Reducing Asthma Attacks in Disadvantaged School Children with Asthma

项目概要/摘要 我们重新提交的提案“减少患有哮喘的弱势学童的哮喘发作” 哮喘”寻求广泛实施我们有效的基于学校的方法来改善哮喘 低收入社区儿童（5 至 12 岁）的差异。使用基于社区的参与 针对高风险人群和社区的方法，我们将结合具体情况进行传播和实施 我们科罗拉多州校本哮喘计划 (Col-SBAP) 的 (D&I)，可减少哮喘恶化， 缺课，同时还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。我们将在评估期间评估不同利益相关者确定的关键指标 在科罗拉多州的农村和小都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：我们基于证据的 Col-SBAP 以及基于证据的评估和管理方法 至关键 SDOH。我们的试点数据显示，这两种干预措施对于改善不同年龄段儿童的哮喘差异至关重要 低收入家庭。这种称为“停止哮喘发作”(SAA) 的两步干预措施将旨在 由学校哮喘导航员和学校护士与初级保健和护理协调进行可持续的交付 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 UG3 规划阶段应用，以 不断调整我们当前的实施指南，以适应适合当地社区的定制实施计划 以及特定地点的需求、资源和优先事项（EPIS 第 1 和 2 阶段）。然后我们将进行UH3 在哮喘“热点”学校系统中进行随机阶梯楔形研究设计的传播试验 科罗拉多州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，UH3 试验）并应用 EPIS 第 1-3 阶段的工作来开发“传播手册” 指导其他学校系统未来采用的计划（EPIS 第 4 阶段）。中心假设是 SAA 将 具有广泛而公平的影响范围（主要结果），并在减少哮喘发作方面产生重要益处 和症状，与尚未实施 SAA 的学校相比。 SAA 的剧本将是 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 后期（T4）实施研究策略”和“促进和改善高海拔地区人口健康” 通过使用公共卫生方法来针对高水平的“热点”学校来减轻社区负担” 不受控制的哮喘和哮喘相关的负担。该提案将包括严格的利益相关者 参与流程，以确保 SAA 传播到科罗拉多州的不同地缘政治地区，并关注 可持续性。总的来说，本评估和手册将加速 SAA 在全国范围内的传播 在儿科哮喘护理方面经历健康不平等的社区。

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.