# Appalachian STAR Trial

> **NIH NIH U01** · UNIV OF ARKANSAS FOR MED SCIS · 2021 · $1,626,543

## Abstract

Health disparities in rural America begin early in life, arising from social determinants of health that start in
childhood. School health programs often provide the only access to preventive services for rural children.
However, school screening is variably implemented, plagued by loss to follow-up, and limited specialists in rural
areas compound barriers to care. We propose to prospectively implement a novel model of care in Appalachian
schools of rural Kentucky to address social determinants at the school, health system, and policy levels that
hinder identification and treatment of preventable health disparities for two NIH-designated disparity populations:
underserved rural and socioeconomically disadvantaged children. Our goal is to establish a novel,
generalizable model of school-based, telehealth-driven preventive care that can be disseminated in
underserved populations across rural America. We will adapt and evaluate our evidence-based approach,
“STAR” (Specialty Telemedicine Access for Referrals), that we have found effective in a Tribal setting in rural
Alaska. Appalachia has some of the poorest counties in the US, making this region ideal for adapting across
rural America. The innovative “Appalachian STAR trial” will be the first study to apply school-based telehealth
for preventive services, with direct access to specialists. Hearing screening will be the prototype for STAR due
to the high burden of preventable, infection-related hearing loss in underserved children and the profound lifelong
implications of childhood hearing loss. Our interdisciplinary team has relationships with underserved
communities in Kentucky and partnership with a Community Advisory Board and Stakeholder Advisory Board
providing support from the highest levels of state government (See KY Governor Letter). We will begin by
adapting the STAR model of care to meet the needs of rural communities and schools through a community-
and stakeholder-driven approach. We will evaluate the STAR care model in 66 schools in rural Kentucky through
a stepped wedge cluster-randomized hybrid type 1 effectiveness-implementation trial with kindergarten children
in 14 counties (n=~3600/year). The STAR intervention includes county-level school screening policy change with
enhanced mHealth school hearing screening, followed by virtual specialty care referral. The stepped-wedge
design allows evaluation of the policy/screening and referral components as well as comparison of usual care
vs. full intervention (years 2 vs.5), while meeting community input that the intervention be available to all. Primary
outcomes are the percentage of 1) children screened and 2) referrals resulting in specialty care within two months
of screening. We conservatively hypothesize the percentage screened will improve by 20% and follow-up will
improve by 40%. During the trial, we will assess multi-level implementation factors and outcomes to inform scale-
up into other rural areas. Our STAR model could be both...

## Key facts

- **NIH application ID:** 10619108
- **Project number:** 7U01OD033247-02
- **Recipient organization:** UNIV OF ARKANSAS FOR MED SCIS
- **Principal Investigator:** Matthew Lee Bush
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $1,626,543
- **Award type:** 7
- **Project period:** 2022-05-15 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10619108

## Citation

> US National Institutes of Health, RePORTER application 10619108, Appalachian STAR Trial (7U01OD033247-02). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10619108. Licensed CC0.

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