RESEARCH: The goal of this proposal is to refine and pilot test Asthma Link, an innovative, low- cost intervention that links pediatric practices, schools, and families to deliver school nurse-supervised asthma therapy to children with poorly controlled asthma in real-world settings. While there are successful examples of school-supervised asthma therapy to improve asthma medication adherence in research settings, this intervention has not been routinely adopted in practice. This is likely due to costly and resource intense protocols that have not yet leveraged the established infrastructure of the clinical system and schools. To address this, our team developed a new model, Asthma Link, in which pediatric providers identify eligible children as part of their routine practice and initiate supervised asthma therapy with the school nurse; the family picks up and delivers the asthma medication to the school: and the school nurse supervises daily asthma medication use. This intervention leverages established infrastructure and requires minimal resources to operate, enhancing sustainability in a real-world setting. Our preliminary studies show that Asthma Link reduces asthma-related emergency room visits yet qualitative interviews showed the protocol needs refinement for real-world use. We propose to refine the Asthma Link protocol for real-world implementation and then pilot test the refined protocol in a cluster RCT of 4 pediatric practices (n=72 parent-child dyads). 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. CANDIDATE: Michelle Trivedi, MD, MPH is a pediatric pulmonologist, Associate Professor of Pediatrics at the University of Massachusetts Medical School (UMMS) in the Division of Pediatric Pulmonology at UMass Memorial Children's Medical Center and an Assistant Professor in the Department of Population and Quantitative Health Sciences at UMMS. She received a Master's of Public Health in Clinical Effectiveness at the Harvard School of Public Health. She has conducted rigorous observational and epidemiologic investigations in pediatric asthma; and with a UMMS KL2 Award has performed two critical pilot studies of Asthma Link, which build the foundation for this K23 proposal. Dr. Trivedi will utilize the K23 Award to become an independent clinician-scientist with expertise in developing and implementing low-cost, sustainable interventions for children with asthma and to ultimately impact state and national asthma policies. ENVIRONMENT: Dr. Trivedi will perform her research and career development at UMMS. Her primary mentor, Dr. Lori Pbert and secondary mentors, Dr. Wanda Phipatanakul, Dr. Milagros Rosal and Dr. Stephenie Lemon, are all leaders in their respective fields of preventive health, health behavior change trials, pediatric asthma clinical trials, community-engaged research and implementation science. Each of Dr. Trivedi's mentors has an excellent track record of mentoring young investigators towards independent research careers.
Over 6 million children in the United States have asthma, causing billions of dollars in healthcare expenditures and over 14 million missed school days annually, with most childhood asthma morbidity attributable to medication non-adherence. The proposed research program will evaluate a school-supervised asthma therapy intervention to improve medication adherence in children with poorly controlled asthma that is tailored for real- world settings. This intervention fills an unmet need for the families, pediatric practices and schools that support children with poorly controlled asthma, and has the potential to dramatically improve childhood asthma outcomes.
