Reducing Asthma Attacks in Disadvantaged School Children with Asthma

减少患有哮喘的弱势学童的哮喘发作

• 批准号: 10723244
• 负责人: Lisa Cicutto
• 金额: $ 103.56万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-10 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10723244
• 关键词: Absenteeism at work; Acceleration; Address; Adoption; Age; Area; Asthma; Attention; Behavior; Caregivers; Caring; Child; Child Care; Childhood Asthma; Cities; Clinic; Colorado; Communication; Communities; Data; Disadvantaged; Disparity; Disparity population; Dissemination and Implementation; Elements; Eligibility Determination; Emergency department visit; Ensure; Equity; Evaluation; Evidence based program; Exploration, Preparation, Implementation, and Sustainment; Family; Funding; Future; Grant; Guidelines; Health; Health Care Quality Indicators; Hospitalization; Hot Spot; Intervention; Investments; Learning; Low income; Maintenance; Measures; Methods; Morbidity - disease rate; Multimedia; National Heart, Lung, and Blood Institute; Outcome; Patients; Performance; Phase; Practical Robust Implementation and Sustainability Model; Primary Care; Process; Public Health; Quality of life; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Reduce health disparities; Research Design; Research Personnel; Resources; Risk Reduction; Rural; School Nursing; Schools; Site; Symptoms; System; Testing; Training; Work; asthma exacerbation; community burden; community engaged research; cost; design; dissemination trial; effectiveness outcome; effectiveness/implementation trial; ethnic minority; evidence base; experience; health disparity; health inequalities; high risk population; implementation evaluation; implementation framework; implementation outcomes; implementation research; implementation strategy; improved; improved outcome; lower income families; member; metropolitan; minority student; neighborhood disadvantage; population health; primary outcome; programs; racial minority; response; school district; school health; screening; secondary outcome; skills; social health determinants; success; trial design

PROJECT SUMMARY/ABSTRACT Our re-submission proposal, “Reducing Asthma Attacks in Disadvantaged School Children with Asthma,” seeks broad-scale implementation of our effective school-based approach to improve asthma disparities for children in low-income communities (ages 5 to 12 years). Using community-based participatory methods with high risk populations and communities, we will contextualize dissemination and implementation (D&I) of our Colorado school-based asthma program (Col-SBAP) that reduces asthma exacerbations and missed school days, while also addressing social determinants of health (SDOH) which our pilot identified as major drivers of asthma disparities. We will evaluate key metrics identified by diverse stakeholders during a dissemination trial in rural and small metropolitan areas of Colorado. Our dissemination trial will include two interventions: our evidence-based Col-SBAP and an evidence-based assessment and management approach to key SDOH. Our pilot data show both interventions are critical to improve asthma disparities for children from low income families. This two-step level of intervention, called Stop Asthma Attacks (SAA), will be designed for sustainable delivery by school asthma navigators and school nurses who coordinate with primary care and community resources. In partnership with our community stakeholders, the Exploration, Preparation, Implementation, Sustainment (EPIS) D&I framework will be applied during the UG3 planning phase to iteratively adapt our current implementation guide to tailored implementation plans that meet local community and site-specific needs, resources and priorities (EPIS Phases 1 & 2). We will then conduct a UH3 dissemination trial with a randomized stepped-wedge study design in asthma “hot spot” school systems across five Colorado regions to evaluate implementation strategies across asthma “hot spot” school systems (EPIS phase 3, UH3 trial) and to apply the work from EPIS phases 1-3 to develop a “dissemination playbook” to guide future program adoption by other school systems (EPIS Phase 4). The central hypothesis is that SAA will have broad and equitable Reach (primary outcome), and yield important benefits in reducing asthma attacks and symptoms, as compared to schools that have not yet implemented SAA. The SAA playbook will be designed to promote the sustainable adoption of SAA, including training materials and a calculation of return on investment. Our proposal is responsive to and addresses key elements of NHLBI HL-20-003 by “testing late-stage (T4) implementation research strategies” and “promoting and improving population health in high- burden communities” by using a public health approach to target “hot spot” schools with high levels of uncontrolled asthma and asthma associated burden. This proposal will both include a rigorous stakeholder engagement process to ensure SAA is disseminated to diverse geopolitical areas of Colorado with attention to sustainability. Collectively, this evaluation and playbook will accelerate dissemination of SAA nationally to communities experiencing health inequities in pediatric asthma care.

项目总结/摘要 我们重新提交的提案，“减少患有哮喘的学龄儿童的哮喘发作， 哮喘，”寻求广泛实施我们有效的以学校为基础的方法来改善哮喘 低收入社区儿童（5至12岁）的差异。利用社区参与性 方法与高风险人群和社区，我们将结合背景传播和实施 （D&I）我们的科罗拉多学校为基础的哮喘计划（Col-SBAP），减少哮喘急性发作， 缺课，同时也解决健康的社会决定因素（SDOH），我们的试点确定为 哮喘差异的主要驱动因素。我们将评估不同利益相关者在 在科罗拉多的农村和小城市地区进行传播试验。我们的传播试验将包括两个 干预措施：我们的循证Col-SBAP和循证评估和管理方法 关键SDOH。我们的试点数据显示，这两种干预措施对改善儿童哮喘差异至关重要， 低收入家庭。这两步干预水平，称为停止哮喘发作（SAA），将设计用于 学校哮喘领航员和学校护士与初级保健协调， 社区资源。与我们的社区利益相关者合作，探索，准备， 实施、维持（EPIS）D&I框架将在UG 3规划阶段应用， 反复调整我们当前实施指南，使其适应符合当地社区需求的定制实施计划 以及具体场地的需要、资源和优先事项（环境规划信息系统第1和第2阶段）。然后我们将进行UH 3 一项在哮喘“热点”学校系统中进行的随机阶梯楔形研究设计的传播试验， 在科罗拉多的五个地区评估哮喘“热点”学校系统的实施策略（EPIS 第3阶段，UH 3试验），并应用EPIS第1-3阶段的工作，制定“传播剧本”， 指导其他学校系统未来采用该计划（EPIS第4阶段）。核心假设是SAA将 具有广泛和公平的覆盖范围（主要结局），并在减少哮喘发作方面产生重要益处 与尚未实施SAA的学校相比，SAA行动手册将 旨在促进SAA的可持续采用，包括培训材料和回报计算 关于投资。我们的提案通过“测试”响应并解决了NHLBI HL-20-003的关键要素 后期（T4）实施研究战略”和“促进和改善人口健康， 通过使用公共卫生方法，以儿童死亡率高的“热点”学校为目标， 不受控制的哮喘和哮喘相关的负担。该提案将包括一个严格的利益相关者 参与过程，以确保SAA传播到科罗拉多的不同地缘政治地区，并注意 持续发展总的来说，这一评估和行动手册将加速SAA在全国的传播， 社区在儿童哮喘护理中经历健康不公平。