Using technology-assisted stepped-care interventions to improve adherence in adolescents with asthma

项目总结/摘要 应聘者：我是一名执业儿科心理学家，其首要职业目标是改善健康 通过技术辅助的干预措施，以依从性为目标，为青少年哮喘患者提供治疗结果。我是 行为医学和临床心理学系（BMCP）儿科助理教授， 辛辛那提儿童医院医疗中心。我在俄克拉荷马州完成了博士学业 大学和T32奖学金在儿科坚持在CCHMC。培训目标：K23 将使我能够填补我目前的培训空白，并使我能够：1）获得传播方面的高级培训 和实施科学，2）发展青少年哮喘临床护理模式的知识， 特别关注社区卫生，3）获得临床研究设计和生物统计学方面的高级培训， 及4）透过资助写作技巧及发表研究成果，加强专业发展。 导师：我的主要导师Kevin Hommel博士是一位NIH资助的研究人员，具有临床研究方面的专业知识。 研究设计和技术支持的青少年行为依从性促进干预措施。下 博士在霍梅尔的指导下，我组建了一个由哮喘和肺部护理领导人组成的专家团队。 Guilbert，Kahn），传播和实施科学（Epstein博士）和统计学（Peugh博士）， 补充霍梅尔博士的专业知识，并将提供宝贵的指导。环境：CCHMC和 辛辛那提大学（UC）拥有独特的设备，以促进初级研究人员的职业发展。 通过加州大学的临床和转化科学奖和哮喘中心，我有当地的资源， 实现我的培训目标，完成我提出的研究。哮喘中心隶属于 肺部医学提供了一个庞大的患者群体，我将利用我现有的 与哮喘中心教师的关系。研究：我提议的研究将测试 一项针对12-18岁青少年的技术辅助分级护理（TASC）依从性促进干预 哮喘患者进行随机对照试验利用传播和实施战略制定了《技术援助和支助战略》， 促进实践转化，并有可能解决现有遵守的局限性 通过克服障碍，提供个性化护理，为青少年哮喘患者提供干预措施， 扩大依从性干预的范围和影响，以改善青少年哮喘患者的健康。 初步疗效将通过改善每日吸入皮质类固醇的依从性来证明， 通过电子监测设备与常规治疗（TAU）对照组进行比较。次要结局 包括疾病严重程度，如通过综合哮喘严重程度指数结合症状测量的， 与TAU相比的治疗和加重，以及通过 过程评估评估覆盖范围、可用性和可持续性。这项研究将为全面 在本K奖结束前，R 01资助申请中提出的动力RCT。

PROJECT SUMMARY/ABSTRACT Candidate: I am a practicing pediatric psychologist whose overarching career goal is to improve health outcomes for adolescents with asthma by targeting adherence through technology-assisted interventions. I am an Assistant Professor of Pediatrics in the Division of Behavioral Medicine and Clinical Psychology (BMCP) at Cincinnati Children's Hospital Medical Center (CCHMC). I completed my doctoral training at Oklahoma State University and a T32 fellowship in pediatric adherence at CCHMC. Training Objectives: The proposed K23 will allow me to fill my current training gaps and enable me to: 1) Obtain advanced training in dissemination and implementation science, 2) Develop knowledge of clinical care models of asthma for adolescents with a specific focus on community health, 3) Obtain advanced training in clinical research design and biostatistics, and 4) Enhance my professional development through grant writing skills and publications of research findings. Mentors: My primary mentor, Kevin Hommel, PhD, is a NIH-funded researcher with expertise in clinical research design and technology-enabled behavioral adherence-promotion interventions for adolescents. Under Dr. Hommel's mentorship, I have assembled an expert team of leaders in asthma and pulmonary care (Drs. Guilbert, Kahn), dissemination and implementation science (Dr. Epstein), and Statistics (Dr. Peugh) who complement Dr. Hommel's expertise and will provide valuable mentorship. Environment: CCHMC and the University of Cincinnati (UC) are uniquely equipped to facilitate the career development of junior researchers. Through UC's Clinical and Translational Science Award and the Asthma Center, I have local resources to achieve my training objectives and complete the proposed research. The Asthma Center within the Division of Pulmonary Medicine provides access to a large patient population and I will capitalize on my existing relationships with Asthma Center faculty. Research: My proposed research will test the preliminary efficacy of a technology-assisted stepped-care (TASC) adherence-promotion intervention for 12-18 year old adolescents with asthma in a pilot RCT. TASC was developed using dissemination and implementation strategies to facilitate translation to practice and has the potential to address the limitations of available adherence interventions for adolescents with asthma by overcoming barriers to access, providing individualized care, and expanding the reach and impact of adherence intervention to improve the health of adolescents with asthma. Preliminary efficacy will be demonstrated by improved adherence to daily inhaled corticosteroids as measured by electronic monitoring devices compared to a treatment as usual (TAU) control group. Secondary outcomes include disease severity as measured by the Composite Asthma Severity Index combining symptoms, treatment, and exacerbations compared to TAU and an assessment of TASC implementation through a process evaluation assessing reach, usability, and sustainability. This research will provide the basis for a fully powered RCT to be proposed in an R01 grant application prior to the end of this K award.