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.

Public Health Relevance

Urban children with asthma suffer from substantial morbidity and suboptimal preventive care. This project may have a profound impact on public health because it proposes an expansion of an innovative school- based intervention to promote adherence to effective asthma care guidelines that is specifically designed to promote optimal care within an existing infrastructure. Should it prove successful in reducing symptoms and improving the health of urban children with asthma, it has the potential to serve as a sustainable model for improved asthma care for this population.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL079954-08
Application #
8853899
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Freemer, Michelle M
Project Start
2005-04-01
Project End
2016-05-31
Budget Start
2015-06-01
Budget End
2016-05-31
Support Year
8
Fiscal Year
2015
Total Cost
Indirect Cost
Name
University of Rochester
Department
Pediatrics
Type
School of Medicine & Dentistry
DUNS #
041294109
City
Rochester
State
NY
Country
United States
Zip Code
14627
Diep, Judy; Fagnano, Maria; Tremblay, Paul et al. (2018) The relationship between caregivers' subjective social status and asthma symptoms and management for urban children. J Asthma :1-7
Halterman, Jill S; Fagnano, Maria; Tajon, Reynaldo S et al. (2018) Effect of the School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) Program on Asthma Morbidity: A Randomized Clinical Trial. JAMA Pediatr 172:e174938
Bhagat, Dhristie; Fagnano, Maria; Halterman, Jill S et al. (2018) Asthma symptoms, interactive physical play and behavioral and academic outcomes in urban children with persistent asthma. J Asthma :1-8
Goldman, Hillary; Fagnano, Maria; Perry, Tamara T et al. (2018) Recruitment and retention of the Hardest-to-Reach families in community-based asthma interventions. Clin Trials 15:543-550
Holderness, Heather; Chin, Nancy; Ossip, Deborah J et al. (2017) Physical activity, restrictions in activity, and body mass index among urban children with persistent asthma. Ann Allergy Asthma Immunol 118:433-438
Gundewar, Anisha; David, Rebecca; Frey, Sean M et al. (2017) Underutilization of Preventive Asthma Visits Among Urban Children With Persistent Asthma. Clin Pediatr (Phila) 56:1312-1318
Halterman, Jill S; Tajon, Reynaldo; Tremblay, Paul et al. (2017) Development of School-Based Asthma Management Programs in Rochester, New York: Presented in Honor of Dr Robert Haggerty. Acad Pediatr 17:595-599
Frey, Sean M; Fagnano, Maria; Halterman, Jill (2016) Medication Identification Among Caregivers of Urban Children With Asthma. Acad Pediatr 16:799-805
Wiesenthal, Elise N; Fagnano, Maria; Cook, Stephen et al. (2016) Asthma and overweight/obese: double trouble for urban children. J Asthma 53:485-91
Koehler, Alana D; Fagnano, Maria; Montes, Guillermo et al. (2014) Elevated burden for caregivers of children with persistent asthma and a developmental disability. Matern Child Health J 18:2080-8

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