Asthma Link: School Supervised Therapy to Improve Medication Adherence in Children with Poorly Controlled Asthma

项目摘要/摘要 研究：该提案的目标是提炼和试点测试哮喘链接，这是一种创新的、低成本的 成本干预，将儿科实践、学校和家庭联系起来，由学校护士监督提供 在现实世界中哮喘控制不佳的儿童的哮喘治疗。虽然有成功的 学校监督哮喘治疗提高哮喘用药依从性的研究实例 在这种情况下，这种干预在实践中并不是经常采用的。这很可能是由于成本高昂和 尚未利用已建立的临床系统基础设施的资源密集型协议 还有学校。为了解决这个问题，我们的团队开发了一种新的模型，哮喘链接，在这种模型中，儿科提供者 确定符合条件的儿童作为其常规实践的一部分，并通过 学校护士；家人取哮喘药物并将其送到学校：学校护士 监督日常哮喘药物的使用。这种干预利用已建立的基础设施和 只需最少的资源即可运行，增强了现实环境中的可持续性。我们的预赛 研究表明，哮喘链接减少了与哮喘相关的急诊室就诊，但定性访谈 显示了该协议需要改进才能在现实世界中使用。我们建议改进哮喘链接协议，以用于 实际实施，然后在包含4个儿科实践(n=72)的集群RCT中对改进后的协议进行试点测试 亲子二人组)。如果被证明有效，哮喘链接可能成为儿童护理的标准 有高风险哮喘，有能力改变做法，即使在有限的资源。 候选人：Michelle Trivedi，医学博士，公共卫生硕士，儿科肺病学家，副教授 马萨诸塞大学医学院(UMMS)儿科肺科 他是加州大学马萨诸塞州纪念儿童医学中心人口学系的助理教授 密歇根州立大学定量健康科学。她获得了公共卫生临床有效性硕士学位。 哈佛大学公共卫生学院。她进行了严格的观察和流行病学研究 儿童哮喘调查；并获得UMMS KL2奖，进行了两项关键的先导性研究 哮喘链接，这为K23提案奠定了基础。Trivedi博士将利用K23奖成为 独立的临床医生兼科学家，具有开发和实施低成本、可持续的专业知识 对哮喘儿童的干预措施，并最终影响州和国家的哮喘政策。 环境：特里维迪博士将在密歇根州立大学进行她的研究和职业发展。她的初选 导师、Lori Pbert博士和二级导师Wanda Phipatanakul博士、Milagros Rosal博士和Stefinie博士 柠檬，都是各自领域的领导者，在预防健康，健康行为改变试验，儿科 哮喘临床试验、社区参与的研究和实施科学。特里维迪博士的每一位导师 在指导年轻研究人员走向独立研究职业生涯方面有着良好的记录。

PROJECT SUMMARY/ABSTRACT RESEARCH: The goal of this proposal is to refine and pilot test Asthma Link, an innovative, low- cost intervention that links pediatric practices, schools, and families to deliver school nurse-supervised asthma therapy to children with poorly controlled asthma in real-world settings. While there are successful examples of school-supervised asthma therapy to improve asthma medication adherence in research settings, this intervention has not been routinely adopted in practice. This is likely due to costly and resource intense protocols that have not yet leveraged the established infrastructure of the clinical system and schools. To address this, our team developed a new model, Asthma Link, in which pediatric providers identify eligible children as part of their routine practice and initiate supervised asthma therapy with the school nurse; the family picks up and delivers the asthma medication to the school: and the school nurse supervises daily asthma medication use. This intervention leverages established infrastructure and requires minimal resources to operate, enhancing sustainability in a real-world setting. Our preliminary studies show that Asthma Link reduces asthma-related emergency room visits yet qualitative interviews showed the protocol needs refinement for real-world use. We propose to refine the Asthma Link protocol for real-world implementation and then pilot test the refined protocol in a cluster RCT of 4 pediatric practices (n=72 parent-child dyads). If proven to be effective, Asthma Link could become the standard of care for children with high-risk asthma, with the power to transform practice, even within limited resources. CANDIDATE: Michelle Trivedi, MD, MPH is a pediatric pulmonologist, Associate Professor of Pediatrics at the University of Massachusetts Medical School (UMMS) in the Division of Pediatric Pulmonology at UMass Memorial Children's Medical Center and an Assistant Professor in the Department of Population and Quantitative Health Sciences at UMMS. She received a Master's of Public Health in Clinical Effectiveness at the Harvard School of Public Health. She has conducted rigorous observational and epidemiologic investigations in pediatric asthma; and with a UMMS KL2 Award has performed two critical pilot studies of Asthma Link, which build the foundation for this K23 proposal. Dr. Trivedi will utilize the K23 Award to become an independent clinician-scientist with expertise in developing and implementing low-cost, sustainable interventions for children with asthma and to ultimately impact state and national asthma policies. ENVIRONMENT: Dr. Trivedi will perform her research and career development at UMMS. Her primary mentor, Dr. Lori Pbert and secondary mentors, Dr. Wanda Phipatanakul, Dr. Milagros Rosal and Dr. Stephenie Lemon, are all leaders in their respective fields of preventive health, health behavior change trials, pediatric asthma clinical trials, community-engaged research and implementation science. Each of Dr. Trivedi's mentors has an excellent track record of mentoring young investigators towards independent research careers.