Document text
Principal Investigator: Susan Davis Emmett
Organization: UNIV OF ARKANSAS FOR MED SCIS
Fiscal Year: 2024
Award: $649,512
Funding agency: National Institute on Deafness and Other Communication Disorders
ABSTRACT
Rural Alaska Native children experience a high prevalence of preventable childhood hearing loss. School-based
programs provide the only access to preventive services for many underserved rural and minority children, yet
loss to follow-up from school hearing screening is common and scarcity of specialists in rural areas compound
barriers to care. The Alaska Tribal Health System addresses geographic barriers to care with a telehealth
network, but the network is not used for school hearing screening and is only available in Tribal regions. This
proposal brings a novel telehealth model directly into schools to reach underserved rural and minority children
across the state of Alaska, including non-Tribal regions. The overall objective is to prospectively implement
and evaluate a new virtual specialty care model in Alaska schools to reduce loss to follow-up from school
hearing screening and improve access to specialty care in rural environments. This work builds on the
team’s recent PCORI-funded cluster-randomized trial that translated Alaska’s existing Tribal telehealth network
in village clinics to a prevention model for school hearing screening referrals. Children randomized to clinic-
based telemedicine specialty referral were 2.3 (95% CI 1.4, 3.8) times more likely to receive an ear/hearing
diagnosis than those receiving the standard referral of a letter home. Success of the clinic-based intervention
varied substantially between communities; stakeholder interviews revealed implementation challenges that could
be addressed by delivering telehealth directly in schools. The current proposal will establish a unique model of
care in Tribal and non-Tribal regions across the state, bringing virtual specialty care directly into schools. Three
accomplished and complementary multi-PIs, who collaborated on PCORI- and NIDCD-funded studies in rural
Alaska, will lead an interdisciplinary team, and an Alaska Stakeholder Team that includes Alaska Commissioners
for Education and Health and Social Services will guide study development. In Aim 1, the team will develop and
pilot an implementation protocol for school-based virtual specialty care for hearing loss through focus groups
and interviews with community stakeholders. In Aim 2, they will conduct a stepped wedge, cluster-randomized
implementation trial of virtual specialty care in three representative regions (n=31 schools; 2,008 children). The
primary outcome is proportion of hearing referrals resulting in specialty follow-up within two months of screening
date. The conservative hypothesis, based on PCORI trial data, is that virtual specialty care will improve follow-
up by 100%. In Aim 3, the team will evaluate sustainability of virtual specialty care in Alaska schools through a
policy analysis to assess alignment between health and education sectors, identify policy and practice barriers
and accelerators, and ascertain payment models for future programmatic financing. This school-based telehealth
model to address preventable childhood hearing loss could be translated to other underserved rural and minority
groups, bringing high-value services into rural schools to alter the paradigm of prevention nationwide.
Terms: <0-11 years old><Access to Care><Achievement><Achievement Attainment><Active Follow-up><Acute><Address><Air><Alaska><Alaska Indian><Alaska Native><Alaska Native group><Alaska Native individual><Alaska Native people><Alaska Native population><Alaskan American><Alaskan Indian><Alaskan Native><Alaskan Native American><American><COVID-19><CV-19><Caring><Child><Child Health><Child Youth><Children (0-21)><Clinic><Cluster randomization trial><Cluster randomized trial><Collaborations><Communities><Consolidated Framework for Implementation Research><Consolidated Framework for Implementation Science><Consolidated Framework for Implementing Change><Consult><Coronavirus Infectious Disease 2019><Data><Development><Diagnosis><Ear><Early treatment><Education><Educational aspects><Employment Opportunities><Feedback><Focus Groups><Funding><Future><Health><Health Services><Health Services Accessibility><Health system><Hearing><Hearing Loss><High Prevalence><History><Home><Hypoacuses><Hypoacusis><Improve Access><Individuals from minority><Individuals of minority><Intervention><Intervention Strategies><Interview><Language Development><Lead><Leadership><Letters><Minority Groups><Minority People><Minority Population><Minority individual><Modeling><Modification><NIDCD><National Institute on Deafness and Other Communication Disorders><Parents><Pathway interactions><Pb element><Policies><Policy Analyses><Policy Analysis><Policy Maker><Population><Prevalence><Preventative service><Prevention><Preventive service><Primary Care><Protocol><Protocols documentation><Randomized><Recording of previous events><Research><Rural><Rural Community><Rural Minority><Rural Population><Rural group><Rural people><School Health Nursing><School Nursing><School Teachers><Schools><Services><Social Service><Social Work><Specialist><Specialty><System><Telemedicine><Testing><Time><Translating><Travel><Triage><Tribes><Underserved Population><Work><access disparities><access to health care><access to health services><access to healthcare><access to services><access to treatment><accessibility disparities><accessibility of health care><accessibility to health care><accessibility to health services><accessibility to healthcare><acquiring language skills><active followup><adolescent minority><availability of services><barrier to care><barrier to health care><barrier to healthcare><barrier to treatment><barriers to implementation><care access><care delivery><childhood hearing loss><clinical care><community based design><community based research><consults><coronavirus disease 2019><coronavirus disease-19><coronavirus infectious disease-19><current pandemic><design><designing><developmental><disparities in access><disparity in health><dysfunctional hearing><early hearing loss><early therapy><effectiveness testing><experience><follow up><follow-up><followed up><followup><geographic barrier><geographic limitation><health care access><health care availability><health care service access><health care service availability><health disparity><health service access><health services availability><healthcare access><healthcare accessibility><healthcare availability><healthcare service access><healthcare service availability><hearing challenged><hearing defect><hearing deficient><hearing deficit><hearing difficulty><hearing dysfunction><hearing impairment><hearing loss in children><hearing screening><heavy metal Pb><heavy metal lead><histories><homes><implementation barriers><implementation challenges><implementation protocol><implementation science><implementation trial><improved><inequality in access><inequity in access><inequity in accessibility><informant><innovate><innovation><innovative><interventional strategy><kids><language acquisition><language learning><medical specialties><minority children><minority youth><novel><obstacle to care><obstacle to healthcare><parent><pathway><payment><pediatric hearing loss><pediatric minority><policy evaluation><present pandemic><primary outcome><programs><prospective><public health relevance><randomisation><randomization><randomly assigned><rural Alaska><rural area><rural environment><rural individual><rural location><rural region><rural under served><rural underserved><scale up><screening><screening program><screenings><service availability><success><support network><teacher><telehealth><treatment access><tribal health><under served group><under served individual><under served people><under served population><underserved group><underserved individual><underserved people><virtual><young minority><youngster>