Using a Novel Technology to Improve Adherence: School-Based Asthma Treatment

描述（由申请人提供）：该申请涉及广泛的挑战领域（06）使能技术，以及特定的挑战主题，06- od (OBSSR)-101*：使用新技术来改善或衡量依从性。我们建议开发和测试一种新技术，以提高对有效预防哮喘药物的依从性，并降低城市儿童的发病率。虽然NHLBI指南建议所有患有持续性哮喘的儿童每天服用维持药物，但研究表明，依从性差是很常见的，美国许多应该接受预防性药物治疗的儿童没有接受这些药物。这个新的转化项目的目标是测试在现实环境中，在学校实施预防性哮喘药物直接观察治疗的可行性和有效性，使用最先进的基于网络的技术进行系统筛查，电子报告生成，以及护士，护理人员和初级保健提供者之间的沟通。这项研究建立在我们之前对530名儿童的研究经验的基础上，该研究表明，以学校为基础的预防性哮喘药物管理可以改善哮喘症状并减少缺勤。为了使这个项目对公共健康产生可持续的影响，我们现在必须开发系统筛查和沟通的技术，以便将其整合到为这些高风险儿童服务的学校和社区系统中。我们建议进行一项为期两年的研究，开发一个综合系统，使用基于网络的技术在学校持续提供预防性哮喘药物（第一年），并进行一项试点随机试验，以评估哮喘发病率干预的可行性和初步有效性，包括无症状天数、生活质量、缺勤和紧急医疗保健使用（第二年）。我们还将评估实施和维持这一新的医疗体系所增加的成本。在第一年，我们将为这一新的护理系统开发技术，并通过与关键线人进行专家咨询和焦点小组方法来改进干预措施。第二年将进行随机试验，对来自12所市中心学校的80名学生进行这种护理模式的测试。我们假设这种以学校为基础的哮喘护理的新适应将；1)在这一人群以及学校和社区工作人员中是可行和可接受的，2)降低哮喘发病率（无症状天数、缺勤和用于哮喘护理的急诊室/紧急护理）。目前还没有针对城市哮喘儿童的切实可行的全系统干预措施，以确保儿童服用他们应该接受的药物。提议的干预措施可能会对公共卫生产生重大影响，作为全国社区哮喘护理的模式，以改善结果并减少差异。此外，它还提供了机会，大大加快新方法的传播，以提高依从性并随后降低发病率，而不会中断非常成功的社区合作。-相关性目前还没有针对城市哮喘儿童的切实可行的全系统干预措施，以确保儿童得到适当的预防性护理。重要的是，有效的哮喘治疗方法如果没有被需要它们的患者使用，就不会起作用。该干预措施旨在通过城市学校的创新项目实施基于指南的哮喘护理。这个项目可能对公共卫生产生深远的影响，因为它提出了一个实用的系统变革，利用技术来促进对有效哮喘护理指南的遵守。我们先前的数据表明，提出的以学校为基础的哮喘干预可以以最小的成本显著降低发病率。这个项目有潜力成为改善全国城市社区哮喘护理的典范。

DESCRIPTION (provided by applicant): This application addresses the broad Challenge Area (06) Enabling Technologies, and specific Challenge Topic, 06-OD(OBSSR)-101*: Using new technologies to improve or measure adherence. We propose the development and testing of a novel technology to improve adherence to effective preventive asthma medications and reduce morbidity among young urban children. While NHLBI guidelines recommend daily maintenance medications for all children with persistent asthma, studies indicate that poor adherence is common, and many children in the US who should receive preventive medications are not receiving them. The goal of this new translational project is to test the feasibility and effectiveness of implementing directly observed therapy of preventive asthma medications in school in a real-world setting, using state-of-the-art web-based technology for systematic screening, electronic report generation, and communication between nurses, caregivers, and primary care providers. This study builds on our experience with a prior study of 530 children that demonstrated that school-based administration of preventive asthma medications improves asthma symptoms and reduces absenteeism. In order for this program to have sustainable public health impact, we must now develop the technology for systematic screening and communication in order to integrate it within the school and community systems that serve these high risk children. We propose a two-year study to develop an integrated system for the sustained delivery of preventive asthma medications in schools using web-based technology (year 1), and to conduct a pilot randomized trial to evaluate the feasibility and preliminary effectiveness of the intervention on asthma morbidity, including symptom-free days, quality of life, absenteeism, and urgent health care use (year 2). We also will evaluate the added cost to implement and sustain this new system of care. In the first year, we will develop the technology for this new system of care and refine the intervention using expert consultation with key informants and focus group methodology. The second year will consist of a randomized trial to test this model of care with 80 students from 12 inner-city schools. We hypothesize that this novel adaptation of school-based asthma care will; 1) be feasible and acceptable among this population and among school and community personnel, and 2) yield reduced asthma morbidity (symptom-free days, absenteeism, and emergency room / urgent care use for asthma care). There currently are no practical, system-wide interventions for urban children with asthma that assure that children take the medications they should be receiving. The proposed intervention could have a major public health impact as a model for asthma care in communities nationwide to improve outcomes and reduce disparities. Further, it provides the opportunity to substantially accelerate the diffusion of a novel method to improve adherence and subsequently reduce morbidity, without interruption of a highly successful community-based collaboration. - RELEVANCE There currently are no practical, system-wide interventions for urban children with asthma that assure that children are receiving appropriate preventive care. Importantly, effective asthma therapies will not work if they are not used by the patients who need them. This intervention is designed to implement guideline- based asthma care through an innovative program in the city schools. This project may have a profound impact on public health because it presents a practical system change utilizing technology to promote adherence to effective asthma care guidelines. Our prior data suggest that the proposed school-based asthma intervention could produce significant reduction in morbidity for minimum cost. This program has the potential to serve as a model for improved asthma care in urban communities nationwide.