R01DC020026

North Star Trial: Specialty Telemedicine Access for Referrals in Rural Alaska - 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. However, loss to follow-up from school hearing screening is common, and the scarcity of specialists in rural areas compounds 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 aims to bring 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. However, the success of the clinic-based intervention varied substantially between communities, and 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 the proportion of hearing referrals resulting in specialty follow-up within two months of the 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 the sustainability of virtual specialty care in Alaska schools through a policy analysis. This analysis will assess alignment between the 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.

University Of Arkansas For Medical Sciences

TO INVESTIGATE SOLUTIONS TO PROBLEMS DIRECTLY RELEVANT TO INDIVIDUALS WITH DEAFNESS OR DISORDERS OF HUMAN COMMUNICATION IN THE AREAS OF HEARING, BALANCE, SMELL, TASTE, VOICE, SPEECH, AND LANGUAGE. THE NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS (NIDCD) SUPPORTS RESEARCH AND RESEARCH TRAINING, INCLUDING INVESTIGATION INTO THE ETIOLOGY, PATHOLOGY, DETECTION, TREATMENT, AND PREVENTION OF DISORDERS OF HEARING AND OTHER COMMUNICATION PROCESSES, PRIMARILY THROUGH THE SUPPORT OF BASIC AND APPLIED RESEARCH IN ANATOMY, AUDIOLOGY, BIOCHEMISTRY, BIOENGINEERING, EPIDEMIOLOGY, GENETICS, IMMUNOLOGY, MICROBIOLOGY, MOLECULAR BIOLOGY, THE NEUROSCIENCES, OTOLARYNGOLOGY, PSYCHOLOGY, PHARMACOLOGY, PHYSIOLOGY, PSYCHOPHYSICS, SPEECH-LANGUAGE PATHOLOGY, AND OTHER SCIENTIFIC DISCIPLINES. THE NIDCD SUPPORTS: (1) RESEARCH INTO THE EVALUATION OF TECHNIQUES AND DEVICES USED IN DIAGNOSIS, TREATMENT, REHABILITATION, AND PREVENTION OF DISORDERS OF HEARING AND OTHER COMMUNICATION PROCESSES, (2) RESEARCH INTO PREVENTION AND EARLY DETECTION AND DIAGNOSIS OF HEARING LOSS AND SPEECH, VOICE, AND LANGUAGE DISORDERS AND RESEARCH INTO PREVENTING THE EFFECTS OF SUCH DISORDERS BY MEANS OF APPROPRIATE REFERRAL AND REHABILITATION, (3) RESEARCH INTO THE DETECTION, TREATMENT, AND PREVENTION OF DISORDERS OF HEARING AND OTHER COMMUNICATION PROCESSES IN THE ELDERLY POPULATION AND ITS REHABILITATION TO ENSURE CONTINUED EFFECTIVE COMMUNICATION SKILLS, AND (4) RESEARCH TO EXPAND KNOWLEDGE OF THE EFFECTS OF ENVIRONMENTAL AGENTS THAT INFLUENCE HEARING OR OTHER COMMUNICATION PROCESSES. SMALL BUSINESS INNOVATION RESEARCH (SBIR) PROGRAM: TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, TO ENCOURAGE SMALL BUSINESS PARTICIPATION IN FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION. SMALL BUSINESS TECHNOLOGY TRANSFER (STTR) PROGRAM: TO STIMULATE AND FOSTER SCIENTIFIC AND TECHNOLOGICAL INNOVATION THROUGH COOPERATIVE RESEARCH AND DEVELOPMENT CARRIED OUT BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO FOSTER TECHNOLOGY TRANSFER BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION.

93.173 - Research Related to Deafness and Communication Disorders

National Institute on Deafness and Other Communication Disorders (NIDCD) [HHS - NIH]

Little Rock, Arkansas 722057101 United States

Single Zip Code

NIDCD Low Risk Clinical Trials in Communication Disorders (R01 Clinical Trial Required) (PAR-21-063)

Amendment Since initial award the total obligations have increased 379% from $687,498 to $3,293,182.