# North STAR Trial: Specialty Telemedicine Access for Referrals in Rural Alaska

> **NIH NIH R01** · DUKE UNIVERSITY · 2021 · $126,225

## Abstract

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
mo...

## Key facts

- **NIH application ID:** 10340829
- **Project number:** 1R01DC020026-01
- **Recipient organization:** DUKE UNIVERSITY
- **Principal Investigator:** Denise A Dillard
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $126,225
- **Award type:** 1
- **Project period:** 2021-09-17 → 2022-05-14

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10340829

## Citation

> US National Institutes of Health, RePORTER application 10340829, North STAR Trial: Specialty Telemedicine Access for Referrals in Rural Alaska (1R01DC020026-01). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10340829. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*