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

项目摘要 全国超过25%的学龄儿童患有一种或多种慢性疾病，学校护士 负责协调与青年及其照顾者之间的护理管理。协调努力改善 卫生保健、减少缺课和减少在青少年疾病管理上花费的数十亿美元。 然而，务实的(“现实世界”)干预措施，以改善护士、青年和他们之间的联系 照顾者是新生的。一种方法是由哈特曼博士(co-I)和他的同事们开发的，以确保 系统性校本哮喘对持续性哮喘儿童的指导治疗 在学校对哮喘控制药物进行筛选和直接监督管理。这一干预 名为校本哮喘疗法(SBAT)。通过大量随机对照试验，SBAT 被发现可以加强哮喘的自我管理，并提高对日常有效预防哮喘的坚持 护理(临床效果)以及减少无症状天数(具有成本效益)。SBAT是多维的， 将儿童哮喘护理从家庭扩展到学校。SBAT的影响力很大，因为以学校为基础 项目可以接触到哮喘发病率最高的儿童，并在以下环境中优化他们的护理 他们一天中的大部分时间都在度过，无论他们与医疗保健系统有什么联系。与 Re-AIM框架，这项工作的目标是提高学生的可及性和哮喘的有效性 管理成果，在学校和学区中广泛采用，并以高质量实施 高质量和低成本，并在患有哮喘的青年的学校和家庭内维持。在过去的几年里 五年来，我们的团队在全国儿童医院(NCH)，它的医生-医院组织， 儿童伙伴(PFK)和罗切斯特大学已将SBAT计划扩大到原来的范围 哥伦布市和西南部城市学区(俄亥俄州哥伦布市)，并被广泛采用(17%至225 学校)和覆盖范围(38名学生到559名学生)和应用SBAT的结果。尽管 SBAT的承诺，该计划的广泛传播尚未完全实现，因为 尚未对该计划的实际实施和评估进行全面评估 搞定了。我们的团队现在准备从有效性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)在现实世界环境中实施。我们亦会评估 促进在全国范围内进一步传播和执行SBAT方案的实施战略 各种各样的学校。对这一综合的、跨专业的、 多维SBAT计划可以作为旨在改善哮喘护理和 减少哮喘高危儿童的发病率，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.