Asthma Link: School Supervised Therapy to Improve Medication Adherence in Children with Poorly Controlled Asthma

哮喘链接：学校监督治疗可提高哮喘控制不佳儿童的药物依从性

基本信息

批准号：
10551340
负责人：
Michelle Trivedi
金额：
$ 16.87万
依托单位：
UNIV OF MASSACHUSETTS MED SCH WORCESTER
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：
2020-02-16 至 2025-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10551340
关键词：
Address Adherence Adopted Adoption Adrenal Cortex Hormones Affect Asthma Award Child Child Care Child Health Child Support Childhood Childhood Asthma Clinical Clinical Trials Clinical effectiveness Communication Communities Data Development Disparity Eligibility Determination Emergency department visit Enrollment Ensure Family Feedback Foundations Frequencies Funding Goals Health Health Expenditures Health Insurance Health Sciences Health behavior change Hospitalization Infrastructure Inhalators Intervention Interview Link Low income Massachusetts Master of Public Health Medical center Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Modeling Morbidity - disease rate Nature Office Nursing Oral Outcome Parents Patient Recruitments Pediatrics Pharmaceutical Preparations Pharmacists Pilot Projects Play Policies Population Preventive Primary Care Procedures Process Program Acceptability Protocols documentation Public Health Public Health Schools Pulmonology Randomized Randomized, Controlled Trials Research Research Personnel Resource-limited setting Resources Retrospective Studies Role School Nursing Schools Scientist Site Spirometry Symptoms System Testing Therapeutic Intervention Time Training United States Universities Work adherence rate career career development clinical infrastructure clinical practice community engaged research cost design effectiveness testing epidemiology study experience follow-up high risk implementation barriers implementation science improved informant innovation intervention cost intervention refinement medical schools medication compliance medication nonadherence mid-career faculty minority children multidisciplinary operation pediatrician pilot test professor programs prospective prototype research and development research study response routine practice standard of care treatment as usual

项目摘要

PROJECT SUMMARY/ABSTRACT RESEARCH: The goal of this proposal is to refine and pilot test Asthma Link, an innovative, low- cost intervention that links pediatric practices, schools, and families to deliver school nurse-supervised asthma therapy to children with poorly controlled asthma in real-world settings. While there are successful examples of school-supervised asthma therapy to improve asthma medication adherence in research settings, this intervention has not been routinely adopted in practice. This is likely due to costly and resource intense protocols that have not yet leveraged the established infrastructure of the clinical system and schools. To address this, our team developed a new model, Asthma Link, in which pediatric providers identify eligible children as part of their routine practice and initiate supervised asthma therapy with the school nurse; the family picks up and delivers the asthma medication to the school: and the school nurse supervises daily asthma medication use. This intervention leverages established infrastructure and requires minimal resources to operate, enhancing sustainability in a real-world setting. Our preliminary studies show that Asthma Link reduces asthma-related emergency room visits yet qualitative interviews showed the protocol needs refinement for real-world use. We propose to refine the Asthma Link protocol for real-world implementation and then pilot test the refined protocol in a cluster RCT of 4 pediatric practices (n=72 parent-child dyads). If proven to be effective, Asthma Link could become the standard of care for children with high-risk asthma, with the power to transform practice, even within limited resources. CANDIDATE: Michelle Trivedi, MD, MPH is a pediatric pulmonologist, Associate Professor of Pediatrics at the University of Massachusetts Medical School (UMMS) in the Division of Pediatric Pulmonology at UMass Memorial Children's Medical Center and an Assistant Professor in the Department of Population and Quantitative Health Sciences at UMMS. She received a Master's of Public Health in Clinical Effectiveness at the Harvard School of Public Health. She has conducted rigorous observational and epidemiologic investigations in pediatric asthma; and with a UMMS KL2 Award has performed two critical pilot studies of Asthma Link, which build the foundation for this K23 proposal. Dr. Trivedi will utilize the K23 Award to become an independent clinician-scientist with expertise in developing and implementing low-cost, sustainable interventions for children with asthma and to ultimately impact state and national asthma policies. ENVIRONMENT: Dr. Trivedi will perform her research and career development at UMMS. Her primary mentor, Dr. Lori Pbert and secondary mentors, Dr. Wanda Phipatanakul, Dr. Milagros Rosal and Dr. Stephenie Lemon, are all leaders in their respective fields of preventive health, health behavior change trials, pediatric asthma clinical trials, community-engaged research and implementation science. Each of Dr. Trivedi's mentors has an excellent track record of mentoring young investigators towards independent research careers.

项目概要/摘要研究：本提案的目标是完善和试点测试 Asthma Link，这是一种创新的、低将儿科诊所、学校和家庭联系起来的成本干预，以提供学校护士监督在现实环境中对哮喘控制不佳的儿童进行哮喘治疗。虽然有成功的学校监督哮喘治疗以提高研究中哮喘药物依从性的例子但这种干预措施在实践中并未得到常规采用。这可能是由于成本高昂且尚未利用临床系统现有基础设施的资源密集型协议和学校。为了解决这个问题，我们的团队开发了一种新模型“Asthma Link”，其中儿科提供者确定符合条件的儿童作为其日常实践的一部分，并与以下机构一起开始监督哮喘治疗学校护士；家人领取哮喘药物并将其送到学校：以及学校护士监督日常哮喘药物的使用。这种干预措施利用了现有的基础设施和需要最少的资源来运营，从而增强现实世界环境中的可持续性。我们的初步研究表明 Asthma Link 减少了与哮喘相关的急诊室就诊次数，但进行了定性访谈表明该协议需要针对实际使用进行改进。我们建议完善 Asthma Link 协议实际实施，然后在 4 个儿科实践的集群随机对照试验中对完善的方案进行试点测试（n=72 亲子二人组）。如果被证明有效，Asthma Link 可能成为儿童护理标准患有高危哮喘的患者，即使在资源有限的情况下，也有能力改变实践。候选人：米歇尔·特里维迪 (Michelle Trivedi)，医学博士、公共卫生硕士，儿科肺科医生、副教授马萨诸塞大学医学院 (UMMS) 儿科小儿肺科麻省大学纪念儿童医学中心人口和人口系助理教授 UMMS 的定量健康科学。她获得了临床有效性公共卫生硕士学位哈佛大学公共卫生学院。她进行了严格的观察和流行病学调查小儿哮喘研究；并获得 UMMS KL2 奖，并进行了两项关键的试点研究 Asthma Link，为 K23 提案奠定了基础。 Trivedi 博士将利用 K23 奖成为一位独立的临床科学家，具有开发和实施低成本、可持续的专业知识对哮喘儿童的干预措施并最终影响州和国家的哮喘政策。环境：Trivedi 博士将在 UMMS 进行研究和职业发展。她的小学导师 Lori Pbert 博士和二级导师 Wanda Phipatanakul 博士、Milagros Rosal 博士和 Stephenie 博士 Lemon，都是各自领域的预防性健康、健康行为改变试验、儿科领域的领导者哮喘临床试验、社区参与研究和实施科学。 Trivedi 博士的每位导师在指导年轻研究人员走向独立研究职业方面拥有出色的记录。