用 EPIS 第 1-3 阶段的工作来开发“传播手册” 指导其他学校系统未来计划的采用（EPIS 第 4 阶段）中心假设是 SAA 将这样做。具有广泛而公平的影响范围（主要结果），并在减少哮喘发作方面产生重要益处和症状，与尚未实施 SAA 的学校相比。旨在促进 SAA 的可持续采用，包括培训材料和回报计算我们的提案通过“测试”响应并解决了 NHLBI HL-20-003 的关键要素。后期（T4）实施研究策略”和“促进和改善高海拔地区人口健康” “负担社区”，利用公共卫生方法针对高水平的“热点”学校该提案将包括严格的利益相关者。参与流程，以确保 SAA 传播到科罗拉多州的不同地缘政治地区，并关注总的来说，本评估和手册将加速 SAA 在全国范围内的传播。在儿科哮喘护理方面经历健康不平等的社区。