A Randomized, Controlled Trial of a Telephone-Based Developmental Care Coordination System

基于电话的发育护理协调系统的随机对照试验

基本信息

批准号：
10379450
负责人：
PAUL J CHUNG
金额：
$ 44.55万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-04-01 至 2024-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10379450
关键词：
5 year old Academy Address Advisory Committees Age American Appointment Birth Caring Child Child Behavior Checklist Child Care Child Health Clinic Clinical Cognitive Collaborations Community Services Control Groups Costs and Benefits Country County Data Development Developmental Delay Disorders Drops Early Intervention Effectiveness Eligibility Determination Employment Enrollment Ensure Equipment and supply inventories Evaluation Extravasation Failure Family Federally Qualified Health Center Gold Health Health Personnel Human Infrastructure Intervention Investigation Language Language Delays Lead Link Location Los Angeles Measures Medical Records Modeling Online Systems Outcome Outcome Measure Parents Participant Pediatrics Population Preventive service Process Provider Randomized Randomized Controlled Trials Recommendation Reporting Research Risk Series Services Site Speech Delay Structure System Systems Development Telephone Testing Time Training Uncertainty Visit Well Child Visits Work autism spectrum disorder base behavior measurement behavioral outcome care coordination care providers care systems child services cost cost estimate early childhood early screening effectiveness testing externalizing behavior follow-up group intervention high risk improved improved outcome innovation intervention program kindergarten member pediatrician prevent primary outcome program costs programs randomized controlled study screening service intervention service organization telephone-based tool treatment as usual voltage vulnerable community

项目摘要

PROJECT SUMMARY/ ABSTRACT Although universal early childhood developmental screening is recommended by the American Academy of Pediatrics, ample evidence suggests that child health providers are not meeting those recommendations, and many early developmental delays are being missed. Additional evidence suggests that both providers and parents struggle to navigate the early childhood developmental system of care, with few high-risk children actually getting referred, and fewer still ultimately receiving services. The gaps in care processes have created gaps in evidence linking developmental screening to developmental outcomes, leading the US Preventive Services Task Force to state that there is not enough evidence to recommend for or against universal screening for speech and language delays or Autism Spectrum Disorders. The proposed project is a randomized controlled trial of a telephone-based early childhood developmental care coordination system, in partnership with 2-1-1 Los Angeles County (211LA), part of a national network of 2-1-1 call centers covering 93% of the US population. We will test the effectiveness of 211LA in increasing referrals for developmental evaluation, increasing the numbers of children deemed eligible for services, and increasing the number of children actually receiving interventions. The trial will enroll 800 children ages 1-3 years who receive well-child care at one of 10 partner clinic sites. We will conduct developmental screening on all children using the Parental Evaluation of Developmental Status (PEDS) Online system, and randomize children 1:1 into intervention (connection to 211LA for developmental care coordination + usual care) or control (usual care alone, with developmental care coordination conducted by clinic staff). Primary outcomes will include referrals to early intervention evaluations, eligibility for intervention services, and receipt of services. We will measure these outcomes through parent report, medical record review, and 211LA data, at 6 months after enrollment. For children with elevated developmental risk based on the PEDS Online results, we will assess development using the gold-standard Brigance Inventory of Early Development III (Brigance), conducted at baseline and 24 months after enrollment. For all children, we will administer the language and cognitive subscales of the Brigance at baseline, 12 months and 24 months, to evaluate development over time in the two groups. We will measure behavioral outcomes for all children using the externalizing behavior subscale of the Child Behavior Checklist. Expected findings include higher rates of referrals, eligibility, and receipt of intervention services among intervention group participants, and greater developmental gains among children in the intervention group. We will also examine the costs of the program in relation to these outcomes, to estimate the costs and potential long-term benefits of this model. If effective, the model has the potential to disseminate rapidly throughout the 2-1-1 network and transform developmental care coordination in the US.

项目摘要/摘要尽管美国学院推荐了普遍的幼儿发展筛查小儿，充分的证据表明，儿童健康提供者没有符合这些建议，并且错过了许多早期发展延迟。其他证据表明，提供者和父母努力应对幼儿发展的护理系统，很少有高危儿童实际被推荐，最终仍会获得服务。护理过程中的差距已经建立将发展筛查与发展成果联系起来的证据差距，带领美国预防服务工作队指出，没有足够的证据来推荐或反对普遍筛选语音和语言延迟或自闭症谱系障碍。拟议的项目是基于电话的幼儿发展护理协调系统的随机对照试验，与2-1-1洛杉矶县（211LA）的合作伙伴关系，该网络由2-1-1拨打中心的国家网络的一部分 93％的美国人口。我们将测试211LA在增加发育推荐方面的有效性评估，增加被认为有资格获得服务的儿童人数，并增加孩子实际接受干预措施。审判将注册800名1-3岁儿童的儿童在10个合作诊所网站之一的护理。我们将使用父母对发展状态（PED）在线系统的评估，并随机将儿童随机化1：1 干预（连接到211LA进行发育护理协调 +常规护理）或控制（通常的护理独自一人，由诊所工作人员进行发育护理协调。主要结果将包括推荐提前干预评估，干预服务的资格和服务。我们将衡量在入学后6个月后，这些结果通过父母报告，病历审查和211LA数据。对于基于PEDS在线结果的发育风险升高的儿童，我们将评估开发使用早期发展III（BRIGANCE）的金标准Brigance清单，在基线和24 入学后几个月。对于所有儿童，我们将管理该语言和认知子量表基线时，12个月零24个月的Brigance，以评估两组的发展。我们将使用儿童行为的外在行为量表来衡量所有儿童的行为结果清单。预期的发现包括更高的转诊率，资格和干预服务的收到在干预小组参与者中，在干预中儿童的发展增长更大团体。我们还将研究该计划与这些结果有关的成本，以估算成本和该模型的潜在长期益处。如果有效，该模型有可能快速传播在整个2-1-1网络中，并改变了美国的发展护理协调。