The Breathe Easy Telehealth Program: A Project-Based Grant Proposal Thesis to Improve Asthma Management among Elementary and Middle School Children in Louisiana Open Access

Padgett, Kia Renee (2017)

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Asthma has emerged as a significant health and economic burden to patients, families, health systems, payors, and society. It is one of the most common chronic childhood conditions in the United States, affecting approximately nine million children under the age of eighteen. Researchers have identified a broad range of genetic, behavioral, and environmental triggers associated with symptoms and exacerbation. Asthma disproportionately affects low-income and minority populations with higher morbidity and mortality rates. Although the etiology of asthma is unknown and currently there is no cure, asthma can be effectively controlled through prevention activities and symptom management. Louisiana has a unique set of demographic, socioeconomic, environmental, and geographical factors that contribute to the state's childhood asthma burden. Under the application guidelines for NIH funding opportunity announcement PA-16-161, I propose a project-based thesis to create opportunities for children and families living in low-income communities to receive specialty health services in the school setting, using a telehealth care delivery model. The proposed research program entitled "The Breathe Easy Telehealth Program" aims to increase access to specialty healthcare; utilize evidence-based prevention strategies; create essential clinical, public health, academic, and community partnerships; improve population health; and demonstrate sustainability.

After obtaining IRB approval, a pilot program will be conducted in eight elementary and middle schools; across four USDA-designated, persistent poverty parishes in Louisiana. Students with signed consent forms and completed asthma impact assessment forms will be eligible for participation in the program. Using encrypted health information technology, audio-visual equipment, and telehealth medical devices, students enrolled in the program will receive HIPAA-compliant health services. Participating students will receive a respiratory focused physical examination, patient education, and individualized asthma action plan. A registered nurse will perform the physical assessment at the presenting site, the school nurse office, while virtually connected with a pediatric pulmonologist who will facilitate the visit, from a hospital setting. Quantitative and qualitative data collected from the asthma impact assessment form, and the telehealth consultations will be entered into IBM SPSS 22.0 and NVivo 11, respectively. Results of data analysis will be used to identify knowledge gaps; evaluate medication adherence; assess the impact of high trigger burden on the frequency of severe asthma exacerbations, hospitalizations, days lost at school; and the impact on overall quality of life. Proven effectiveness of the Breathe Easy Telehealth Program will allow for reproducibility of the program, as a viable healthcare delivery model, that can be expanded to other school-based telehealth specialty services including diabetes management and behavioral health consultations.

Table of Contents

Table of Contents

Abstract vi

Acknowledgement vii

Table of contents vii

List of tables viii

List of figures viii

Chapter 1: Introduction

Introduction and rationale 1

Problem statement 1

Purpose statement 1

Project addressed by the proposal 2

Significance statement 2

Theoretical framework 2

Detailed description of proposed program 3

Definition of terms 5

Chapter 2: Review of literature 6

Overview of childhood asthma 6

Global burden of asthma 8

Healthy People 2020 - Respiratory Disease 10

Social determinants of childhood asthma 12

Economic impact of asthma 14

Environmental health and asthma 17

Application of a theoretical framework to asthma management 20

Patient Centered Medical Home and Telehealth 24

Evaluation of School-Based Telehealth asthma Programs 26

Chapter 3: Methodology 29

Review funding agencies that address asthma 29

Summary of the request for proposal 31

Rationale for choosing funding source 32

Program aims and objectives 32

Target population 33

Research design 39

Protection of Human Subjects and Vulnerable Population 40

Data collection and procedures 43

Budget 47

Evaluation 51

Sustainability plan 53

Statistical analysis and reporting of results 54

Public health implications 55

Chapter 4: Incorporation of Grant Proposal Reviewer Comments 56

Acknowledgement of thesis committee 56

Grant reviewers comments on request for proposal 57

Chapter 5: PA--16--161 NIH Exploratory/Developmental Research Grant Proposal 59

References 88

Appendix 92

Appendix A: Assent and consent form 92

Appendix B: Asthma impact assessment form 96

Appendix C: Asthma action plan 104

Appendix D: Telehealth evaluation form 105

Appendix E: Modular budget 107

Appendix F: Logic model 108

Appendix G: Gantt chart 109

Appendix H: Letter of commitment 110

Appendix I: Subaward agreement 111

List of Tables

Table 1. Asthma Severity among Children with Current Asthma by U.S. State 8

Table 2. Projected Medicare Savings from Telehealth 25

Table 3. Equipment budget justifications 49

Table 4. Travel budget justifications 50

List of Figures

Figure 1. Global Prevalence of Asthma 9

Figure 2. U.S. Asthma Prevalence by Age, Sex, and Race 11

Figure 3: BenMAP-CE Economic Estimates of Health Impacts related to Changes in Air Quality 17

Figure 4: Social Ecological Model 20

Figure 5: Persistent Poverty Parishes in Louisiana 34

Figure 6: Percentage of Population Enrolled in Medicaid by Parish 35

Figure 7: Quality Counts 2016: State of Louisiana Report Card 36

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