Using technology-assisted stepped-care interventions to improve adherence in adolescents with asthma

使用技术辅助的阶梯式护理干预措施来提高青少年哮喘患者的依从性

• 批准号: 10227923
• 负责人: Rachelle R. Ramsey
• 金额: $ 16.63万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-15 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10227923
• 关键词: 18 year old; Address; Adherence; Adolescent; Adrenal Cortex Hormones; Applications Grants; Appointment; Asthma; Behavior Therapy; Behavioral; Behavioral Medicine; Biometry; Caring; Cellular Phone; Childhood; Clinical; Clinical Psychology; Clinical Research; Clinical Trials; Clinical Trials Design; Clinical and Translational Science Awards; Collection; Community Health; Complement; Consultations; Control Groups; Development; Development Plans; Dissemination and Implementation; Doctor of Philosophy; Educational Materials; Emotional; Environment; Evaluation; Faculty; Feedback; Fellowship; Frequencies; Funding; Future; Goals; Grant; Health; Health Technology; Health behavior; Inhalation; Inhalators; Internet; Intervention; K-Series Research Career Programs; Knowledge; Lung; Measures; Medical; Medical center; Mentors; Mentorship; Modeling; Monitor; Morbidity - disease rate; Oklahoma; Outcome; Outpatients; Parents; Patients; Pattern; Pediatric Hospitals; Pediatrics; Phase; Population; Populations at Risk; Problem Solving; Process; Provider; Psychologist; Public Health; Publications; Pulmonology; Quality of life; Randomized Controlled Trials; Research; Research Design; Research Personnel; Resources; Self Management; Severities; Severity of illness; Structure; Symptoms; System; Technology; Technology Assessment; Testing; Text Messaging; Time; Training; Translations; Treatment Failure; Uncertainty; United States National Institutes of Health; Universities; Writing; adolescent health; adolescent health outcomes; arm; asthma model; base; behavioral adherence; care costs; career; career development; clinical care; dissemination strategy; dissemination trial; effectiveness implementation study; effectiveness trial; experience; handheld mobile device; health care service utilization; implementation intervention; implementation science; implementation strategy; implementation trial; improved; indexing; innovation; innovative technologies; medication compliance; monitoring device; novel; patient population; personalized care; professor; research and development; research study; secondary outcome; skills; statistics; success; symptom treatment; technology validation; telehealth; therapy development; treatment as usual; trial comparing; usability; web portal

PROJECT SUMMARY/ABSTRACT Candidate: I am a practicing pediatric psychologist whose overarching career goal is to improve health outcomes for adolescents with asthma by targeting adherence through technology-assisted interventions. I am an Assistant Professor of Pediatrics in the Division of Behavioral Medicine and Clinical Psychology (BMCP) at Cincinnati Children's Hospital Medical Center (CCHMC). I completed my doctoral training at Oklahoma State University and a T32 fellowship in pediatric adherence at CCHMC. Training Objectives: The proposed K23 will allow me to fill my current training gaps and enable me to: 1) Obtain advanced training in dissemination and implementation science, 2) Develop knowledge of clinical care models of asthma for adolescents with a specific focus on community health, 3) Obtain advanced training in clinical research design and biostatistics, and 4) Enhance my professional development through grant writing skills and publications of research findings. Mentors: My primary mentor, Kevin Hommel, PhD, is a NIH-funded researcher with expertise in clinical research design and technology-enabled behavioral adherence-promotion interventions for adolescents. Under Dr. Hommel's mentorship, I have assembled an expert team of leaders in asthma and pulmonary care (Drs. Guilbert, Kahn), dissemination and implementation science (Dr. Epstein), and Statistics (Dr. Peugh) who complement Dr. Hommel's expertise and will provide valuable mentorship. Environment: CCHMC and the University of Cincinnati (UC) are uniquely equipped to facilitate the career development of junior researchers. Through UC's Clinical and Translational Science Award and the Asthma Center, I have local resources to achieve my training objectives and complete the proposed research. The Asthma Center within the Division of Pulmonary Medicine provides access to a large patient population and I will capitalize on my existing relationships with Asthma Center faculty. Research: My proposed research will test the preliminary efficacy of a technology-assisted stepped-care (TASC) adherence-promotion intervention for 12-18 year old adolescents with asthma in a pilot RCT. TASC was developed using dissemination and implementation strategies to facilitate translation to practice and has the potential to address the limitations of available adherence interventions for adolescents with asthma by overcoming barriers to access, providing individualized care, and expanding the reach and impact of adherence intervention to improve the health of adolescents with asthma. Preliminary efficacy will be demonstrated by improved adherence to daily inhaled corticosteroids as measured by electronic monitoring devices compared to a treatment as usual (TAU) control group. Secondary outcomes include disease severity as measured by the Composite Asthma Severity Index combining symptoms, treatment, and exacerbations compared to TAU and an assessment of TASC implementation through a process evaluation assessing reach, usability, and sustainability. This research will provide the basis for a fully powered RCT to be proposed in an R01 grant application prior to the end of this K award.

项目概要/摘要 候选人：我是一名执业儿科心理学家，其首要职业目标是改善健康 通过技术辅助干预措施提高依从性，从而改善患有哮喘的青少年的结果。我是 行为医学和临床心理学 (BMCP) 部儿科助理教授 辛辛那提儿童医院医疗中心 (CCHMC)。我在俄克拉荷马州立大学完成了博士培训 大学和 CCHMC 儿科依从性 T32 奖学金。培训目标：建议的K23 将使我能够填补当前的培训空白，并使我能够：1）获得传播方面的高级培训 和实施科学，2) 培养患有哮喘的青少年的临床护理模式知识 特别关注社区健康，3) 获得临床研究设计和生物统计学方面的高级培训， 4) 通过资助写作技巧和研究成果的发表来加强我的专业发展。 导师：我的主要导师 Kevin Hommel 博士是一位 NIH 资助的研究人员，拥有临床专业知识 针对青少年的研究设计和技术支持的行为依从性促进干预措施。在下面 在 Hommel 博士的指导下，我组建了一支由哮喘和肺部护理领域的领导者组成的专家团队（Drs. Hommel）。 Guilbert, Kahn）、传播和实施科学（Epstein 博士）以及统计学（Peugh 博士） 补充 Hommel 博士的专业知识并将提供宝贵的指导。环境：CCHMC 和 辛辛那提大学 (UC) 拥有独特的能力来促进初级研究人员的职业发展。 通过加州大学的临床和转化科学奖以及哮喘中心，我拥有本地资源 实现我的培训目标并完成拟议的研究。分部内的哮喘中心 肺科为大量患者提供了接​​触机会，我将利用我现有的 与哮喘中心教师的关系。研究：我提出的研究将测试初步功效 针对 12-18 岁青少年的技术辅助阶梯式护理 (TASC) 依从性促进干预措施 试点随机对照试验中患有哮喘。 TASC 的开发采用了传播和实施策略 促进转化为实践，并有可能解决现有依从性的局限性 通过克服获取障碍、提供个性化护理和对患有哮喘的青少年进行干预 扩大依从性干预的范围和影响，以改善哮喘青少年的健康。 初步疗效将通过测量每日吸入皮质类固醇的依从性的改善来证明 通过电子监控设备与常规治疗（TAU）对照组进行比较。次要结果 包括通过综合哮喘严重程度指数结合症状来衡量的疾病严重程度， 与 TAU 相比的治疗和恶化情况以及通过 TAU 对 TASC 实施情况的评估 流程评估评估范围、可用性和可持续性。这项研究将为全面研究提供基础 在本次 K 奖结束之前，将在 R01 拨款申请中提出有动力的 RCT。