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Appalachian STAR Trial

阿巴拉契亚之星试验

基本信息

批准号：
10412885
负责人：
Matthew Lee Bush
金额：
$ 19.24万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-22 至 2022-05-14
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10412885
关键词：
Achievement Address Adoption Advocacy Appalachian Region Caring Child Childhood Clinic Cluster randomized trial Communities Consolidated Framework for Implementation Research County Education Employment Evaluation Female Funding Future Goals Health Health Services Accessibility Health system Healthcare Home Hybrids Improve Access Inequality Infection Infrastructure Intervention Kentucky Language Development Lead Letters Life Life Cycle Stages Location Modeling Parents Pathway interactions Plant Roots Policies Population Preventive care Preventive service Primary Health Care Randomized Research Rural Rural Community School Nursing Schools Screening procedure Shapes Specialist State Government Technology Telemedicine Testing Time Translating Underserved Population United States National Institutes of Health Work acute care barrier to care base childhood hearing loss community engagement design digital effectiveness evaluation effectiveness implementation trial evidence base follow-up 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 therapy design treatment as usual underserved community underserved minority 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距开始在生命的早期，由健康的社会决定因素，童年.学校保健方案往往是农村儿童获得预防服务的唯一途径。然而，学校筛查的实施并不顺利，受到随访丢失和农村地区专家有限的困扰。区域复合护理障碍。我们建议在阿巴拉契亚前瞻性地实施一种新的护理模式农村肯塔基州的学校，以解决学校，卫生系统和政策层面的社会决定因素，阻碍识别和治疗两个NIH指定差异人群可预防的健康差异：服务不足的农村和社会经济弱势儿童。我们的目标是建立一个小说，以学校为基础、以远程保健为驱动的预防保健的可推广模式，美国农村地区的弱势群体。我们将调整和评估我们的循证方法， “星星”（转诊专业远程医疗接入），我们发现在农村部落环境中有效阿拉斯加阿巴拉契亚有一些最贫穷的县在美国，使这个地区的理想适应跨越美国乡村创新的“阿巴拉契亚星星试验”将是第一个应用学校远程医疗的研究预防性服务，可直接接触专家。听力筛查将成为星星的原型，在服务不足的儿童中，可预防的感染相关听力损失的负担很高，儿童听力损失的影响我们的跨学科团队与服务不足的肯塔基州的社区，并与社区咨询委员会和利益相关者咨询委员会建立伙伴关系提供州政府最高层的支持（见肯塔基州州长信）。我们将开始调整星星护理模式，以满足农村社区和学校的需要，和股东驱动的方法。我们将评估肯塔基州农村66所学校的星星护理模式，一项在幼儿园儿童中进行的阶梯式楔形群随机混合1型有效性实施试验 14个县（n=~3600/年）。星星干预措施包括县级学校筛查政策的改变，加强移动健康学校听力筛查，然后进行虚拟专科护理转诊。阶梯楔设计允许评估政策/筛查和转诊组成部分，以及比较常规护理 vs.全面干预（第2年与第5年），同时满足社区的意见，即所有人都可以进行干预。初级结果是1）筛查儿童和2）在两个月内转诊到专科护理的百分比的筛选。我们保守地假设，筛查的百分比将提高20%，随访将提高40%。在试验期间，我们将评估多层次的实施因素和结果，以告知规模- 到其他农村地区。我们的星星模式既可以在美国农村推广，也可以应用于其他地区。可预防的健康差距，将学校健康政策变革与数字创新相结合，在全国范围内扩大服务不足的农村和社会经济弱势儿童获得护理的机会。