Appalachian Specialty Telemedicine Access for Referrals (STAR) Trial
University of Arkansas
Summary
This trial will evaluate a multilevel intervention (STAR model) that combines mobile health (mHealth) hearing screening tools with telemedicine technology for specialty care access in rural Kentucky schools. An initial version of the model was used in rural Alaska where telemedicine-based specialty referral improved both proportion of children receiving follow-up and time to follow-up. The refined STAR model will utilize an enhanced mHealth screening protocol that includes tympanometry for the detection of middle ear disease. The STAR model will also include a specialty telemedicine referral process in schools for children who refer school screening.
Description
Childhood hearing loss has substantial lifelong consequences, including speech-language delay, worse academic performance, and limited vocational opportunities. In rural settings, where access to care is limited, school-based preventative screening programs can help in early identification of childhood hearing loss. The state of Kentucky mandates hearing screening for all schools; however, the effectiveness of these programs is unclear. Further, current school programs do not include a middle ear assessment, which is needed to detect infection-related hearing loss common in children in rural a…
Eligibility
- Age range
- 3–11 years
- Sex
- All
- Healthy volunteers
- Yes
Inclusion Criteria: * Enrolled in school in one of the 14 participating counties * Initial entry into elementary school * Eligible regardless of age, gender, race, or ethnicity Exclusion Criteria: • N/A
Interventions
- OtherStandard School Screening and Referral
Counties in the control condition will use standard hearing screening and standard referral by school district. Standard referral is typically a letter home from the school to parents/caregivers of children who refer screening.
- OtherEnhanced mHealth Screening
The enhanced screening protocol will consist of an mHealth-based hearing screen combined with tympanometry.
- OtherSpecialty Telemedicine Referral
The specialty telemedicine referral will include a lay-friendly smartphone or tablet that connects to tools necessary for an ear and hearing evaluation. If a child requires referral from hearing screening, a school nurse/teacher will complete the established protocol for the specialty telemedicine referral and send details asynchronously to an audiologist for consultation.
Location
- University of KentuckyLexington, Kentucky