Asthma Link: A Partnership between Pediatric Practices, Schools, and Families to Improve Medication Adherence and Health Outcomes in Children with Poorly Controlled Asthma

哮喘链接：儿科诊所、学校和家庭之间的合作，以改善哮喘控制不佳的儿童的药物依从性和健康结果

• 批准号: 10711025
• 负责人: Michelle Trivedi
• 金额: $ 76.14万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-15 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10711025
• 关键词: 14 year old; Address; Adherence; Adopted; Adrenal Cortex Hormones; Affect; Asthma; Black race; Caring; Child; Child Care; Child Health; Child Support; Childhood; Childhood Asthma; Chronic Disease; Cities; Clinic; Clinical; Communities; Control Groups; Data; Effectiveness; Eligibility Determination; Emergency department visit; Ensure; Family; Future; Health; Health Care Costs; Health Expenditures; Health Personnel; Health Promotion; Hispanic; Hospitalization; Human Resources; Infrastructure; Inhalation; Inhalation Drug Administration; Inhalators; Intervention; Latino; Leadership; Link; Low income; Massachusetts; Measures; Medicaid; Medical Records; Methods; Modeling; Morbidity - disease rate; Outcome; Parents; Performance; Pharmaceutical Preparations; Pharmacy facility; Physicians; Play; Policies; Prevention; Preventive; Principal Investigator; Process; Process Assessment; Proctor framework; Protocols documentation; Public Health; Quality of life; Questionnaires; Randomized, Controlled Trials; Recording of previous events; Regimen; Reporting; Reproducibility; Research; Research Personnel; Resource-limited setting; Resources; Risk; Role; School Nursing; School-Age Population; Schools; Symptoms; System; Testing; Therapeutic Intervention; Time; United States; United States National Institutes of Health; Work; adherence rate; asthma exacerbation; clinical practice; comparison intervention; compliance behavior; cost; disabling disease; effectiveness evaluation; effectiveness testing; effectiveness trial; ethnic minority; experience; feasibility trial; follow-up; future implementation; health disparity; high risk; implementation trial; improved; innovation; interest; medication compliance; medication nonadherence; minority children; multidisciplinary; pediatrician; pilot trial; pragmatic trial; primary care practice; primary outcome; process evaluation; programs; racial minority; response; routine practice; school health; standard of care; treatment adherence; treatment as usual

PROJECT SUMMARY/ABSTRACT Asthma is the most common chronic disease of childhood with significant morbidity including school absences, poor school performance, parental lost workdays, emergency room visits and hospital admissions. The majority of childhood asthma morbidity is due to medication non-adherence, and both morbidity and medication non-adherence disproportionately impact low-income, Black, and Latino children. School-supervised asthma therapy ensures that children receive their preventive asthma medication daily at school and has shown efficacy in improving medication adherence and asthma health outcomes, particularly in low-income and racial/ethnic minority children. However, this strategy has not been widely adopted in practice to produce meaningful public health impact. This is likely due to costly and resource intense protocols that have not yet leveraged the established infrastructure of pediatric practices, schools, and families; groups that play vital roles in the asthma health of children, yet largely work in silos. To address this gap, our team developed a new model, Asthma Link, which partners pediatric practices, schools, and families to deliver school-supervised asthma therapy. First, pediatric providers identify eligible children as part of their routine clinical practice and send preventive medication orders to schools to initiate supervised asthma therapy. Next, families pick up and deliver the asthma medication to school, and existing school staff supervise daily preventive asthma medication use. This intervention leverages established infrastructure and requires minimal resources to operate, enhancing sustainability in a real-world setting. Our pilot trial of Asthma Link showed improved asthma symptoms when compared to an enhanced usual care condition, particularly among low-income, Black and Latino children, and demonstrated trial feasibility. Moreover, we have adapted this intervention for real- world use using input from diverse, multi-level community stakeholders. Asthma Link is now primed for an effectiveness trial and rigorous process assessment. We propose a cluster RCT in 14 pediatric practices (n=350 parent-child dyads) in two of the highest asthma burden cities in the nation, Worcester and Springfield, Massachusetts. In Aim 1 we will determine the effectiveness of Asthma Link versus an enhanced usual care condition in improving asthma health outcomes in school-aged children with poorly controlled asthma. Our primary outcome is asthma symptoms (measured by Asthma Control Test scores) and secondary health outcomes are adherence to inhaled corticosteroids, child and parent quality of life, emergency department visits, hospital admissions, school absences, and parental lost workdays. Aim 2 of this study will explore the implementation potential of Asthma Link by examining clinic, school and family-level measures of fidelity and acceptability using mixed methods and the Proctor framework. Data collected will inform a future nation-wide implementation trial. 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.

项目摘要/摘要 哮喘是儿童期最常见的慢性疾病，发病率很高，包括缺课， 学校表现不佳、父母失去工作日、急诊室就诊和住院。的 大多数儿童哮喘发病率是由于药物治疗不依从性， 不遵守不成比例地影响低收入，黑人和拉丁美洲儿童。 学校监督哮喘 治疗确保儿童每天在学校接受预防性哮喘药物， 改善药物依从性和哮喘健康结果的有效性，特别是在低收入和 种族/少数民族儿童。然而，这种策略在实践中并没有被广泛采用， 对公共卫生产生重大影响。这可能是由于昂贵和资源密集的协议，尚未 利用儿科诊所、学校和家庭的现有基础设施;发挥重要作用的团体 在儿童哮喘健康方面，但在很大程度上工作在筒仓。为了解决这一差距，我们的团队开发了一种新的 哮喘链接模式，它与儿科实践，学校和家庭合作，提供学校监督的 哮喘治疗首先，儿科提供者将合格儿童作为其常规临床实践的一部分， 向学校发送预防性药物订单，开始监督哮喘治疗。接下来，家庭拿起， 将哮喘药物送到学校，现有的学校工作人员监督日常预防哮喘 药物使用。这种干预利用了已建立的基础设施，只需要最少的资源， 在现实世界中提高可持续性。我们的哮喘链接试点试验显示， 哮喘症状相比，加强日常护理条件，特别是低收入，黑人 和拉丁裔儿童，并证明了试验的可行性。此外，我们已经调整了这种干预措施，以真实的- 利用来自不同的、多层次的社区利益相关者的投入，哮喘链接现在准备好了， 有效性试验和严格的过程评估。我们建议在14个儿科实践中进行一项随机对照试验 （n=350对亲子）在全国哮喘负担最高的两个城市，伍斯特和斯普林菲尔德， 马萨诸塞州。在目标1中，我们将确定哮喘链接与加强常规护理的有效性 在改善控制不良的学龄儿童哮喘健康结果的条件。我们 主要结果是哮喘症状（通过哮喘控制测试分数测量）和次要健康 结果是坚持吸入皮质类固醇，儿童和父母的生活质量，急诊科 探视、住院、缺课和父母失去的工作日。本研究的目标2将探索 通过检查诊所、学校和家庭层面的忠诚度和 使用混合方法和普罗克特框架来评估可接受性。收集的数据将为未来的全国范围的 执行试验。如果被证明是有效的，哮喘链接可能成为标准的照顾儿童， 高风险哮喘，即使在有限的资源内，也有能力改变实践。