School-Based Asthma Therapy (SBAT) to Reduce Disparities in Childhood Asthma: Pragmatic Process and Program

学校哮喘治疗 (SBAT) 旨在减少儿童哮喘的差异：务实的流程和计划

基本信息

批准号：
10248567
负责人：
Kimberly Joan Arcoleo
金额：
$ 58.53万
依托单位：
UNIVERSITY OF RHODE ISLAND
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-01 至 2023-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10248567
关键词：
17 year old Absenteeism Address Adherence Administrator Adopted Adoption Asthma Caregivers Caring Child Child Care Child health care Childhood Childhood Asthma Chronic Chronic Disease Cities Clinical Clinical effectiveness Data Disease Management Dissemination and Implementation Effectiveness Enrollment Ensure Evaluation Family Goals Guidelines Health Health Personnel Health system Healthcare Healthcare Systems Home Hospitals Human Resources Hybrids Instruction Insurance Carriers Intervention Medical Medical Research Medication Management Methods Modeling Morbidity - disease rate Nurses Ohio Outcome Pediatric Hospitals Pharmaceutical Preparations Physician-Hospital Organizations Pragmatic clinical trial Prevalence Preventive Process Program Evaluation Public Health Randomized Controlled Trials Reach, Effectiveness, Adoption, Implementation, and Maintenance Research Priority Resources Role School Nursing School-Age Population Schools Self Management Service delivery model Students Symptoms Testing Time Universities Work Youth asthma inhaler asthmatic base care coordination care outcomes chronic care model clinical effect contextual factors cost cost effective cost effectiveness design disparity reduction dissemination research dissemination strategy economic cost effectiveness implementation study effectiveness implementation trial effectiveness outcome efficacy study health care availability high risk implementation facilitation implementation framework implementation outcomes implementation process implementation research implementation strategy improved improved outcome innovation patient home care pragmatic trial program dissemination programs prototype satisfaction scale up school district screening success tool trial design usability user centered design

项目摘要

PROJECT ABSTRACT Over 25% of the nation’s school-aged children have one or more chronic health conditions and school nurses are responsible for coordinating care management with youth and their caregivers. Coordinated efforts improve health, reduce school absences, and mitigate the billions of dollars spent on youth disease management. However, pragmatic (“real world”) interventions to improve connection between nurses, youth, and their caregivers are nascent. One approach was developed by Dr. Halterman (co-I) and colleagues to ensure guideline-based treatment for children with persistent asthma through systematic school-based asthma screening and directly observed administration of asthma controller medications in school. This intervention was titled the School-Based Asthma Therapy (SBAT). Through numerous randomized controlled trials, SBAT was found to enhance asthma self-management and improve adherence to daily, effective preventive asthma care (clinical effect) as well as reduction in symptom-free days (cost-effective). SBAT is multidimensional, extending child asthma care from the home to the school setting. SBAT is high-impact because school-based programs can reach children at highest risk for asthma morbidity and optimize their care in the setting in which they spend most of their day, regardless of their contacts with the health care system. In alignment with the RE-AIM framework, the goal of this work is to improve the reach of students and effectiveness of asthma management outcomes, be broadly adopted among schools and school districts, be implemented with high quality and at a low cost, and be maintained within the schools and homes of asthmatic youth. Over the last five years, our team based at the Nationwide Children’s Hospital (NCH), its physician-hospital organization, Partners for Kids (PFK), and the University of Rochester has expanded the SBAT program beyond the original Columbus City and South Western City School Districts (Columbus, OH) and found strong adoption (17 to 225 schools) and reach (38 students to 559 students) outcomes with the application of SBAT. Despite the promises of SBAT, widespread dissemination of the program has not been fully achieved because a comprehensive assessment of real-world implementation and evaluation of this program has not been done. Our team is now poised to move from efficacy studies to a hybrid effectiveness-implementation study. We will conduct a rigorous, comprehensive evaluation of SBAT implementation outcomes (i.e., clinical and academic outcomes, and cost-effectiveness) when implemented in a real-world setting. We will also assess the implementation strategies in facilitating further dissemination and implementation of the SBAT program across a variety of schools. Dissemination and implementation research on this integrated, interprofessional, multidimensional SBAT program could serve as a model for programs that aim to improve asthma care and reduce morbidity for high risk children with asthma and has applications for other chronic health conditions.

项目摘要全国超过 25% 的学龄儿童患有一种或多种慢性健康问题和学校护士负责与青少年及其护理人员协调护理管理。健康，减少缺勤，并减少用于青少年疾病管理的数十亿美元支出。然而，务实的（“现实世界”）干预措施可以改善护士、青少年及其家属之间的联系 Halterman 博士（co-I）及其同事开发了一种方法来确保护理人员的健康。通过系统性学校哮喘对持续性哮喘儿童进行基于指南的治疗在学校进行哮喘控制药物的筛查和直接观察给药。被称为学校哮喘治疗（SBAT）通过大量随机对照试验，SBAT。被发现可以增强哮喘自我管理并提高日常有效预防哮喘的依从性护理（临床效果）以及减少无症状天数（成本效益）。将儿童哮喘护理从家庭扩展到学校环境具有很大影响，因为以学校为基础。项目可以接触到哮喘发病风险最高的儿童，并在以下环境中优化他们的护理：无论他们与医疗保健系统的联系如何，他们一天中的大部分时间都与医疗保健系统保持一致。 RE-AIM 框架，这项工作的目标是提高学生的接触范围和哮喘的有效性管理成果在学校和学区中广泛采用，并得到高度实施质量好、成本低，并在哮喘青少年的学校和家庭中得到维护。五年来，我们的团队在全国儿童医院 (NCH) 及其医生医院组织中， Partners for Kids (PFK) 和罗彻斯特大学将 SBAT 项目扩展到原来的范围之外哥伦布市和西南市学区（俄亥俄州哥伦布市）的采用率很高（17 至 225 尽管有 SBAT 的应用，但仍达到（38 名学生至 559 名学生）的成绩。 SBAT 的承诺，该计划的广泛传播尚未完全实现，因为尚未对该计划的实际实施情况进行全面评估和评价我们的团队现在准备从功效研究转向混合有效性实施研究。我们将对 SBAT 实施结果（即临床和学术成果和成本效益）在现实世界中实施时我们还将评估。促进 SBAT 计划在各地进一步传播和实施的实施战略各种学校对此综合的、跨专业的传播和实施研究。多维 SBAT 计划可以作为旨在改善哮喘护理和治疗的计划的模型降低哮喘高危儿童的发病率，并可用于治疗其他慢性健康状况。