Reducing Asthma Attacks in Disadvantaged School Children with Asthma

项目摘要/摘要 我们重新提交的提案《减少贫困学龄儿童哮喘发作》 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(5至12岁)儿童的差距。使用基于社区的参与式 方法对于高危人群和社区，我们将把传播和实施联系起来 (d&i)我们的科罗拉多州校本哮喘计划(COL-SBAP)，可减少哮喘恶化和 错过了上学的日子，同时也解决了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 在科罗拉多州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：我们的循证COL-SBAP和循证评估和管理方法 到密钥SDOH。我们的试点数据显示，这两种干预措施对于改善儿童哮喘差异至关重要。 低收入家庭。这种称为停止哮喘发作(SAA)的两步干预水平将设计用于 由学校哮喘导航员和学校护士可持续分娩，他们与初级保健和 社区资源。与我们的社区利益相关者合作，探索、准备、 实施、可持续发展(EPIS)D&I框架将在UG3规划阶段应用于 反复调整我们当前的实施指南，使其适应符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阶段1和2)。然后我们将进行一次UH3 在哮喘“热点”学校系统中采用随机阶梯-楔形研究设计的传播试验 科罗拉多州五个地区评估哮喘热点学校系统(EPIS)的实施策略 阶段3，UH3试验)，并将EPIS阶段1-3的工作应用到以下方面 指导其他学校系统未来采用计划(EPIS阶段4)。中心假设是SAA将 具有广泛和公平的覆盖范围(主要结果)，并在减少哮喘发作方面产生重要好处 与尚未实施SAA的学校相比，这是一种新的学习方式和症状。SAA的行动手册将是 旨在促进可持续地采用SAA，包括培训材料和计算回报 在投资方面。我们的提案响应并解决了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在高 通过使用公共卫生方法来针对具有较高水平的 不受控制的哮喘和哮喘相关负担。这项提案将包括一个严格的利益相关者 参与进程，以确保将SAA传播到科罗拉多州的不同地缘政治地区，并关注 可持续发展。总体而言，这一评价和行动纲领将加速在全国范围内传播SAA 在儿童哮喘护理中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.