Reducing Asthma Disparities Through School-Based Telemedicine for Rural Children

描述（由申请人提供）：哮喘不成比例地加重了少数民族和低收入儿科人群的负担，尽管十多年前NHLBI哮喘管理指南已经传播，但这些差异在高危儿童中仍然存在。以前的调查表明，哮喘指南为基础的护理并没有转化为生活在农村地区的高危儿童。在生活在阿肯色州的密西西比三角洲地区的高风险农村儿童中，哮喘相关的发病率和不遵守哮喘指南是普遍的，该地区是美国贫困和医疗服务不足的地区。尚未设计大规模的干预措施，以减少高风险农村儿童的哮喘负担，并为其他人群设计的干预措施是不可行的，由于距离和旅行的障碍和缺乏专科哮喘服务，农村社区固有的。拟议项目的总体目标是减少生活在医疗服务不足的农村环境中的高危儿童之间的哮喘健康结果差异。为了实现这一目标，我们建议对540名4-17岁的儿童进行一项群集随机试验，在农村公立学区实施以学校为基础的远程医疗干预。以学校为基础的干预措施将通过远程医疗向患有哮喘的农村儿童、他们的照顾者和学校护士提供全面的哮喘教育;通过远程医疗前瞻性地监测哮喘症状和肺功能;并根据全国公布的哮喘指南向初级保健提供者提供治疗提示。我们假设，与接受常规护理的儿童相比，接受学校哮喘教育和通过远程医疗进行监测并结合提供者治疗提示的儿童将降低哮喘相关的发病率。该项目的目的是：1）检查以学校为基础的哮喘远程医疗干预在改善干预组与常规护理组相比的哮喘相关健康结果方面的有效性; 2）检查以学校为基础的哮喘远程医疗干预对哮喘自我管理技能的影响; 3）确定干预的成本。远程医疗将允许利用经过验证的技术，为高危人群提供最先进的哮喘干预措施，并将大大减少与农村社区固有的距离和旅行障碍有关的挑战。一个创新的远程医疗方法，以改善高风险的农村儿童哮喘的健康结果具有很高的影响潜力，因为从拟议的干预措施的结果将直接告知公共卫生战略，在学校为基础的环境中实施大规模的远程医疗服务。该干预措施将直接适用于农村和医疗服务不足地区的其他高危哮喘人群，并可转化为以学校为基础的健康干预战略，以针对其他慢性健康状况。

DESCRIPTION (provided by applicant): Asthma disproportionately burdens minority and low-income pediatric populations, and these disparities have persisted among high-risk children despite the dissemination of NHLBI asthma management guidelines more than a decade ago. Previous investigations suggest that asthma guidelines-based care has not translated to high-risk children living in rural regions. Asthma-related morbidity and non-adherence to asthma guidelines is prevalent among high-risk rural children living in the Mississippi Delta region of Arkansas, an impoverished and medically underserved region of the United States. Large-scale interventions to decrease asthma burden among high-risk rural children have not been designed, and interventions designed for other populations are not feasible due to distance and travel barriers and lack of subspecialty asthma services inherent to rural communities. The overall goal of the proposed project is to decrease asthma health outcomes disparities among high-risk children living in a rural, medically underserved environment. To address this goal, we propose conducting a cluster randomized trial with 540 children, ages 4-17 years, to implement a school-based telemedicine intervention in rural public school districts. The school-based intervention will provide comprehensive asthma education via telemedicine to rural children with asthma, their caregivers and school nurses; prospectively monitor asthma symptoms and lung function via telemedicine; and provide primary care providers with treatment prompts according to nationally published asthma guidelines. We hypothesize that children receiving school-based asthma education and monitoring via telemedicine in conjunction with a provider treatment prompt will have decreased asthma-related morbidity as compared to children receiving usual care. The aims of the project will: 1) examine the efficacy of a school-based asthma telemedicine intervention in improving asthma-related health outcomes in an intervention group compared to a usual care group; 2) examine the effects of a school-based asthma telemedicine intervention on asthma self-management skills; and 3) determine the cost of the intervention. Telemedicine will allow for the utilization of proven technology to deliver a state-of-the-art asthma intervention in a high-risk population and will significantly reduce challenges associated with distance and travel barriers inherent to rural communities. An innovative telemedicine approach to improve asthma health outcomes among high-risk rural children has high impact potential because findings from the proposed intervention will directly inform public health strategies to implement large-scale telemedicine services in a school-based setting. The intervention will have direct applicability to other high-risk asthma populations in rural and medically underserved regions and can be translated to school-based health intervention strategies to target other chronic health conditions.