Appalachian STAR Trial

阿巴拉契亚之星试验

基本信息

批准号：
10831880
负责人：
Matthew Lee Bush
金额：
$ 107.76万
依托单位：
UNIV OF ARKANSAS FOR MED SCIS
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-05-15 至 2026-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10831880
关键词：
Achievement Address Adoption Advocacy Appalachian Region Caring Child Childhood Clinic Cluster randomized trial Communities Consolidated Framework for Implementation Research County Disparity Disparity population Education Employment Female Friends Funding Future Goals Health Health Services Accessibility Health Technology Health system Healthcare Home Hybrids Improve Access Inequality Infection Infrastructure Intervention Kentucky Language Development Lead Letters Life Life Cycle Stages Location Minority Modeling Parents Pathway interactions Policies Policy Analysis Population Preventive Health Services Preventive care Preventive service Primary Care Randomized Reduce health disparities Research Rural Rural Community School Nursing Schools Screening procedure Shapes Specialist State Government Technology Telemedicine Testing Time Translating Tribes Underserved Population United States National Institutes of Health Work acute care barrier to care childhood hearing loss community engagement community-level factor design digital effectiveness evaluation effectiveness/implementation trial evidence base follow-up health care model health disparity hearing impairment hearing screening implementation determinants implementation facilitators implementation outcomes implementation science improved innovation insight kindergarten mHealth medical specialties meetings multidisciplinary novel primary outcome programs prospective prototype public health relevance randomized trial rural Alaska rural America rural area rural counties rural environment rural health disparities rural underserved scale up school health screening screening policy social determinants social health determinants socioeconomic disadvantage teacher telehealth telehealthcare therapy design treatment as usual underserved community virtual virtual technology

项目摘要

Health disparities in rural America begin early in life, arising from social determinants of health that start in childhood. School health programs often provide the only access to preventive services for rural children. However, school screening is variably implemented, plagued by loss to follow-up, and limited specialists in rural areas compound barriers to care. We propose to prospectively implement a novel model of care in Appalachian schools of rural Kentucky to address social determinants at the school, health system, and policy levels that hinder identification and treatment of preventable health disparities for two NIH-designated disparity populations: underserved rural and socioeconomically disadvantaged children. Our goal is to establish a novel, generalizable model of school-based, telehealth-driven preventive care that can be disseminated in underserved populations across rural America. We will adapt and evaluate our evidence-based approach, “STAR” (Specialty Telemedicine Access for Referrals), that we have found effective in a Tribal setting in rural Alaska. Appalachia has some of the poorest counties in the US, making this region ideal for adapting across rural America. The innovative “Appalachian STAR trial” will be the first study to apply school-based telehealth for preventive services, with direct access to specialists. Hearing screening will be the prototype for STAR due to the high burden of preventable, infection-related hearing loss in underserved children and the profound lifelong implications of childhood hearing loss. Our interdisciplinary team has relationships with underserved communities in Kentucky and partnership with a Community Advisory Board and Stakeholder Advisory Board providing support from the highest levels of state government (See KY Governor Letter). We will begin by adapting the STAR model of care to meet the needs of rural communities and schools through a community-and stakeholder-driven approach. We will evaluate the STAR care model in 66 schools in rural Kentucky through a stepped wedge cluster-randomized hybrid type 1 effectiveness-implementation trial with kindergarten children in 14 counties (n=~3600/year). The STAR intervention includes county-level school screening policy change with enhanced mHealth school hearing screening, followed by virtual specialty care referral. The stepped-wedge design allows evaluation of the policy/screening and referral components as well as comparison of usual care vs. full intervention (years 2 vs.5), while meeting community input that the intervention be available to all. Primary outcomes are the percentage of 1) children screened and 2) referrals resulting in specialty care within two months of screening. We conservatively hypothesize the percentage screened will improve by 20% and follow-up will improve by 40%. During the trial, we will assess multi-level implementation factors and outcomes to inform scale-up into other rural areas. Our STAR model could be both scaled across rural America and applied to other preventable health disparities, combining policy change on school health with digital innovations to radically expand access to care for underserved rural and socioeconomically disadvantaged children nationwide.

美国农村地区的健康差异从很小的时候就开始了，其根源在于健康的社会决定因素学校保健计划往往为农村儿童提供获得预防服务的唯一途径。然而，学校筛查的实施情况参差不齐，受到随访缺失以及农村地区专家有限的困扰。我们建议在阿巴拉契亚地区前瞻性地实施一种新颖的护理模式。肯塔基州农村学校解决学校、卫生系统和政策层面的社会决定因素阻碍对两个 NIH 指定的差异人群可预防的健康差异的识别和治疗：我们的目标是为服务不足的农村和社会弱势儿童建立一个新颖的、以学校为基础、远程医疗驱动的预防性护理的普遍模式，可以在我们将调整和评估我们基于证据的方法，我们发现“STAR”（转诊专业远程医疗访问）在农村部落环境中非常有效阿巴拉契亚拥有美国一些最贫困的县，使该地区成为适应各种环境的理想地区。创新的“阿巴拉契亚 STAR 试验”将是第一个应用基于学校的远程医疗的研究。直接接触专家的预防性服务将成为 STAR due 的原型。对服务不足的儿童来说，可预防的、与感染相关的听力损失造成的沉重负担，以及深远的终生影响我们的跨学科团队与服务不足的人有联系。肯塔基州的社区以及与社区咨询委员会和利益相关者咨询委员会的合作伙伴关系提供州政府最高层的支持（参见肯塔基州州长信函）。通过社区和利益相关者驱动的方法调整 STAR 护理模式，以满足农村社区和学校的需求我们将通过以下方式评估肯塔基州农村地区 66 所学校的 STAR 护理模式。针对幼儿园儿童的阶梯楔形整群随机混合 1 型有效性实施试验 STAR 干预包括 14 个县（n=~3600/年）的县级学校筛查政策的改变。加强 mHealth 学校听力筛查，然后进行虚拟专业护理转诊。设计允许评估政策/筛查和转诊组成部分以及常规护理的比较与全面干预（第 2 年与第 5 年），同时满足社区意见，即干预措施可供所有人使用。结果是 1) 接受筛查的儿童和 2) 两个月内获得特殊护理的转诊百分比我们保守地进行筛查，筛查百分比将提高 20%，后续将提高。在试验期间，我们将评估多层次的实施因素和结果，以告知我们的 STAR 模型可以在美国农村地区推广并应用于其他地区。可预防的健康差异，将学校健康政策变化与数字创新相结合，从根本上解决扩大全国范围内服务不足的农村儿童和社会经济弱势儿童获得护理的机会。