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：
9094438
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/9094438
关键词：
Accident and Emergency department Acute Address Admission activity Advisory Committees 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 Emergency department visit Environmental Risk Factor Face Family Fostering Future Genotype Geographic Factor Geographic Locations Goals Grant Head Start Program Health 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 Patient-Focused Outcomes 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 Work asthmatic patient base career career development clinical care cohort cost experience health disparity high risk implementation science improved improved outcome innovation insight medication compliance novel novel strategies psychological distress 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存在持续的差异。哮喘控制不良和反复住院或急诊科（ED）访问的人口通常会聚集在受哮喘与哮喘相关的社会和环境风险影响不成比例的地区。然而，在了解如何在住院儿科哮喘护理期间识别和采取行动，存在一个根本的差距。当营销人员和政治运动使用地理数据来针对资源时，拟议的研究的贡献是确定可以充分意识到的关键地理因素或地理标志物 - 完全为护理提供了信息并改善患者的结果。最初的重点将放在与地区级别或社区，贫困，住房质量和卫生服务访问有关的地理标志上。中心假设是，这样的地理标记将预测哮喘相关的再入院风险，并重新审视了可能修改的患者特征。理由是，从孩子到达该部门的那一刻起，可以个性化旨在减少病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，该假设将以三个具体的目的进行检验：1）确定地向标志物预测随后的再入院风险和ED在住院的哮喘儿童中的重新审视； 2）检查地貌与相应的患者级风险之间的关联； 3）开发和试行通过基于Geomarker的识别策略和社区卫生工作者进行干预以个性化患者慢性哮喘护理的可行性。拟议的研究具有创新性，因为它将以表征和预测个人风险的方式来进行新的公共数据使用，并有效地告知评估和行动，并在患者相遇的早期开始。这将是重要的，因为如果住院临床护理更有效和有针对性，则家庭将看到满意度的提高并降低了随后的发病率。摘要：拟议的项目将为住院儿科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研究。该奖项将为他提供在未来对地理基础干预的大规模试验中取得成功的培训和研究。此外，该职业发展奖将促进贝克博士的发展成为全国认可的独立研究者和领导者进行研究，从而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成果。