Asthma Link: A Partnership between Pediatric Practices, Schools, and Families to Improve Medication Adherence and Health Outcomes in Children with Poorly Controlled Asthma

项目摘要/摘要 哮喘是儿童最常见的慢性疾病，发病率很高，包括缺课， 糟糕的学校表现、父母失去的工作日、急诊室就诊和医院入院。这个 儿童哮喘的发病大多是由于不坚持用药所致，发病与用药并存。 不遵守规定对低收入、黑人和拉丁裔儿童的影响不成比例。 学校监督的哮喘 治疗确保儿童每天在学校接受预防性哮喘药物治疗，并已显示 改善服药依从性和哮喘健康结局的有效性，特别是在低收入和 种族/少数民族儿童。然而，这种策略并没有在实践中被广泛采用来生产 对公共健康有意义的影响。这很可能是由于昂贵且资源密集型的协议尚未 利用已建立的儿科诊所、学校和家庭的基础设施；发挥重要作用的团体 在儿童哮喘健康方面，但主要是在竖井中工作。为了解决这一差距，我们的团队开发了一种新的 模型，哮喘链接，与儿科诊所、学校和家庭合作，提供由学校监督的 哮喘治疗。首先，儿科提供者确定符合条件的儿童作为其常规临床实践的一部分， 向学校发送预防性用药命令，以启动受监督的哮喘治疗。下一步，家庭拾起并 将哮喘药物送到学校，现有学校工作人员监督日常预防哮喘 药物使用。此干预利用已建立的基础架构，并且只需最少的资源即可 运营，增强现实世界环境中的可持续性。我们的哮喘链接试点试验显示情况有所改善 哮喘症状与加强的日常护理条件相比，特别是在低收入黑人中 和拉丁裔儿童，并证明了试验的可行性。此外，我们已经将这种干预调整为真正的- 利用来自不同的、多层次的社区利益相关者的投入，在世界范围内使用。哮喘链接现在已经为一场 有效性试验和严格的过程评估。我们建议在14个儿科诊所中进行群集性随机对照试验。 (n=350对亲子)在全国哮喘负担最高的两个城市伍斯特和斯普林菲尔德， 马萨诸塞州。在目标1中，我们将确定哮喘链接与强化常规护理的有效性 改善哮喘控制不佳学龄儿童哮喘健康结局的条件。我们的 主要结果是哮喘症状(通过哮喘控制测试分数衡量)和次要健康 结果是坚持吸入皮质类固醇，儿童和父母的生活质量，急诊科 探视、入院、旷课和父母损失的工作日。这项研究的目标2将探索 通过检查诊所、学校和家庭层面的保真度和 使用混合方法和Proctor框架的可接受性。收集的数据将为未来全国范围内的 实施试行。如果被证明有效，哮喘链接可能成为患有哮喘的儿童的标准护理 高风险哮喘，有能力改变做法，即使在有限的资源。

PROJECT SUMMARY/ABSTRACT Asthma is the most common chronic disease of childhood with significant morbidity including school absences, poor school performance, parental lost workdays, emergency room visits and hospital admissions. The majority of childhood asthma morbidity is due to medication non-adherence, and both morbidity and medication non-adherence disproportionately impact low-income, Black, and Latino children. School-supervised asthma therapy ensures that children receive their preventive asthma medication daily at school and has shown efficacy in improving medication adherence and asthma health outcomes, particularly in low-income and racial/ethnic minority children. However, this strategy has not been widely adopted in practice to produce meaningful public health impact. This is likely due to costly and resource intense protocols that have not yet leveraged the established infrastructure of pediatric practices, schools, and families; groups that play vital roles in the asthma health of children, yet largely work in silos. To address this gap, our team developed a new model, Asthma Link, which partners pediatric practices, schools, and families to deliver school-supervised asthma therapy. First, pediatric providers identify eligible children as part of their routine clinical practice and send preventive medication orders to schools to initiate supervised asthma therapy. Next, families pick up and deliver the asthma medication to school, and existing school staff supervise daily preventive asthma medication use. This intervention leverages established infrastructure and requires minimal resources to operate, enhancing sustainability in a real-world setting. Our pilot trial of Asthma Link showed improved asthma symptoms when compared to an enhanced usual care condition, particularly among low-income, Black and Latino children, and demonstrated trial feasibility. Moreover, we have adapted this intervention for real- world use using input from diverse, multi-level community stakeholders. Asthma Link is now primed for an effectiveness trial and rigorous process assessment. We propose a cluster RCT in 14 pediatric practices (n=350 parent-child dyads) in two of the highest asthma burden cities in the nation, Worcester and Springfield, Massachusetts. In Aim 1 we will determine the effectiveness of Asthma Link versus an enhanced usual care condition in improving asthma health outcomes in school-aged children with poorly controlled asthma. Our primary outcome is asthma symptoms (measured by Asthma Control Test scores) and secondary health outcomes are adherence to inhaled corticosteroids, child and parent quality of life, emergency department visits, hospital admissions, school absences, and parental lost workdays. Aim 2 of this study will explore the implementation potential of Asthma Link by examining clinic, school and family-level measures of fidelity and acceptability using mixed methods and the Proctor framework. Data collected will inform a future nation-wide implementation trial. If proven to be effective, Asthma Link could become the standard of care for children with high-risk asthma, with the power to transform practice, even within limited resources.