Nurse Practitioners Follow-up: Mobile Technology, Perinatal Outcomes, & Charges

执业护士跟进：移动技术、围产期结果、

基本信息

批准号：
8698791
负责人：
Jean L Hannan
金额：
$ 14.09万
依托单位：
FLORIDA INTERNATIONAL UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-08-17 至 2015-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8698791
关键词：
Accident and Emergency department Acute Advanced Practice Nurse Affect Birth Budgets Caring Cells Cellular Phone Charge Chi-Square Tests Child Chronic Chronic Disease Communication Communities Community Healthcare Control Groups Cost Sharing Data Emergency Care Family Florida Health Health Care Costs Health Insurance Health Services Health Services Accessibility Healthcare Healthcare Fees Healthcare Systems Home visitation Hospitalization Hospitals Hour House Call Housing Immunization Incidence Infant Infant Health Intervention Language Laws Learning Life Low income Maternal Health Maternal-Child Health Services Medicaid Medical Minority Morbidity - disease rate Mothers Newborn Infant Normal Statistical Distribution Nurse Practitioners Nurses Outcome Patients Perinatal Pilot Projects Population Postpartum Period Poverty Primary Care Physician Principal Investigator Provider Randomized Randomized Clinical Trials Recruitment Activity Reporting Research Risk Sampling Schedule Series Social support State Children&apos s Health Insurance Program Stress Technology Telephone Testing Text Time Transportation United States Public Health Service Visit Weight Gain compliance behavior cost early experience follow-up group intervention health care cost/financing health care delivery improved infant outcome maternal stress meetings mortality payment programs treatment adherence urgent care

项目摘要

DESCRIPTION (provided by applicant): There are over 4 million births annually in the U.S.; most are healthy full-term newborns. However, mothers with full-term infants experience early postpartum hospital discharge (within 24-48 hours) and little to no routine additional support following hospital discharge. This is especially problematic if mothers are poor, minority, first time mothers, and have problems with access to postbirth health care. Low-income, first-time mothers represent one of the largest groups living below the poverty level, having no health insurance; low social support; increased stress; unmet learning needs; and difficulty accessing the healthcare system. And problems will only increase for this group. Proposed federal and state healthcare budget cuts include: a House $155 billion federal payment reduction forcing hospitals to eliminate many maternal child- community health care services; proposed House cuts to Medicaid affecting nearly 30 million low-income children who depend on Medicaid for health care; cuts for the State Children's Health Insurance Program (SCHIP); cuts to state public health services for low-income families; and the federal Medicaid law allowing states to impose cost sharing on families with children on Medicaid. These legislative acts, making access to health care more difficult for children, are creating major delays for both routine and acute newborn healthcare resulting in increased infant hospitalizations and mortality rates. Interventions to improve maternal and newborn outcomes in low-income postpartum mothers have included nurse home visits, hospital or community follow-up programs, follow-up telephone calls or a combination of these. They have been costly and difficult to sustain. Studies using promising mobile technology have reported improved communication and increased treatment adherence in those with chronic health problems. Studies with low-income new mothers using mobile technology are almost nonexistent. Thus, the purpose of this randomized clinical trial is to test the effects of a mobile technology intervention on maternal and infant health outcomes and healthcare charges between 2 groups of low-income, first-time mothers and their full-term newborns. All mothers (N=126) will receive routine post-hospital discharge care. Intervention group mothers will receive a minimum of 10 two-way advanced practice nurse (APN) cell phone calls plus text messaging on post hospital discharge days 3, 7, 14, 21, months 1-6; be able to contact the APNs by cell phone or texting Monday through Saturday from 9 a.m. to 5 p.m. Outcomes include: maternal outcomes of stress, social support; infant outcomes of immunizations, weight gain, morbidity; and healthcare charges for urgent care , emergency care, rehospitalizations. Data will be analyzed using two-sample t-tests and Chi- square test for equality of proportions to determine a difference in the means between control intervention groups. Wilcoxon Signed Rank test, will be used if the assumption of normal distribution is not met. Significant differences in means will support the hypotheses.

描述（由申请人提供）：美国每年有超过400万的出生；大多数是健康的完整新生儿。但是，有足月婴儿的母亲经历了产后早期出院（在24-48小时内），出院后几乎没有额外的支持。如果母亲贫穷，少数，第一次母亲，并且在获得分娩后的医疗保健方面存在问题，这尤其有问题。低收入，初次母亲是生活在贫困水平以下的最大群体之一，没有健康保险；社会支持低；压力增加；未满足的学习需求；并难以访问医疗保健系统。而且问题只会增加该组。拟议中的联邦和州医疗保健预算削减包括：一家房屋1550亿美元的联邦付款减少迫使医院消除许多产妇儿童社区医疗保健服务；拟议的房屋削减了医疗补助，影响了近3000万低收入儿童，他们依靠医疗补助来进行医疗保健；削减州儿童健康保险计划（SCHIP）；削减针对低收入家庭的公共卫生服务；联邦医疗补助法允许各州对有儿童医疗补助的家庭施加成本分担。这些立法行为使儿童更加困难地获得医疗保健，正在为常规和急性新生儿医疗保健造成重大延迟，从而增加了婴儿住院和死亡率。在低收入产后母亲中改善孕产妇和新生儿结果的干预措施包括护士家访，医院或社区随访计划，后续电话或这些结合。它们的成本高昂和难以维持。使用有前途的移动技术的研究报告说，患有慢性健康问题的人的沟通和治疗依从性提高了。使用移动技术的低收入新母亲的研究几乎不存在。因此，这项随机临床试验的目的是测试移动技术干预对2组低收入，首次母亲及其完整新生儿之间的母亲和婴儿健康结果和医疗费用的影响。所有母亲（n = 126）将获得常规的院后出院护理。干预小组的母亲将至少获得10个双向高级练习护士（APN）手机电话，以及在医院出院后第3、7、14、21，1-6月的文本消息传递；能够通过手机与APN联系，或在周一至周六的上午9点至下午5点与APN联系。结果包括：压力的产妇结果，社会支持；婴儿免疫，体重增加，发病率的结果；以及急诊，急诊，重新建立的医疗保健费用。将使用两样本t检验和Chi-Square测试对数据进行分析，以确定控制干预组之间平均值的差异。如果未达到正态分布的假设，将使用Wilcoxon签名的等级测试。平均值的显着差异将支持假设。