Telemedicine to Reduce Disparities in the Identification and Treatment of Neonatal Encephalopathy

远程医疗可减少新生儿脑病的识别和治疗方面的差异

基本信息

批准号：
10348684
负责人：
Alexa Kanwit Craig
金额：
$ 43.84万
依托单位：
MAINEHEALTH
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-02-10 至 2026-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10348684
关键词：
Absence Epilepsy Address Birth Brain Brain Injuries Caring Centers of Research Excellence Cessation of life Childhood Clinical Clinical Research Clinical Trials Collaborations Community Hospitals Consent Consult Consultations Critical Care Critical Illness Data Disadvantaged Discipline of obstetrics Edema Electroencephalogram Eligibility Determination Future Goals Hospital Mortality Hospitals Hour Individual Informed Consent Interview Legal patent Life Limb structure Location Magnetic Resonance Imaging Maine Mentorship Movement Muscle Tonus Neonatal Neonatology Neurologic Neurologist New England Newborn Infant Outcome Parents Patient Selection Pediatric Neurology Pediatrics Pilot Projects Predictive Value Primary Care Physician Process Qualitative Methods Reflex action Research Research Personnel Resuscitation Risk Rural Rural Community Secure Seizures Services Standardization Telemedicine Therapeutic Time Trauma acute care adverse outcome base care outcomes disparity reduction effectiveness testing excitotoxicity experience health care availability health care disparity implementation science improved member mental state metabolic rate natural hypothermia neonatal encephalopathy neonate neuroinflammation prevent programs rural area rural disparities rural healthcare standard of care sucking teleconsultation tertiary care

项目摘要

Abstract Newborns with neonatal encephalopathy delivered in community hospitals in rural Maine experience critical delays in resuscitation and initiation of therapeutic hypothermia (TH), a standard-of-care neuroprotective therapy. A rapid assessment of neonatal encephalopathy is required to determine eligibility for TH, because TH is only performed in two tertiary care centers in Maine. More than half of the neonates born annually are disadvantaged due to the lack of immediately available expertise in the community hospital and the need to be transported within the first 6 hours of life for assessment and care. There is a critical need to test effectiveness of strategies, such as telemedicine, to provide immediate expert consultation in neonatal critical care in rural community hospital settings. Our long-term goal is to use implementation science to improve survival and neurodevelopmental outcomes for neonates born in rural states. Our objective is to develop our telemedicine consultative network to improve both timeliness and patient selection for TH, and thus improve short-term outcomes and decrease rural healthcare disparities. In Aim 1, telemedicine consults will be used in eight community hospitals in Maine to determine if the time to initiation of TH can be decreased through the use of telemedicine. In Aim 2, telemedicine consults will be used in three tertiary care centers to develop evidence for the threshold at which neonates can be safely excluded from hypothermia treatment. In Aim 3, we will investigate the parent experience of participating in telemedicine consults, and specifically in giving consent for neonatal critical care research through the telemedicine interface. We aim to understand the parent experience in the context of the trauma associated with a newborn being critically ill at birth. Upon completion of this study, we anticipate that the telemedicine network in New England will include three tertiary care centers in two states and 8 or more community hospitals. This collaboration of tertiary care centers and community hospitals will be poised to welcome new members into the network, which will have the capacity to plan and execute clinical trials addressing topics that will further refine the delivery of timely TH care to neonates who meet criteria. Through implementation science, the proposed project and future projects will insure that neonates born in rural community hospitals have access to the same care available in a tertiary care center. This project is led by Dr. Alexa Craig, a junior investigator and neonatal/pediatric neurologist with a research program to address healthcare outcome disparities for neonates born in rural areas. She recently completed a KL2 project and pilot studies to establish feasibility for the current studies. Her strong mentorship team will bring expertise in clinical pediatrics (M. Ottolini) and pediatric neurology clinical research (G. Holmes), and Dr. Craig will utilize this COBRE to advance her research partnerships and program across northern New England.

抽象的在缅因州农村社区医院分娩的患有新生儿脑病的新生儿病情危重延迟复苏和开始低温治疗（TH），这是一种标准护理神经保护措施治疗。需要对新生儿脑病进行快速评估以确定 TH 的资格，因为 TH 仅在缅因州的两个三级护理中心进行。每年出生的新生儿中有一半以上是由于社区医院缺乏立即可用的专业知识并且需要在出生后 6 小时内转运以进行评估和护理。迫切需要测试有效性制定远程医疗等战略，为农村地区的新生儿重症监护提供即时专家咨询社区医院设置。我们的长期目标是利用实施科学来改善生存和农村地区出生的新生儿的神经发育结果。我们的目标是发展远程医疗咨询网络，以提高 TH 的及时性和患者选择，从而改善短期成果并减少农村医疗保健差距。在目标 1 中，远程医疗咨询将用于八个领域缅因州的社区医院确定是否可以通过使用以下方法来缩短开始 TH 的时间远程医疗。在目标 2 中，三个三级护理中心将使用远程医疗咨询来为以下方面提供证据：新生儿可以安全地排除低温治疗的阈值。在目标 3 中，我们将调查家长参与远程医疗咨询的经历，特别是同意远程医疗咨询的经历通过远程医疗界面进行新生儿重症监护研究。我们的目标是了解家长的经历新生儿出生时病情危重所造成的创伤。完成这项研究后，我们预计新英格兰的远程医疗网络将包括两个州的三个三级护理中心以及8个及以上社区医院。三级医疗中心和社区医院的合作将准备欢迎新成员加入该网络，该网络将有能力规划和执行临床试验的主题将进一步完善向符合标准的新生儿提供及时的 TH 护理。通过实施科学，拟议的项目和未来的项目将确保出生在农村社区医院可以获得与三级护理中心相同的护理服务。该项目由 Alexa Craig 博士领导，她是一名初级研究员和新生儿/儿科神经学家，拥有旨在解决农村地区出生的新生儿医疗保健结果差异的研究计划。她最近完成了 KL2 项目和试点研究，以确定当前研究的可行性。她强有力的指导团队将带来临床儿科 (M. Ottolini) 和儿科神经病学临床研究 (G. Ottolini) 方面的专业知识。 Holmes），克雷格博士将利用这个 COBRE 来推进她的研究合作伙伴关系和项目新英格兰北部。