Telehealth nursing intervention for children with complex health care needs

针对具有复杂医疗保健需求的儿童的远程医疗护理干预

基本信息

批准号：
7944034
负责人：
STANLEY M FINKELSTEIN
金额：
$ 55.37万
依托单位：
UNIVERSITY OF MINNESOTA
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-09-30 至 2013-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7944034
关键词：
Abbreviations Accident and Emergency department Address Advanced Practice Nurse Ambulatory Care Area Calendar Care given by nurses Caregivers Caring Case Management Case Manager Child Child Care Childhood Chronic Chronic Disease Clinic Clinical Communication Communication Methods Complex Control Groups Data Discipline of Nursing Effectiveness Electronic Health Record Equipment and Supplies Evaluation Event Exposure to Family Family Study Goals Hand Health Health Planning Health Professional Health Services Health Status Healthcare Home environment Hospitalization Hospitalized Child Imagery Interdisciplinary Study Intervention Knowledge Medical Methods Minnesota Monitor Nurse Practitioners Outcome Parents Pediatric Hospitals Pediatric Nursing Pediatrics Perception Population Provider Quality of life Questionnaires Randomized Randomized Controlled Trials Registered nurse Reliance Reporting Research Role Sensitivity Training Groups Services Stress Surveys System Technology Telemedicine Telephone Testing Time Training Triage Visit Visual arm base experience follow-up group intervention health care quality health care service planning health care service utilization health related quality of life improved nursing intervention programs public health relevance satisfaction standard of care telehealth treatment as usual

项目摘要

DESCRIPTION (provided by applicant): The overall objective of this study is to evaluate the effectiveness of a telehealth care coordination and case management nursing intervention for children with complex special health care needs. Children with complex special health care needs are those children who have multiple, complex, chronic health conditions who require health and related services of a type or amount beyond that required by children generally. When these children are hospitalized, they receive services as part of an integrated system that provides centralized record keeping and care orders, clearly identified roles and methods of communication for health professionals involved in their care, an established method to obtain equipment and supplies, and regular monitoring of the child's condition. However, when the same child is cared for at home, services are often fragmented, and rarely accessed and delivered in a coordinated system. The task of coordinating services and sharing information between providers almost always becomes the responsibility of the parent or guardian. Families report that their greatest challenges are the stress of coordinating multiple providers, and the disconnect and lack of communication between services and providers. This study will address these issues, using an advanced practice nurse program of telehealth care coordination and case management in support of these families. Either the telephone or telephone plus interactive video are used by an advanced practice nurse to provide care coordination and case management. Goals of the program are to (1) reduce the number of crisis or unplanned uses of health care services and increase the number of non-crisis or planned health care service usage, (2) improve the quality of life for these children and their families, and (3) reduce the deficit between help needed and help received for the families in caring for these children. The study objective will be accomplished using a three armed randomized controlled trial. Children will be randomized into a control group receiving usual care that includes LPN-delivered care coordination and RN-delivered telephone triage, an intervention group receiving APN-delivered telephone care coordination and case management, and another intervention group receiving APN-delivered telephone + video care coordination and case management services. It is hypothesized that as the level of telehealth use in coordination and management increases the utilization of unplanned, or crisis, health care service utilization will decrease, that families will receive more of their needed care, and quality of life for the children and their families will improve. PUBLIC HEALTH RELEVANCE: Two areas that are critical to the health and quality of life of children with complex special health care needs and their families are (1) care coordination and case management and (2) home telehealth. The lack of interdisciplinary research into the effectiveness of coordination and management interventions by advanced practice nurses represents a significant gap in the current knowledge of providing optimal care for children with complex special health care needs, while the lack of research into the efficacy of home-based telehealth in this population represents a significant gap in the current knowledge of pediatric telehealth. The randomized controlled trial described in this proposal will address both of these issues, with the goal of developing and testing advanced practice nurse based care coordination and case management programs with increased reliance on home telehealth technology to accomplish this objective.

描述（由申请人提供）：这项研究的总体目的是评估具有复杂特殊医疗保健需求的儿童的远程医疗保健协调和案例管理护理干预的有效性。具有复杂特殊医疗保健需求的儿童是那些患有多个，复杂，慢性健康状况的儿童，他们需要通常的儿童所要求的类型或数量的健康和相关服务。当这些孩子住院后，他们将获得服务，作为综合系统的一部分，该系统提供了集中的记录保存和护理订单，清楚地确定了参与其护理的卫生专业人员的角色和沟通方法，一种既定的方法，用于获取设备和供应，并定期监测孩子的状况。但是，当在家中照顾同一孩子时，服务通常会分散，很少在协调系统中访问和交付。协调服务和共享信息之间的任务几乎总是成为父母或监护人的责任。家庭报告说，他们最大的挑战是协调多个提供商的压力，以及服务与提供者之间的脱节和缺乏沟通。这项研究将使用远程医疗护理协调和案例管理的高级实践护士计划来解决这些问题，以支持这些家庭。高级练习护士使用电话或电话以及交互式视频来提供护理协调和病例管理。该计划的目标是（1）减少危机数量或计划外的医疗保健服务使用数量，并增加非危机或计划中的医疗保健服务的使用次数，（2）改善这些儿童及其家人的生活质量，以及（3）减少所需的帮助和对这些孩子的家庭所需要的帮助之间的赤字。研究目标将使用三个武装随机对照试验来实现。儿童将被随机分为一个接受常规护理的对照组，其中包括LPN递送的护理协调和RN传递电话分诊，一个接收APN交付的电话护理协调和病例管理的干预组，以及另一个接收APN交付的干预小组，以使用APN的电话 +视频护理协调协调和案例管理服务。假设，随着在协调和管理中的远程医疗水平增加了计划外或危机的利用，医疗服务的利用率将减少，因此家庭将获得更多所需的护理，儿童及其家人的生活质量将有所改善。公共卫生相关性：两个对具有复杂特殊医疗保健需求的儿童健康和生活质量至关重要的领域，其家人是（1）护理协调和病例管理以及（2）家庭远程医疗。缺乏对高级实践护士协调和管理干预措施的有效性的跨学科研究，这在当前知识的知识方面存在一个很大的差距，即为具有复杂特殊医疗保健需求的儿童提供最佳的护理，而缺乏对家庭远程医疗在该人群中的效力的研究代表了对培养学远程健康的当前知识的重大差距。本提案中描述的随机对照试验将解决这两个问题，目的是开发和测试基于高级执业护士的护理协调和案例管理计划，并越来越依赖家庭远程医疗技术来实现这一目标。