Innovative Trial Aims to Improve School-based Health Screening in Rural Areas


The goal is to promote policy change and utilize technological advancements to establish an innovative model of school-based, accessible, telehealth-driven preventive care that can be used in underserved populations across rural America.

Children from rural areas often rely on school programs for preventative health care and services; however, these screenings can be plagued by inconsistent implementation, lack of proper follow-up, and limited specialists in rural areas that already lack access to care.

The University of Kentucky College of Medicine’s Matthew Bush, MD, PhD, MBA, is a principal investigator, along with Susan Emmett, MD, MPH, associate professor of surgery and global health at Duke University, leading the first study of its kind to improve school-based health screening in rural communities.

Dr. Bush, as the project leader in Kentucky, will adapt, implement, and evaluate an evidence-based school hearing screening intervention referred to as Specialty Telemedicine Access for Referrals (STAR). Called the “Appalachian STAR trial” or “AppSTAR,” the project will investigate the perspectives of educational leaders throughout those counties regarding school hearing programs. Based on that information Dr. Bush and his team will adapt and evaluate the AppSTAR school-based telehealth hearing screening program in Kentucky elementary schools in 14 counties throughout Appalachia.

The novel aspect of this program is found in the provision of enhanced preventative services with direct access to hearing health care experts. This intervention has the potential to improve the effectiveness of county-level school screening protocols, the accuracy of health screenings within schools, and the efficiency of specialty care appointments.

Project leads have chosen hearing screening as the model 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,” according to the study’s abstract.

The goal is to promote policy change and utilize technological advancements to establish an innovative model of school-based, accessible, telehealth-driven preventive care that can be used in underserved populations across rural America.

The Appalachian STAR trial has been awarded funding as part of the Transformative Research to Address Health Disparities and Advance Health Equity initiative from the National Institutes of Health (NIH), an effort managed collaboratively by the NIH Common Fund, Office of Research on Women's Health, National Institute on Minority Health and Health Disparities, Tribal Health Research Office, and the National Institute of Nursing Research. 

The NIH has funded 11 grants, including Appalachian STAR, for highly innovative health disparities research through this initiative, which aims to work toward eliminating health disparities and paving the road to achieve health equity.

Dr. Bush is a professor and the vice chair for research in the UK College of Medicine Department of Otolaryngology – Head and Neck Surgery. His research is focused on increasing access to and utilization of hearing health care for underserved and rural children and adults. His research is currently funded through several NIH grants; however, he was previously a KL2 Scholar through the UK Center for Clinical and Translational Science, which provides research resources, mentorship, and funding to support investigators seeking to obtain independent research awards.