School-Based Asthma Therapy (SBAT) to Reduce Disparities in Childhood Asthma: Pragmatic Process and Program

项目摘要 全国超过25%的学龄儿童有一种或多种慢性健康状况， 负责与青年及其照顾者协调照顾管理。协调努力改善 健康，减少缺课，并减少用于青少年疾病管理的数十亿美元。 然而，务实的（“真实的世界”）干预措施，以改善护士，青年和他们的 照顾者是新生的。一种方法是由Halterman博士（co-I）及其同事开发的，以确保 以学校为基础的系统性哮喘治疗对持续性哮喘儿童的指导性治疗 在学校进行哮喘控制药物的筛查和直接观察给药。这种干预 以学校为基础的哮喘治疗（SBAT）。通过大量的随机对照试验，SBAT 增强哮喘自我管理，提高对日常有效预防哮喘的依从性 护理（临床效果）以及减少无病天数（成本效益）。SBAT是多维的， 将儿童哮喘护理从家庭扩展到学校。SBAT是高影响力的，因为基于学校的 项目可以接触到哮喘发病风险最高的儿童，并在以下情况下优化他们的护理： 他们一天中的大部分时间都花在这方面，而不管他们与卫生保健系统的接触如何。与其对准 RE-AIM框架，这项工作的目标是提高学生的哮喘和有效性 管理成果，在学校和学区中广泛采用， 质量和成本低，并保持在学校和家庭的哮喘青年。在过去 五年来，我们的团队在全国儿童医院（NCH），其医生医院组织， 儿童合作伙伴（PFK）和罗切斯特大学已经扩大了SBAT计划超出了原来的 哥伦布市和西南城市学区（哥伦布，俄亥俄州），并发现了强大的采用（17至225 学校）和达到（38名学生到559名学生）的结果与应用SBAT。尽管 SBAT的承诺，该计划的广泛传播尚未完全实现，因为 对该计划的实际实施和评估的全面评估尚未得到 完了我们的团队现在准备从功效研究转向混合有效性-实施研究。 我们将对SBAT实施结果进行严格、全面的评估（即，临床和 学术成果，和成本效益）时，在现实世界中实施。我们亦会评估 实施战略，以促进进一步传播和实施SBAT方案， 各种各样的学校对这一综合的、跨专业的、 多维度SBAT项目可以作为旨在改善哮喘护理和 降低患有哮喘的高危儿童的发病率，并适用于其他慢性健康状况。

PROJECT ABSTRACT Over 25% of the nation’s school-aged children have one or more chronic health conditions and school nurses are responsible for coordinating care management with youth and their caregivers. Coordinated efforts improve health, reduce school absences, and mitigate the billions of dollars spent on youth disease management. However, pragmatic (“real world”) interventions to improve connection between nurses, youth, and their caregivers are nascent. One approach was developed by Dr. Halterman (co-I) and colleagues to ensure guideline-based treatment for children with persistent asthma through systematic school-based asthma screening and directly observed administration of asthma controller medications in school. This intervention was titled the School-Based Asthma Therapy (SBAT). Through numerous randomized controlled trials, SBAT was found to enhance asthma self-management and improve adherence to daily, effective preventive asthma care (clinical effect) as well as reduction in symptom-free days (cost-effective). SBAT is multidimensional, extending child asthma care from the home to the school setting. SBAT is high-impact because school-based programs can reach children at highest risk for asthma morbidity and optimize their care in the setting in which they spend most of their day, regardless of their contacts with the health care system. In alignment with the RE-AIM framework, the goal of this work is to improve the reach of students and effectiveness of asthma management outcomes, be broadly adopted among schools and school districts, be implemented with high quality and at a low cost, and be maintained within the schools and homes of asthmatic youth. Over the last five years, our team based at the Nationwide Children’s Hospital (NCH), its physician-hospital organization, Partners for Kids (PFK), and the University of Rochester has expanded the SBAT program beyond the original Columbus City and South Western City School Districts (Columbus, OH) and found strong adoption (17 to 225 schools) and reach (38 students to 559 students) outcomes with the application of SBAT. Despite the promises of SBAT, widespread dissemination of the program has not been fully achieved because a comprehensive assessment of real-world implementation and evaluation of this program has not been done. Our team is now poised to move from efficacy studies to a hybrid effectiveness-implementation study. We will conduct a rigorous, comprehensive evaluation of SBAT implementation outcomes (i.e., clinical and academic outcomes, and cost-effectiveness) when implemented in a real-world setting. We will also assess the implementation strategies in facilitating further dissemination and implementation of the SBAT program across a variety of schools. Dissemination and implementation research on this integrated, interprofessional, multidimensional SBAT program could serve as a model for programs that aim to improve asthma care and reduce morbidity for high risk children with asthma and has applications for other chronic health conditions.