Using a Novel Technology to Improve Adherence: School-Based Asthma Treatment

使用新技术提高依从性：学校哮喘治疗

• 批准号: 7935418
• 负责人: Jill S Halterman
• 金额: $ 48.28万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7935418
• 关键词: Absenteeism; Accident and Emergency department; Address; Adherence; Administrator; Age; Area; Arts; Asthma; Biological Preservation; Caregivers; Caring; Child; Childhood; Chronic Disease; Cities; Collaborations; Communication; Communities; Computerized Medical Record; Consultations; Data; Development; Diffusion; Directly Observed Therapy; Dose; Effectiveness; Effectiveness of Interventions; Electronics; Enrollment; Ensure; Exhalation; Focus Groups; Generations; Goals; Guidelines; Healthcare; Hospitalization; Human Resources; Interruption; Intervention; Investigation; Knowledge; Mails; Maintenance; Measurement; Measures; Medical; Methodology; Methods; Minority Groups; Modeling; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Nitric Oxide; Nurses; Online Systems; Outcome; Patients; Pharmaceutical Preparations; Population; Preventive; Primary Health Care; Provider; Public Health; Quality of life; Reporting; School Nursing; Schools; Screening procedure; Students; Support System; Symptoms; System; Technology; Testing; Translating; Work; airway inflammation; base; care systems; cost; design; effectiveness trial; experience; high risk; improved; informant; inner city; innovation; new technology; novel; programs; randomized trial

DESCRIPTION (provided by applicant): This application addresses the broad Challenge Area (06) Enabling Technologies, and specific Challenge Topic, 06-OD(OBSSR)-101*: Using new technologies to improve or measure adherence. We propose the development and testing of a novel technology to improve adherence to effective preventive asthma medications and reduce morbidity among young urban children. While NHLBI guidelines recommend daily maintenance medications for all children with persistent asthma, studies indicate that poor adherence is common, and many children in the US who should receive preventive medications are not receiving them. The goal of this new translational project is to test the feasibility and effectiveness of implementing directly observed therapy of preventive asthma medications in school in a real-world setting, using state-of-the-art web-based technology for systematic screening, electronic report generation, and communication between nurses, caregivers, and primary care providers. This study builds on our experience with a prior study of 530 children that demonstrated that school-based administration of preventive asthma medications improves asthma symptoms and reduces absenteeism. In order for this program to have sustainable public health impact, we must now develop the technology for systematic screening and communication in order to integrate it within the school and community systems that serve these high risk children. We propose a two-year study to develop an integrated system for the sustained delivery of preventive asthma medications in schools using web-based technology (year 1), and to conduct a pilot randomized trial to evaluate the feasibility and preliminary effectiveness of the intervention on asthma morbidity, including symptom-free days, quality of life, absenteeism, and urgent health care use (year 2). We also will evaluate the added cost to implement and sustain this new system of care. In the first year, we will develop the technology for this new system of care and refine the intervention using expert consultation with key informants and focus group methodology. The second year will consist of a randomized trial to test this model of care with 80 students from 12 inner-city schools. We hypothesize that this novel adaptation of school-based asthma care will; 1) be feasible and acceptable among this population and among school and community personnel, and 2) yield reduced asthma morbidity (symptom-free days, absenteeism, and emergency room / urgent care use for asthma care). There currently are no practical, system-wide interventions for urban children with asthma that assure that children take the medications they should be receiving. The proposed intervention could have a major public health impact as a model for asthma care in communities nationwide to improve outcomes and reduce disparities. Further, it provides the opportunity to substantially accelerate the diffusion of a novel method to improve adherence and subsequently reduce morbidity, without interruption of a highly successful community-based collaboration. - RELEVANCE There currently are no practical, system-wide interventions for urban children with asthma that assure that children are receiving appropriate preventive care. Importantly, effective asthma therapies will not work if they are not used by the patients who need them. This intervention is designed to implement guideline- based asthma care through an innovative program in the city schools. This project may have a profound impact on public health because it presents a practical system change utilizing technology to promote adherence to effective asthma care guidelines. Our prior data suggest that the proposed school-based asthma intervention could produce significant reduction in morbidity for minimum cost. This program has the potential to serve as a model for improved asthma care in urban communities nationwide.

描述(由申请人提供)：本申请涉及广泛的挑战领域(06)支持技术，以及具体的挑战主题06-OD(OBSSR)-101*：使用新技术来改进或衡量遵从性。我们建议开发和测试一种新技术，以提高对有效预防哮喘药物的依从性，并降低城市儿童的发病率。虽然NHLBI指南建议所有患有持续性哮喘的儿童每天服用维持性药物，但研究表明，依从性差的情况很常见，美国许多应该接受预防性药物治疗的儿童没有接受这些药物。这个新的翻译项目的目标是在现实世界中测试在学校实施预防哮喘药物的直接观察治疗的可行性和有效性，使用最先进的基于网络的技术进行系统筛选、电子报告生成以及护士、照顾者和初级保健提供者之间的沟通。这项研究建立在我们之前对530名儿童进行的一项研究的经验基础上，该研究表明，基于学校的预防性哮喘药物管理可以改善哮喘症状，减少缺勤。为了使这项计划对公共卫生产生可持续的影响，我们现在必须开发系统的筛查和交流技术，以便将其整合到为这些高危儿童服务的学校和社区系统中。我们建议进行一项为期两年的研究，以发展一套综合系统，利用网上科技在学校持续提供预防哮喘药物(第一年)，并进行一项试验性随机试验，以评估干预哮喘发病率的可行性和初步成效，包括无症状天数、生活质素、缺勤和紧急医疗服务使用(第二年)。我们还将评估实施和维持这一新护理系统的额外成本。在第一年，我们将为这一新的护理系统开发技术，并通过与关键线人的专家咨询和焦点小组方法来完善干预。第二年将包括一项随机试验，对来自市中心12所学校的80名学生进行这种护理模式的测试。我们假设，这种以学校为基础的哮喘护理的新适应将：1)在这一人群中以及在学校和社区工作人员中是可行和可接受的，2)减少哮喘发病率(无症状天数、缺勤和急诊室/紧急护理用于哮喘护理)。目前还没有针对城市哮喘儿童的实用的、全系统的干预措施来确保儿童服用他们应该接受的药物。拟议的干预措施可能会对公共卫生产生重大影响，成为全国社区哮喘护理的典范，以改善结果并减少差距。此外，它提供了机会，在不中断非常成功的基于社区的合作的情况下，大幅加快新方法的传播，以提高遵从性并随后降低发病率。-相关性目前没有对患有哮喘的城市儿童采取切实可行的全系统干预措施，以确保儿童得到适当的预防性护理。重要的是，有效的哮喘疗法如果不被需要的患者使用，就不会奏效。这项干预措施旨在通过城市学校的创新计划实施以指南为基础的哮喘护理。这个项目可能会对公共卫生产生深远的影响，因为它提出了一种实际的系统变革，利用技术来促进遵守有效的哮喘护理指南。我们先前的数据表明，拟议的以学校为基础的哮喘干预措施可以以最低的成本显着降低发病率。这项计划有可能成为全国城市社区改善哮喘护理的典范。