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：
10723244
负责人：
Lisa Cicutto
金额：
$ 103.56万
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 2027-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10723244
关键词：
Absenteeism at work Acceleration Address Adoption Age Area Asthma Attention Behavior Caregivers Caring Child Child Care Childhood Asthma Cities Clinic Colorado Communication Communities Data Disadvantaged Disparity Disparity population Dissemination and Implementation Elements Eligibility Determination Emergency department visit Ensure Equity Evaluation Evidence based program Exploration, Preparation, Implementation, and Sustainment Family Funding Future Grant Guidelines Health Health Care Quality Indicators Hospitalization Hot Spot Intervention Investments Learning 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 Care Process Public Health Quality of life Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Reduce health disparities Research Design Research Personnel Resources Risk Reduction Rural School Nursing Schools Site Symptoms System Testing Training Work asthma exacerbation community burden community engaged research cost design dissemination trial effectiveness outcome effectiveness/implementation trial ethnic minority evidence base experience health disparity health inequalities high risk population implementation evaluation implementation framework implementation outcomes implementation research implementation strategy improved improved outcome lower income families member metropolitan minority student neighborhood disadvantage population health primary outcome programs racial minority response school district school health screening secondary outcome skills social health determinants success trial design

Absenteeism at work Acceleration Address Adoption Age Area Asthma Attention Behavior Caregivers Caring Child Child Care Childhood Asthma Cities Clinic Colorado Communication Communities Data Disadvantaged Disparity Disparity population Dissemination and Implementation Elements Eligibility Determination Emergency department visit Ensure Equity Evaluation Evidence based program Exploration, Preparation, Implementation, and Sustainment Family Funding Future Grant Guidelines Health Health Care Quality Indicators Hospitalization Hot Spot Intervention Investments Learning 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 Care Process Public Health Quality of life Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Reduce health disparities Research Design Research Personnel Resources Risk Reduction Rural School Nursing Schools Site Symptoms System Testing Training Work asthma exacerbation community burden community engaged research cost design dissemination trial effectiveness outcome effectiveness/implementation trial ethnic minority evidence base experience health disparity health inequalities high risk population implementation evaluation implementation framework implementation outcomes implementation research implementation strategy improved improved outcome lower income families member metropolitan minority student neighborhood disadvantage population health primary outcome programs racial minority response school district school health screening secondary outcome skills social health determinants success trial design

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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.

项目摘要/摘要我们的重新提出建议：“减少弱势学童的哮喘攻击哮喘，“寻求大规模实施我们有效的基于学校的方法来改善哮喘低收入社区儿童的差异（5至12岁）。使用基于社区的参与具有高风险人群和社区的方法，我们将在传播和实施方面进行情境化（D＆I）我们的科罗拉多州学校哮喘计划（Col-SBAP）减少了哮喘病情和错过上学的日子，同时还向我们的飞行员确定为健康的社会决定者（SDOH）哮喘分布的主要驱动力。我们将评估各种利益相关者确定的关键指标在科罗拉多州的粗糙和小城市地区的传播试验。我们的传播审判将包括两个干预措施：我们基于证据的Col-SBAP和基于证据的评估和管理方法到关键SDOH。我们的飞行员数据显示，这两种干预措施对于改善儿童的哮喘分布至关重要低收入家庭。这种两步的干预水平，称为停止哮喘攻击（SAA），将是为学校哮喘导航员和学校护士的可持续交付，他们与初级保健协调社区资源。与我们的社区利益相关者合作，探索，准备工作，实施，维持（EPIS）D＆I框架将在UG3计划阶段应用于迭代地适应我们当前的实施指南，以适应符合当地社区的实施计划以及特定于网站的需求，资源和优先事项（第1和第2集）。然后，我们将进行UH3 在哮喘“热点”学校系统中进行随机阶梯窗格研究设计的传播试验五个科罗拉多州评估哮喘“热点”学校系统的实施策略（EPIS）第3阶段，UH3试验）并应用了第1-3集中的作品，以开发“传播剧本” 指导其他学校系统采用未来的计划（EPIP第4阶段）。中心假设是SAA将会具有广泛而公平的范围（主要结果），并在减少哮喘攻击方面产生重要的好处和符号，与尚未实施SAA的学校相比。 SAA剧本将是旨在促进SAA的可持续采用，包括培训材料和回报计算投资。我们的建议对通过“测试后期（T4）实施研究策略”和“促进和改善高级人口健康负担社区”通过采用公共卫生方法来针对高水平的“热点”学校不受控制的哮喘和哮喘相关的伯恩。该提议都将包括一个严格的利益相关者参与过程，以确保SAA被传播到科罗拉多州潜水员地缘政治地区，并注意可持续性。总的来说，这本评估和剧本将在全国范围内加速SAA的传播在儿科哮喘护理中遇到健康不平等的社区。