School-Based Telemedicine Enhanced Asthma Management (SB-TEAM)

描述（由申请人提供）：本申请是一个基于学校的项目的首次竞争性更新，旨在通过促进提供基于指南的护理和提高对有效预防哮喘药物的依从性来降低贫困哮喘儿童的发病率。2006年，我们对来自50多所城市学校的530名儿童实施了基于学校的哮喘治疗（SBAT）试验（R01HL079954）。SBAT试验的主要干预措施包括在学校直接观察预防性哮喘药物的施用（根据NHLBI指南进行剂量调整）。这项研究的结果表明，这些高危儿童的发病率、缺勤率和病情恶化率都有所降低。该项目有潜力成为改善城市社区哮喘护理的典范，然而，有几个因素限制了该项目目前形式的传播。例如，筛查和实施该方案需要大量资源，并且与提供者进行持续监测症状的沟通效率低下，经常延迟推荐的药物调整。为了使这个项目对公共卫生产生可持续的影响，我们现在必须测试一个系统，该系统允许在为这些儿童服务的学校和社区系统中充分整合。在这个新的应用程序中，我们提出了我们研究的下一阶段，这是我们与城市学区扩大合作关系的关键一步。我们建议对罗切斯特市小学患有持续性哮喘的儿童测试一个新的校本项目（校本远程医疗增强哮喘管理），该项目直接建立在我们之前的工作基础上。我们最近开发并试点测试了基于网络的筛查和沟通技术（RC1HL099432），现在提议在整个学区进行全面试验，使用该技术，并增加远程医疗哮喘评估，以确保适当的后续护理和最佳治疗。我们假设接受SB-TEAM护理的儿童与接受强化常规护理（eUC）对照组的儿童相比，哮喘相关发病率更低。此外，我们预计，由于能够更优化地定制每个孩子的药物治疗方案，这种益处将比最初的SBAT试验中看到的更大。SB-TEAM项目包括系统的基于网络的哮喘筛查，在学校直接观察预防性哮喘药物的管理，以及使用基于学校的远程医疗进行持续监测和定制护理方案。eUC组的儿童将接受哮喘筛查，并通知他们的PCP，以及对父母和提供者的系统反馈，以促进适当的基于指南的随访护理。这一应用代表了我们工作的合理延伸，以提高对有效哮喘药物的依从性，这可以减少健康差异，并最终在全国社区持续下去。

DESCRIPTION (provided by applicant): This application is for a first competing renewal of a school-based program designed to reduce morbidity for poor children with asthma by facilitating delivery of guideline-based care and improving adherence to effective preventive asthma medications. In 2006, we implemented the School Based Asthma Therapy (SBAT) trial (R01HL079954) with 530 children from more than 50 urban schools. The primary intervention for the SBAT trial consisted of directly observed administration of preventive asthma medications in school (with dose adjustments according to NHLBI guidelines). Results from this study demonstrate reduced morbidity, decreased absenteeism, and fewer exacerbations for these very high-risk children. This program has the potential to serve as a model for improved asthma care in urban communities, however several factors limit dissemination of the program in its current form. For example, extensive resources were required for screening and implementation of the program, and communications with providers for ongoing monitoring of symptoms were inefficient, often delaying recommended medication adjustments. In order for this program to have sustainable public health impact, we must now test a system that allows for full integration within the school and community systems that serve these children. In this new application we propose the next phase in our research, which represents a critical step in our expanding partnership with the city school district. We propose testing a novel school-based program (SB-TEAM - School-Based Telemedicine Enhanced Asthma Management), which directly builds on our prior work, for children with persistent asthma in Rochester City Elementary Schools. We recently developed and pilot-tested the technology for web-based screening and communication for this intervention (RC1HL099432), and now propose a full-scale trial across an entire school district using this technology with the addition of telemedicin asthma assessments to assure appropriate follow-up care and optimal treatment. We hypothesize that children receiving care through SB-TEAM will experience less asthma- related morbidity compared to children in an enhanced usual care (eUC) comparison group. Further, we anticipate that the benefits will be even greater than those seen in the original SBAT trial, due t the ability to more optimally tailor each child's medication regimen. The SB-TEAM program includes systematic web-based asthma screening, directly observed administration of preventive asthma medications in school, and ongoing monitoring and tailoring of the care regimen using school-based telemedicine. Children in the eUC group will receive asthma screening with notification of their PCP, as well as systematic feedback to the parent and provider to promote appropriate guideline based follow-up care. This application represents a logical extension of our work to improve adherence to effective asthma medications that can reduce health disparities and could ultimately be sustained in communities nationwide.