Policy Focused Implementation Mapping to Advance Equity and Best Practice in School Asthma Services




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Purpose: The goal of Dissemination and Implementation (D&I) science is to reduce the gap between best practices and those services widely implemented; D&I is key to improving health outcomes and equity. Pediatric asthma services exemplify the critical need for D&I, but application to advance best practices has been limited. Despite the availability of effective treatment, the CDC estimates that 44% of children with current asthma are poorly managed with entrenched disparities in adverse outcomes. Comprehensive school asthma programs with stocked quick-relief medication are shown to be effective. However, only 2% of Texas school districts have policies to permit this intervention. Further, before 2023, Texas legislation regarding stock albuterol was at sharp variance to national recommendations. In 2023, state-wide collaboration in Texas resulted in amendments that align policy with published recommendations. Asthma 411 is a model to advance comprehensive best practices in school asthma services including stock albuterol. It is currently adopted by 350 schools in North Central Texas. Implementation mapping is a multi-step process with systematic strategies to advance each stage of D&I. Producing implementation protocols and tools is a key element of the 5th step of the process. Policy-focused implementation mapping brings these approaches to legislative initiatives to maximize public health benefits and advance equity. The purpose of this study is to initiate policy implementation mapping for the guideline-based, Texas legislation passed in 2023 focusing on protocols and tools for implementation of the Asthma 411 model. Methods: Newly passed Texas legislation (SB 294 88R) was outlined and included categories of implementation mandates along with the specific requirements within each category. Each existing Asthma 411 implementation tool was independently assessed by two researchers and matched to corresponding legislative requirements. The researchers then identified mandates and guidelines that were not matched to any existing tool. Existing Asthma 411 tools that were matched to the new requirements, were also independently reviewed by two researchers to determine whether it was in alignment with policy or required modification. Discrepancies in researcher assessment were resolved by consensus review. New tools or modifications of existing tools were then drafted to create a preliminary, full suite of tools to support Task 4 of the implementation mapping process. Results: Researchers identified eight relevant categories within the new legislation. Nine existing tools were identified that require modification to align with new legislation and associated guidelines. Five new requirements in the new policy were identified that lack a tool or protocol to support the implementation of the new policy. Draft modifications and new implementation tools have been constructed. Conclusion: The resulting set of preliminary tools are uploaded to the Asthma 411 website where they are free and available for download. Free, online, on-demand professional development modules are being constructed for the use of these tools. Evaluation is ongoing. This work exemplifies the application of policy-focused implementation mapping to produce tools that support state-level best practices to improve asthma outcomes and advance equity. The process developed may be applied to the implementation of other school health policies.