Reducing Asthma Disparities Through School-Based Telemedicine for Rural Children

描述（由申请人提供）：哮喘对少数民族和低收入儿科人群的负担不成比例，尽管十多年前NHLBI哮喘管理指南已广为传播，但这些差异在高危儿童中仍然存在。先前的调查表明，基于哮喘指南的护理并没有转化为生活在农村地区的高危儿童。哮喘相关的发病率和不遵守哮喘指南在生活在阿肯色州密西西比三角洲地区的高风险农村儿童中很普遍，这是美国贫困和医疗服务不足的地区。目前还没有设计大规模干预措施来减少农村高危儿童的哮喘负担，而且由于距离和出行障碍以及农村社区缺乏亚专科哮喘服务，为其他人群设计的干预措施也不可行。拟议项目的总体目标是减少生活在农村、医疗服务不足环境中的高风险儿童的哮喘健康结果差异。为了实现这一目标，我们建议对540名年龄在4-17岁的儿童进行随机分组试验，在农村公立学区实施基于学校的远程医疗干预。校本干预将通过远程医疗对农村哮喘儿童及其护理人员和学校护士进行全面的哮喘教育；通过远程医疗前瞻性监测哮喘症状和肺功能；并根据国家发布的哮喘指南向初级保健提供者提供治疗提示。我们假设，与接受常规护理的儿童相比，接受以学校为基础的哮喘教育和通过远程医疗与提供者治疗提示进行监测的儿童，哮喘相关发病率将降低。该项目的目的是：1)与常规护理组相比，检查以学校为基础的哮喘远程医疗干预在改善哮喘相关健康结果方面的效果；2)校本哮喘远程医疗干预对哮喘自我管理技能的影响；3)确定干预的成本。远程医疗将允许利用经过验证的技术在高危人群中提供最先进的哮喘干预，并将大大减少与农村社区固有的距离和旅行障碍相关的挑战。改善高危农村儿童哮喘健康结果的创新远程医疗方法具有很高的影响潜力，因为拟议干预的结果将直接为公共卫生战略提供信息，以便在学校环境中实施大规模远程医疗服务。该干预措施将直接适用于农村和医疗服务不足地区的其他高危哮喘人群，并可转化为以学校为基础的健康干预战略，以针对其他慢性健康状况。

DESCRIPTION (provided by applicant): Asthma disproportionately burdens minority and low-income pediatric populations, and these disparities have persisted among high-risk children despite the dissemination of NHLBI asthma management guidelines more than a decade ago. Previous investigations suggest that asthma guidelines-based care has not translated to high-risk children living in rural regions. Asthma-related morbidity and non-adherence to asthma guidelines is prevalent among high-risk rural children living in the Mississippi Delta region of Arkansas, an impoverished and medically underserved region of the United States. Large-scale interventions to decrease asthma burden among high-risk rural children have not been designed, and interventions designed for other populations are not feasible due to distance and travel barriers and lack of subspecialty asthma services inherent to rural communities. The overall goal of the proposed project is to decrease asthma health outcomes disparities among high-risk children living in a rural, medically underserved environment. To address this goal, we propose conducting a cluster randomized trial with 540 children, ages 4-17 years, to implement a school-based telemedicine intervention in rural public school districts. The school-based intervention will provide comprehensive asthma education via telemedicine to rural children with asthma, their caregivers and school nurses; prospectively monitor asthma symptoms and lung function via telemedicine; and provide primary care providers with treatment prompts according to nationally published asthma guidelines. We hypothesize that children receiving school-based asthma education and monitoring via telemedicine in conjunction with a provider treatment prompt will have decreased asthma-related morbidity as compared to children receiving usual care. The aims of the project will: 1) examine the efficacy of a school-based asthma telemedicine intervention in improving asthma-related health outcomes in an intervention group compared to a usual care group; 2) examine the effects of a school-based asthma telemedicine intervention on asthma self-management skills; and 3) determine the cost of the intervention. Telemedicine will allow for the utilization of proven technology to deliver a state-of-the-art asthma intervention in a high-risk population and will significantly reduce challenges associated with distance and travel barriers inherent to rural communities. An innovative telemedicine approach to improve asthma health outcomes among high-risk rural children has high impact potential because findings from the proposed intervention will directly inform public health strategies to implement large-scale telemedicine services in a school-based setting. The intervention will have direct applicability to other high-risk asthma populations in rural and medically underserved regions and can be translated to school-based health intervention strategies to target other chronic health conditions. PUBLIC HEALTH RELEVANCE: This project may have a profound impact on public health because it presents a practical school-based intervention to promote adherence to effective asthma care guidelines. Should it prove successful in reducing symptoms and improving the health of rural children with asthma, it has the potential to serve as a model for improved asthma care in other medically underserved communities.