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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

基本信息

批准号：
10490362
负责人：
Denise A Dillard
金额：
$ 65.54万
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：
2021
资助国家：
美国
起止时间：
2021-09-17 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10490362
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 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 geographic barrier 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

项目摘要

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.

摘要阿拉斯加农村原住民儿童经历了可预防的儿童听力损失的高患病率。校本校本这些方案为许多未得到充分服务的农村和少数民族儿童提供了唯一的预防性服务，但学校听力筛查的随访缺失很常见，农村地区缺乏专科医生关爱的障碍。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，仅在部落地区可用。这一项提案将一种新的远程医疗模式直接带入学校，接触到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。总体目标是前瞻性地实施并评估阿拉斯加学校的一种新的虚拟特殊护理模式，以减少学校随访的损失听力筛查和改善在农村环境中获得专科护理的机会。这项工作建立在该团队最近由PCORI资助的集群随机试验将阿拉斯加现有的部落远程医疗网络在村卫生室以预防模式为学校进行听力筛查转诊。儿童被随机分配到诊所- 基于远程医疗专科转诊的人接受耳朵/听力的可能性是2.3(95%可信区间1.4，3.8)倍诊断比那些收到标准转介的家书要好。以临床为基础的干预成功在不同社区之间差异很大；利益相关者访谈揭示了实施方面的挑战通过在学校直接提供远程保健来解决这一问题。目前的提议将建立一个独特的模式在全州的部落和非部落地区提供护理，将虚拟专业护理直接带入学校。三完成并相互补充的多个个人，在PCORI和NIDCD资助的农村研究中进行合作阿拉斯加将领导一个跨学科团队，以及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、卫生和社会服务部将指导研究发展。在目标1中，团队将开发和通过重点群体试点以学校为基础的听力损失虚拟专科护理实施方案以及与社区利益相关者的访谈。在目标2中，他们将进行阶梯式楔形，集群随机在三个有代表性的地区(n=31所学校；2,008名儿童)实施虚拟专科护理试点。这个主要结果是筛查后两个月内听力转介导致专科随访的比例约会。基于PCORI试验数据的保守假设是，虚拟专科护理将改善随访- 增长了100%。在Aim 3中，该团队将通过一项政策分析，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，并确定未来方案筹资的支付模式。这种以学校为基础的远程医疗解决可预防的儿童听力损失的模式可以推广到其他服务不足的农村和少数民族将高价值服务带到农村学校，以改变全国的预防模式。