School-Based Telemedicine Enhanced Asthma Management (SB-TEAM)

描述(由申请人提供)：本申请是首次竞争性地更新一项以学校为基础的计划，旨在通过促进以指南为基础的护理的提供和提高对有效预防哮喘药物的依从性来减少贫困哮喘儿童的发病率。2006年，我们实施了以学校为基础的哮喘治疗(SBAT)试验(R01HL079954)，共有来自50多所城市学校的530名儿童参加。SBAT试验的主要干预措施包括在学校直接监督给药预防哮喘药物(根据NHLBI指南调整剂量)。这项研究的结果显示，对于这些非常危险的儿童来说，发病率降低，缺勤减少，病情恶化也更少。这项计划有可能成为改善城市社区哮喘护理的典范，但有几个因素限制了该计划目前形式的传播。例如，筛查和实施该计划需要大量资源，与提供者进行持续监测症状的沟通效率低下，经常推迟建议的药物调整。为了使这一计划产生可持续的公共卫生影响，我们现在必须测试一个系统，该系统允许完全整合到为这些儿童服务的学校和社区系统中。在这一新的申请中，我们提出了我们研究的下一个阶段，这是我们扩大与城市学区合作伙伴关系的关键一步。我们建议测试一种新的校本计划(SB-Team-School-Based远程医疗增强哮喘管理)，该计划直接建立在我们先前工作的基础上，用于罗切斯特市小学的持续性哮喘儿童。我们最近开发并试点测试了这项干预措施的基于网络的筛查和通信技术(RC1HL099432)，现在建议在整个学区进行一项全面的试验，使用这项技术并增加远程医疗哮喘评估，以确保适当的后续护理和最佳治疗。我们假设通过SB-Team接受护理的儿童与增强型常规护理(EUC)对照组的儿童相比，哮喘相关发病率较低。此外，我们预计，由于能够更优化地定制每个儿童的用药方案，其益处将比最初的SBAT试验中看到的更大。SB-Team计划包括系统的基于网络的哮喘筛查，学校对预防哮喘药物的直接监督管理，以及使用基于学校的远程医疗对护理方案进行持续监测和定制。EUC组的儿童将接受哮喘筛查，并通知他们的PCP，以及向家长和提供者提供系统的反馈，以促进适当的基于指南的后续护理。这一应用代表了我们工作的合理延伸，即提高对有效哮喘药物的依从性，这种药物可以减少健康差距，并最终可以在全国范围内的社区持续下去。

DESCRIPTION (provided by applicant): This application is for a first competing renewal of a school-based program designed to reduce morbidity for poor children with asthma by facilitating delivery of guideline-based care and improving adherence to effective preventive asthma medications. In 2006, we implemented the School Based Asthma Therapy (SBAT) trial (R01HL079954) with 530 children from more than 50 urban schools. The primary intervention for the SBAT trial consisted of directly observed administration of preventive asthma medications in school (with dose adjustments according to NHLBI guidelines). Results from this study demonstrate reduced morbidity, decreased absenteeism, and fewer exacerbations for these very high-risk children. This program has the potential to serve as a model for improved asthma care in urban communities, however several factors limit dissemination of the program in its current form. For example, extensive resources were required for screening and implementation of the program, and communications with providers for ongoing monitoring of symptoms were inefficient, often delaying recommended medication adjustments. In order for this program to have sustainable public health impact, we must now test a system that allows for full integration within the school and community systems that serve these children. In this new application we propose the next phase in our research, which represents a critical step in our expanding partnership with the city school district. We propose testing a novel school-based program (SB-TEAM - School-Based Telemedicine Enhanced Asthma Management), which directly builds on our prior work, for children with persistent asthma in Rochester City Elementary Schools. We recently developed and pilot-tested the technology for web-based screening and communication for this intervention (RC1HL099432), and now propose a full-scale trial across an entire school district using this technology with the addition of telemedicin asthma assessments to assure appropriate follow-up care and optimal treatment. We hypothesize that children receiving care through SB-TEAM will experience less asthma- related morbidity compared to children in an enhanced usual care (eUC) comparison group. Further, we anticipate that the benefits will be even greater than those seen in the original SBAT trial, due t the ability to more optimally tailor each child's medication regimen. The SB-TEAM program includes systematic web-based asthma screening, directly observed administration of preventive asthma medications in school, and ongoing monitoring and tailoring of the care regimen using school-based telemedicine. Children in the eUC group will receive asthma screening with notification of their PCP, as well as systematic feedback to the parent and provider to promote appropriate guideline based follow-up care. This application represents a logical extension of our work to improve adherence to effective asthma medications that can reduce health disparities and could ultimately be sustained in communities nationwide.