North STAR Trial: Specialty Telemedicine Access for Referrals in Rural Alaska

North STAR 试验：阿拉斯加农村地区的转诊专业远程医疗服务

• 批准号: 10340829
• 负责人: Denise A Dillard
• 金额: $ 12.62万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-17 至 2022-05-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10340829
• 关键词: Achievement; Acute; Address; Air; Alaska; Alaska Native; American; COVID-19; Caring; Child; Child Health; Clinic; Cluster randomized trial; Communities; Consolidated Framework for Implementation Research; Consult; Data; Development; Diagnosis; Ear; Early treatment; Education; Employment Opportunities; Feedback; Focus Groups; Funding; Future; Geography; Group Interviews; Health; Health Services; Health Services Accessibility; Health system; Hearing; High Prevalence; Home; Improve Access; Intervention; Interview; Language Development; Lead; Leadership; Letters; Minority Groups; Modeling; Modification; National Institute on Deafness and Other Communication Disorders; Parents; Pathway interactions; Policies; Policy Analysis; Population; Prevalence; Prevention; Preventive service; Primary Health Care; Protocols documentation; Randomized; Recording of previous events; Research; Rural; Rural Community; Rural Population; School Nursing; School Teachers; Schools; Science Policy; Services; Social Work; Specialist; System; Telemedicine; Testing; Time; Translating; Travel; Triage; Underserved Population; Work; barrier to care; base; care delivery; childhood hearing loss; clinical care; community based research; design; effectiveness testing; experience; follow-up; health care availability; health disparity; hearing impairment; hearing screening; implementation barriers; implementation protocol; implementation science; implementation trial; improved; informant; innovation; medical specialties; minority children; novel; pandemic disease; payment; primary outcome; programs; prospective; public health relevance; rural Alaska; rural area; rural environment; rural underserved; scale up; screening; screening program; success; support network; teacher; telehealth; tribal health; underserved minority; virtual

ABSTRACT Rural Alaska Native children experience a high prevalence of preventable childhood hearing loss. School-based programs provide the only access to preventive services for many underserved rural and minority children, yet loss to follow-up from school hearing screening is common and scarcity of specialists in rural areas compound barriers to care. The Alaska Tribal Health System addresses geographic barriers to care with a telehealth network, but the network is not used for school hearing screening and is only available in Tribal regions. This proposal brings a novel telehealth model directly into schools to reach underserved rural and minority children across the state of Alaska, including non-Tribal regions. The overall objective is to prospectively implement and evaluate a new virtual specialty care model in Alaska schools to reduce loss to follow-up from school hearing screening and improve access to specialty care in rural environments. This work builds on the team’s recent PCORI-funded cluster-randomized trial that translated Alaska’s existing Tribal telehealth network in village clinics to a prevention model for school hearing screening referrals. Children randomized to clinic- based telemedicine specialty referral were 2.3 (95% CI 1.4, 3.8) times more likely to receive an ear/hearing diagnosis than those receiving the standard referral of a letter home. Success of the clinic-based intervention varied substantially between communities; stakeholder interviews revealed implementation challenges that could be addressed by delivering telehealth directly in schools. The current proposal will establish a unique model of care in Tribal and non-Tribal regions across the state, bringing virtual specialty care directly into schools. Three accomplished and complementary multi-PIs, who collaborated on PCORI- and NIDCD-funded studies in rural Alaska, will lead an interdisciplinary team, and an Alaska Stakeholder Team that includes Alaska Commissioners for Education and Health and Social Services will guide study development. In Aim 1, the team will develop and pilot an implementation protocol for school-based virtual specialty care for hearing loss through focus groups and interviews with community stakeholders. In Aim 2, they will conduct a stepped wedge, cluster-randomized implementation trial of virtual specialty care in three representative regions (n=31 schools; 2,008 children). The primary outcome is proportion of hearing referrals resulting in specialty follow-up within two months of screening date. The conservative hypothesis, based on PCORI trial data, is that virtual specialty care will improve follow- up by 100%. In Aim 3, the team will evaluate sustainability of virtual specialty care in Alaska schools through a policy analysis to assess alignment between health and education sectors, identify policy and practice barriers and accelerators, and ascertain payment models for future programmatic financing. This school-based telehealth model to address preventable childhood hearing loss could be translated to other underserved rural and minority groups, bringing high-value services into rural schools to alter the paradigm of prevention nationwide.

抽象的 阿拉斯加农村原住民儿童的可预防儿童听力损失患病率很高。 方案为许多服务不足的农村和少数民族儿童提供了获得预防服务的唯一途径，但 学校听力筛查失访的情况很常见，而且农村地区缺乏专家 阿拉斯加部落卫生系统通过远程医疗解决了护理的地理障碍。 网络，但该网络不用于学校听力筛查，并且仅在部落地区可用。 该提案将一种新颖的远程医疗模式直接引入学校，以惠及服务不足的农村和少数民族儿童 整个阿拉斯加州，包括非部落地区，总体目标是前瞻性实施。 评估阿拉斯加学校的新虚拟专业护理模式，以减少学校跟进损失 这项工作建立在农村环境中的听力筛查和改善获得专业护理的机会的基础上。 团队最近进行的由 PCORI 资助的整群随机试验，对阿拉斯加现有的部落远程医疗网络进行了翻译 在乡村诊所采用学校听力筛查转介的预防模式 儿童被随机分配到诊所。 基于远程医疗专业转诊的接受耳科/听力检查的可能性高出 2.3 (95% CI 1.4, 3.8) 倍 诊断比那些接受标准的家书转介的人更成功。 社区之间的利益相关者访谈揭示了可能存在差异的实施挑战 通过直接在学校提供远程医疗来解决这一问题当前的提案将建立一种独特的远程医疗模式。 整个州的部落地区和非部落地区的护理，将虚拟专业护理直接带入学校三。 成就卓著且互补的多位 PI，他们合作开展 PCORI 和 NIDCD 资助的农村研究 阿拉斯加将领导一个跨学科团队和一个包括阿拉斯加专员在内的阿拉斯加利益相关者团队 教育、健康和社会服务部门将指导研究开发 在目标 1 中，该团队将开发和实施。 通过焦点小组试行基于学校的听力损失虚拟专业护理实施方案 在目标 2 中，他们将进行阶梯式楔形、整群随机访谈。 在三个代表性地区（n=31 所学校；2,008 名儿童）实施虚拟专业护理试点。 主要结果是在筛查后两个月内进行专业随访的听力转诊比例 基于 PCORI 试验数据的保守假设是，虚拟专科护理将改善随访。 在目标 3 中，团队将通过以下方式评估阿拉斯加学校虚拟专业护理的可持续性。 政策分析，以评估卫生和教育部门之间的一致性，确定政策和实践障碍 和加速器，并确定未来计划性融资的支付模式。 解决可预防的儿童听力损失问题的模式可以推广到其他服务不足的农村和少数民族 团体，将高价值服务引入农村学校，以改变全国范围内的预防范式。