Inpatient Asthma Care for Children: Adding a Place-Based, Community-Focused Appro

儿童住院哮喘护理：增加基于地点、以社区为中心的批准

基本信息

批准号：
8755172
负责人：
Andrew Finkel Beck
金额：
$ 13.15万
依托单位：
CINCINNATI CHILDRENS HOSP MED CTR
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-08-04 至 2019-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8755172
关键词：
Accident and Emergency department Acute Address Admission activity Advocacy Allergens Ally Area Asthma Award Biological Markers Building Codes Caregivers Caring Characteristics Child Child Care Child health care Childhood Childhood Asthma Chronic Chronic Disease Clinical Communities Community Health Community Hospitals Complement County Data Development Economics Electronic Health Record Environmental Risk Factor Face Family Fostering Future Genotype Geographic Factor Geographic Locations Goals Grant Head Start Program Health Health Services Health Services Accessibility Home environment Hospitalization Hospitalized Child Hospitals Household Housing Individual Information Systems Inpatients Intervention Interview K-Series Research Career Programs Knowledge Learning Legal Link Measures Medical Mentorship Methods Mission Molds Morbidity - disease rate Neighborhoods Ohio Outcome Patient Care Planning Patients Pharmacy facility Population Positioning Attribute Poverty Preventive Primary Health Care Protocols documentation Provider Public Health Quality of life Reporting Research Research Personnel Research Training Resources Risk Risk Factors Social Impacts Surveys Symptoms Testing Time Training Visit Work base career career development clinical care cohort cost experience health disparity high risk implementation science improved innovation insight medication compliance novel novel strategies psychological distress public health relevance satisfaction skills social

项目摘要

DESCRIPTION (provided by applicant): There are persistent disparities in the distribution of pediatric asthma morbidity. Populations at high risk for poor asthma control and repeated hospitalizations or emergency department (ED) visits often cluster within areas disproportionately impacted by asthma-relevant social and environmental risks. There is a fundamental gap, however, in the knowledge of how such risks can be identified and acted upon during inpatient pediatric asthma care. Much as marketers and political campaigns use geographic data to target resources, the contribution of the proposed research is to identify key geographic factors, or geomarkers, that could meaning- fully inform care and improve patient outcomes. The initial focus will be on geomarkers related to area-level, or neighborhood, poverty, housing quality, and health service access. The central hypothesis is that such geo- markers will predict asthma-related risk of readmission and ED revisit along with potentially modifiable patient characteristics. The rationale is that informed inpatient asthma care plans, aimed at reducing post-discharge morbidity, can be personalized from the moment a child arrives on the unit. Guided by strong preliminary data, this hypothesis will be tested with three specific aims: 1) Determine the extent to which geomarkers predict subsequent risk of readmission and ED revisit among hospitalized children with asthma; 2) Examine the association between geomarkers and corresponding patient-level risks; and 3) Develop and pilot the feasibility of an intervention to personalize a patient's chronic asthma care via a geomarker-based identification strategy and a community health worker. The proposed research is innovative because it would make novel use of public data in ways that characterize and predict an individual's risk, efficiently informing assessments and actions to be initiated early in a patient encounter. This will be significant because if inpatient clinical care is more effective and targeted, families will see improved satisfaction and reduced subsequent morbidity. Summary: The proposed project will bring a place-based approach to inpatient pediatric asthma care. Dr. Beck's research and clinical training, pilot work investigating these methods, and experienced mentorship and advisory team make him ideally suited to pursue this line of research. This award will provide him with the training and research needed to be successful in a future, large-scale trial of a geographically-grounded intervention. Furthermore, this career development award will facilitate Dr. Beck's development into a nationally- recognized independent investigator and leader conducting research that improves child health outcomes by identifying and mitigating key social and environmental determinants of health.

描述（由申请人提供）：小儿哮喘发病率的分布始终存在差异。哮喘控制不佳和反复住院或急诊科 (ED) 就诊的高风险人群往往聚集在受哮喘相关社会和环境风险影响尤为严重的地区。然而，在住院小儿哮喘护理期间如何识别和应对此类风险的知识上存在根本性差距。就像营销人员和政治活动利用地理数据来定位资源一样，拟议研究的贡献是确定关键的地理因素或地理标记，这些因素可以为护理提供有意义的信息并改善患者的治疗结果。最初的重点将是与地区或邻里、贫困、住房质量和医疗服务获取相关的地理标记。核心假设是，此类地理标记将预测与哮喘相关的再入院和急诊室复诊风险以及潜在可改变的患者特征。其基本原理是，从孩子到达病房的那一刻起，就可以个性化制定旨在降低出院后发病率的知情住院哮喘护理计划。在强有力的初步数据的指导下，这一假设将通过三个具体目标进行检验：1）确定地理标记在多大程度上预测哮喘住院儿童随后的再入院和急诊室复诊风险； 2) 检查地理标记与相应患者风险之间的关联； 3) 通过基于地理标记的识别策略和社区卫生工作者，开发和试点干预措施的可行性，以个性化患者的慢性哮喘护理。拟议的研究具有创新性，因为它将以新颖的方式利用公共数据来描述和预测个人风险，从而有效地为患者早期就诊的评估和行动提供信息。这将具有重要意义，因为如果住院临床护理更加有效和有针对性，家庭将看到更高的满意度并减少随后的发病率。摘要：拟议项目将为住院小儿哮喘护理带来基于地点的方法。贝克博士的研究和临床培训、研究这些方法的试点工作以及经验丰富的指导和咨询团队使他非常适合从事这一领域的研究。该奖项将为他提供在未来大规模基于地理的干预试验中取得成功所需的培训和研究。此外，该职业发展奖将促进贝克博士发展成为全国公认的独立研究者和领导者，开展通过识别和减轻健康的关键社会和环境决定因素来改善儿童健康结果的研究。