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

哮喘链接：学校监督治疗可提高哮喘控制不佳儿童的药物依从性

• 批准号: 10551340
• 负责人: Michelle Trivedi
• 金额: $ 16.87万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-02-16 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10551340
• 关键词: Address; Adherence; Adopted; Adoption; Adrenal Cortex Hormones; Affect; Asthma; Award; Child; Child Care; Child Health; Child Support; Childhood; Childhood Asthma; Clinical; Clinical Trials; Clinical effectiveness; Communication; Communities; Data; Development; Disparity; Eligibility Determination; Emergency department visit; Enrollment; Ensure; Family; Feedback; Foundations; Frequencies; Funding; Goals; Health; Health Expenditures; Health Insurance; Health Sciences; Health behavior change; Hospitalization; Infrastructure; Inhalators; Intervention; Interview; Link; Low income; Massachusetts; Master of Public Health; Medical center; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Modeling; Morbidity - disease rate; Nature; Office Nursing; Oral; Outcome; Parents; Patient Recruitments; Pediatrics; Pharmaceutical Preparations; Pharmacists; Pilot Projects; Play; Policies; Population; Preventive; Primary Care; Procedures; Process; Program Acceptability; Protocols documentation; Public Health; Public Health Schools; Pulmonology; Randomized; Randomized, Controlled Trials; Research; Research Personnel; Resource-limited setting; Resources; Retrospective Studies; Role; School Nursing; Schools; Scientist; Site; Spirometry; Symptoms; System; Testing; Therapeutic Intervention; Time; Training; United States; Universities; Work; adherence rate; career; career development; clinical infrastructure; clinical practice; community engaged research; cost; design; effectiveness testing; epidemiology study; experience; follow-up; high risk; implementation barriers; implementation science; improved; informant; innovation; intervention cost; intervention refinement; medical schools; medication compliance; medication nonadherence; mid-career faculty; minority children; multidisciplinary; operation; pediatrician; pilot test; professor; programs; prospective; prototype; research and development; research study; response; routine practice; standard of care; treatment as usual

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.

项目总结/摘要 研究：这项提案的目标是完善和试点测试哮喘链接，一个创新的，低- 将儿科实践、学校和家庭联系起来的成本干预， 在现实世界环境中对哮喘控制不佳的儿童进行哮喘治疗。虽然有成功的 学校监督哮喘治疗以提高研究中哮喘药物依从性的实例 在这种情况下，这种干预措施在实践中并没有得到例行采用。这可能是由于成本高， 尚未利用临床系统的已建立基础设施的资源密集型方案 和学校为了解决这个问题，我们的团队开发了一种新的模式，哮喘链接，其中儿科提供者 确定符合条件的儿童作为其常规实践的一部分，并开始与 学校护士;家庭拿起并将哮喘药物送到学校;学校护士 监督日常哮喘药物的使用。这种干预利用了现有的基础设施， 需要最少的资源来运行，提高了现实世界环境中的可持续性。我们的初步 研究表明，哮喘链接减少了哮喘相关的急诊室就诊， 表明该协议需要改进以供实际使用。我们建议完善哮喘链接协议， 真实世界的实施，然后在4个儿科实践（n=72）的集群RCT中对改进的方案进行初步测试 父子二人组）。如果被证明是有效的，哮喘链接可能成为儿童护理的标准 即使在有限的资源内，也有能力改变实践。 候选人：Michelle Trivedi，医学博士，公共卫生硕士，是一名儿科肺病学家， 马萨诸塞州大学医学院（UMMS）儿科学儿科肺病学分部 在马萨诸塞大学纪念儿童医疗中心和助理教授在人口和 在UMMS的定量健康科学。她获得了临床有效性公共卫生硕士学位， 哈佛公共卫生学院。她进行了严格的观察和流行病学研究， 儿童哮喘的研究;并与UMMS KL 2奖进行了两项关键的试点研究， Asthma Link为K23提案奠定了基础。Trivedi博士将利用K23奖成为 一个独立的临床医生，科学家，在开发和实施低成本，可持续发展的专业知识， 为哮喘儿童提供干预措施，并最终影响州和国家的哮喘政策。 环境：Trivedi博士将在UMMS进行研究和职业发展。她的主要 导师洛里·普伯特博士和二级导师万达·菲帕塔纳库尔博士、米拉格罗斯·罗萨尔博士和斯蒂芬妮博士 柠檬，都是在各自领域的预防保健，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 在指导年轻的研究人员走向独立的研究事业方面有着出色的记录。