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North STAR Trial: Specialty Telemedicine Access for Referrals in Rural Alaska

North STAR 试验：阿拉斯加农村地区的转诊专业远程医疗服务

基本信息

批准号：
10340829
负责人：
Denise A Dillard
金额：
$ 12.62万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-17 至 2022-05-14
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10340829
关键词：
Achievement Acute Address Air Alaska Alaska Native American COVID-19 Caring Child Child Health Clinic Cluster randomized trial Communities Consolidated Framework for Implementation Research Consult Data Development Diagnosis Ear Early treatment Education Employment Opportunities Feedback Focus Groups Funding Future Geography Group Interviews Health Health Services Health Services Accessibility Health system Hearing High Prevalence Home Improve Access Intervention Interview Language Development Lead Leadership Letters Minority Groups Modeling Modification National Institute on Deafness and Other Communication Disorders Parents Pathway interactions Policies Policy Analysis Population Prevalence Prevention Preventive service Primary Health Care Protocols documentation Randomized Recording of previous events Research Rural Rural Community Rural Population School Nursing School Teachers Schools Science Policy Services Social Work Specialist System Telemedicine Testing Time Translating Travel Triage Underserved Population Work barrier to care base care delivery childhood hearing loss clinical care community based research design effectiveness testing experience follow-up health care availability health disparity hearing impairment hearing screening implementation barriers implementation protocol implementation science implementation trial improved informant innovation medical specialties minority children novel pandemic disease payment primary outcome programs prospective public health relevance rural Alaska rural area rural environment rural underserved scale up screening screening program success support network teacher telehealth tribal health underserved minority virtual

项目摘要

ABSTRACT Rural Alaska Native children experience a high prevalence of preventable childhood hearing loss. School-based programs provide the only access to preventive services for many underserved rural and minority children, yet loss to follow-up from school hearing screening is common and scarcity of specialists in rural areas compound barriers to care. The Alaska Tribal Health System addresses geographic barriers to care with a telehealth network, but the network is not used for school hearing screening and is only available in Tribal regions. This proposal brings a novel telehealth model directly into schools to reach underserved rural and minority children across the state of Alaska, including non-Tribal regions. The overall objective is to prospectively implement and evaluate a new virtual specialty care model in Alaska schools to reduce loss to follow-up from school hearing screening and improve access to specialty care in rural environments. This work builds on the team’s recent PCORI-funded cluster-randomized trial that translated Alaska’s existing Tribal telehealth network in village clinics to a prevention model for school hearing screening referrals. Children randomized to clinic- based telemedicine specialty referral were 2.3 (95% CI 1.4, 3.8) times more likely to receive an ear/hearing diagnosis than those receiving the standard referral of a letter home. Success of the clinic-based intervention varied substantially between communities; stakeholder interviews revealed implementation challenges that could be addressed by delivering telehealth directly in schools. The current proposal will establish a unique model of care in Tribal and non-Tribal regions across the state, bringing virtual specialty care directly into schools. Three accomplished and complementary multi-PIs, who collaborated on PCORI- and NIDCD-funded studies in rural Alaska, will lead an interdisciplinary team, and an Alaska Stakeholder Team that includes Alaska Commissioners for Education and Health and Social Services will guide study development. In Aim 1, the team will develop and pilot an implementation protocol for school-based virtual specialty care for hearing loss through focus groups and interviews with community stakeholders. In Aim 2, they will conduct a stepped wedge, cluster-randomized implementation trial of virtual specialty care in three representative regions (n=31 schools; 2,008 children). The primary outcome is proportion of hearing referrals resulting in specialty follow-up within two months of screening date. The conservative hypothesis, based on PCORI trial data, is that virtual specialty care will improve follow- up by 100%. In Aim 3, the team will evaluate sustainability of virtual specialty care in Alaska schools through a policy analysis to assess alignment between health and education sectors, identify policy and practice barriers and accelerators, and ascertain payment models for future programmatic financing. This school-based telehealth model to address preventable childhood hearing loss could be translated to other underserved rural and minority groups, bringing high-value services into rural schools to alter the paradigm of prevention nationwide.

抽象的阿拉斯加农村原住民儿童的可预防儿童听力损失患病率很高。校本方案为许多服务不足的农村和少数民族儿童提供了获得预防服务的唯一途径，但学校听力筛查失访的情况很常见，而且农村地区缺乏专家护理的障碍。阿拉斯加部落卫生系统通过远程医疗解决护理的地理障碍网络，但该网络不用于学校听力筛查，并且仅在部落地区可用。这该提案将一种新颖的远程医疗模式直接引入学校，以惠及服务不足的农村和少数民族儿童整个阿拉斯加州，包括非部落地区。总体目标是前瞻性地实施评估阿拉斯加学校的新虚拟专业护理模式，以减少学校跟进损失听力筛查并改善农村环境中获得专业护理的机会。这项工作建立在团队最近进行的 PCORI 资助的整群随机试验对阿拉斯加现有的部落远程医疗网络进行了翻译在乡村诊所建立学校听力筛查转介的预防模式。儿童被随机分配到临床- 基于远程医疗专业转诊的接受耳科/听力检查的可能性高出 2.3 (95% CI 1.4, 3.8) 倍诊断比那些接受标准的家书转介的人要多。临床干预的成功社区之间差异很大；利益相关者访谈揭示了实施方面的挑战通过直接在学校提供远程医疗来解决这个问题。当前的提案将建立一个独特的模型在全州的部落和非部落地区提供护理服务，将虚拟专业护理直接带入学校。三成就卓著且互补的多位 PI，他们合作开展 PCORI 和 NIDCD 资助的农村研究阿拉斯加将领导一个跨学科团队和一个包括阿拉斯加专员在内的阿拉斯加利益相关者团队教育、健康和社会服务部将指导研究发展。在目标 1 中，团队将开发并通过焦点小组试行基于学校的听力损失虚拟专业护理实施方案以及与社区利益相关者的访谈。在目标 2 中，他们将进行阶梯楔形、集群随机化在三个代表性地区（n=31 所学校；2,008 名儿童）实施虚拟专业护理试点。这主要结果是在筛查后两个月内进行专业随访的听力转诊比例日期。基于 PCORI 试验数据的保守假设是，虚拟专科护理将改善后续治疗增长 100%。在目标 3 中，团队将通过以下方式评估阿拉斯加学校虚拟专业护理的可持续性：政策分析，以评估卫生和教育部门之间的一致性，确定政策和实践障碍和加速器，并确定未来计划性融资的支付模式。这个基于学校的远程医疗解决可预防的儿童听力损失的模型可以推广到其他服务不足的农村和少数民族团体，将高价值服务引入农村学校，以改变全国范围内的预防范式。