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

描述（由申请人提供）：本申请是一项以学校为基础的计划的首次竞争性更新，该计划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，我们在50多所城市学校的530名儿童中实施了以学校为基础的哮喘治疗（SBAT）试验（R 01 HL 079954）。SBAT试验的主要干预措施包括在学校直接观察预防哮喘药物的给药（根据NHLBI指南进行剂量调整）。这项研究的结果表明，降低发病率，减少缺勤，并减少这些非常高风险的儿童加重。该项目有可能成为改善城市社区哮喘护理的典范，但有几个因素限制了该项目目前形式的传播。例如，筛查和实施该计划需要大量资源，与提供者进行持续监测症状的沟通效率低下，经常推迟推荐的药物调整。为了使这一计划具有可持续的公共卫生影响，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伙伴关系的关键一步。我们建议测试一种新的校本计划（SB-TEAM -校本远程医疗增强哮喘管理），它直接建立在我们以前的工作，为儿童持续性哮喘在罗切斯特市小学。 我们最近开发并试点测试了基于网络的筛查技术和这种干预措施的通信（RC 1HL 099432），现在建议在整个学区使用该技术进行全面试验，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。我们假设通过SB-TEAM接受护理的儿童与加强常规护理（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儿童的药物治疗方案，其益处将比最初的SBAT试验中看到的益处更大。SB-TEAM计划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对护理方案进行持续监测和定制。eUC组的儿童将接受哮喘筛查，并通知他们的PCP，以及向父母和提供者提供系统反馈，以促进适当的基于指南的后续护理。该应用程序代表了我们工作的逻辑扩展，以提高对有效哮喘药物的依从性，从而减少健康差异，并最终在全国社区中持续下去。

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.