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Appalachian STAR Trial

阿巴拉契亚之星试验

基本信息

批准号：
10831880
负责人：
Matthew Lee Bush
金额：
$ 107.76万
依托单位：
UNIV OF ARKANSAS FOR MED SCIS
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-05-15 至 2026-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10831880
关键词：
Achievement Address Adoption Advocacy Appalachian Region Caring Child Childhood Clinic Cluster randomized trial Communities Consolidated Framework for Implementation Research County Disparity Disparity population Education Employment Female Friends Funding Future Goals Health Health Services Accessibility Health Technology Health system Healthcare Home Hybrids Improve Access Inequality Infection Infrastructure Intervention Kentucky Language Development Lead Letters Life Life Cycle Stages Location Minority Modeling Parents Pathway interactions Policies Policy Analysis Population Preventive Health Services Preventive care Preventive service Primary Care Randomized Reduce health disparities Research Rural Rural Community School Nursing Schools Screening procedure Shapes Specialist State Government Technology Telemedicine Testing Time Translating Tribes Underserved Population United States National Institutes of Health Work acute care barrier to care childhood hearing loss community engagement community-level factor design digital effectiveness evaluation effectiveness/implementation trial evidence base follow-up health care model health disparity hearing impairment hearing screening implementation determinants implementation facilitators implementation outcomes implementation science improved innovation insight kindergarten mHealth medical specialties meetings multidisciplinary novel primary outcome programs prospective prototype public health relevance randomized trial rural Alaska rural America rural area rural counties rural environment rural health disparities rural underserved scale up school health screening screening policy social determinants social health determinants socioeconomic disadvantage teacher telehealth telehealthcare therapy design treatment as usual underserved community virtual virtual technology

项目摘要

Health disparities in rural America begin early in life, arising from social determinants of health that start in childhood. School health programs often provide the only access to preventive services for rural children. However, school screening is variably implemented, plagued by loss to follow-up, and limited specialists in rural areas compound barriers to care. We propose to prospectively implement a novel model of care in Appalachian schools of rural Kentucky to address social determinants at the school, health system, and policy levels that hinder identification and treatment of preventable health disparities for two NIH-designated disparity populations: underserved rural and socioeconomically disadvantaged children. Our goal is to establish a novel, generalizable model of school-based, telehealth-driven preventive care that can be disseminated in underserved populations across rural America. We will adapt and evaluate our evidence-based approach, “STAR” (Specialty Telemedicine Access for Referrals), that we have found effective in a Tribal setting in rural Alaska. Appalachia has some of the poorest counties in the US, making this region ideal for adapting across rural America. The innovative “Appalachian STAR trial” will be the first study to apply school-based telehealth for preventive services, with direct access to specialists. Hearing screening will be the prototype for STAR due to the high burden of preventable, infection-related hearing loss in underserved children and the profound lifelong implications of childhood hearing loss. Our interdisciplinary team has relationships with underserved communities in Kentucky and partnership with a Community Advisory Board and Stakeholder Advisory Board providing support from the highest levels of state government (See KY Governor Letter). We will begin by adapting the STAR model of care to meet the needs of rural communities and schools through a community-and stakeholder-driven approach. We will evaluate the STAR care model in 66 schools in rural Kentucky through a stepped wedge cluster-randomized hybrid type 1 effectiveness-implementation trial with kindergarten children in 14 counties (n=~3600/year). The STAR intervention includes county-level school screening policy change with enhanced mHealth school hearing screening, followed by virtual specialty care referral. The stepped-wedge design allows evaluation of the policy/screening and referral components as well as comparison of usual care vs. full intervention (years 2 vs.5), while meeting community input that the intervention be available to all. Primary outcomes are the percentage of 1) children screened and 2) referrals resulting in specialty care within two months of screening. We conservatively hypothesize the percentage screened will improve by 20% and follow-up will improve by 40%. During the trial, we will assess multi-level implementation factors and outcomes to inform scale-up into other rural areas. Our STAR model could be both scaled across rural America and applied to other preventable health disparities, combining policy change on school health with digital innovations to radically expand access to care for underserved rural and socioeconomically disadvantaged children nationwide.

美国农村地区的健康差距在生命早期就开始了，这是由健康的社会决定因素引起的