Well-Child Care Clinical Practice Redesign: A Parent Coach-Led Model of Care for Young Children

儿童保健临床实践重新设计：家长教练主导的幼儿护理模式

• 批准号: 9344674
• 负责人: Tumaini Rucker Coker
• 金额: $ 61.97万
• 依托单位: SEATTLE CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-02 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9344674
• 关键词: Accident and Emergency department; Address; Adult; Age; Attention; Behavior; Behavioral; Caring; Child; Child Care; Child Rearing; Childhood; Chronic Disease; Clinic; Communities; Community Practice; Community of Practice; Cost Analysis; Custom; Development; Disease Management; Education; Elements; Emergency department visit; Family; Family Physicians; Future; Guidelines; Health; Health Educators; Health Planning; Health education; Intervention; Life; Low income; Measures; Mental Health; Methods; Modeling; Newborn Infant; Nurse Practitioners; Nursery Schools; Outcome; Parents; Patients; Periodicity; Perioperative Nursing; Physicians; Positioning Attribute; Preventive; Preventive care; Preventive healthcare; Primary Health Care; Process; Provider; Quality of Care; Randomized Controlled Trials; Reporting; Self Efficacy; Services; Site; Structure; System; Testing; Text; Time; Toddler; Variant; Visit; base; behavioral health; care delivery; clinical practice; clinical research site; cost; evidence base; experience; health care service utilization; improved; innovation; intervention effect; lower income families; pediatrician; pragmatic trial; psychosocial; screening; social; urban area; urgent care

Project Summary Well-Child Care (WCC) visits for child preventive health care during the first three years of life are critical because they may be the only opportunity before a child reaches preschool to identify and address important social, developmental, behavioral, and health issues that could have significant impact and long-lasting effects on children's lives as adults. Unfortunately, this opportunity is often missed for children in low-income communities. The structure of WCC in the U.S. cannot support the vast array of WCC needs of these vulnerable children and their families. Key structural problems include (a) reliance on physicians for basic, routine preventive care services, (b) limitation to a 15-minute face-to-face clinician-directed well-visit for the wide array of education and guidance services needed, and (c) lack of a systematic, patient-driven method for visit customization to meet families' needs. These structural problems contribute to the wide variations in processes of care and preventive care outcomes, resulting in poorer quality of WCC and perhaps worse health outcomes. We previously used a rigorous, structured community-based participatory approach guided by key WCC stakeholders and expert panel methods to develop and test a new, innovative model of WCC delivery to meet the needs of children in low-income communities: Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT). PARENT is a team-based approach to care using a health educator (“Parent Coach”) to provide the bulk of WCC services, address specific needs faced by families in low-income communities, and decrease reliance on the clinician as the primary provider of WCC services. In an initial pilot randomized controlled trial of PARENT among 251 low-income families in two urban area pediatric practices, we found strong and consistent intervention effects on the quality of preventive care provided to families, and on reducing emergency department (ED) utilization. A larger trial of PARENT with multiple clinics is needed to position PARENT as an evidence-based, financially sustainable model for WCC delivery that can be implemented by practices and clinics nationwide. In a clinic-randomized controlled trial of PARENT, we will examine parent-reported quality of care and healthcare utilization (e.g., ED utilization), conduct a cost analysis, and use direct observations to assess changes in physician time allocation with Parent Coach-led well-visits. The study will be conducted in partnership with 12 clinics and their health plan payers, and address the following Specific Aims: Aim #1: Measure the effect of PARENT on receipt of nationally-recommended WCC services and parent experiences of care. Aim #2: Determine the effects of PARENT on WCC, urgent care, and ED utilization, and on net costs. Aim #3: Examine the effect of PARENT on physician time allocation for WCC and urgent care visits. Aim #4: Assess the effect of PARENT on parent-focused outcomes in an exploratory analysis.

项目摘要 在生命的头三年，儿童预防性医疗保健访问是至关重要的 因为他们可能是孩子到达学龄前识别和解决重要的唯一机会 可能产生重大影响和持久影响的社会，发展，行为和健康问题 关于儿童成年人的生活。不幸的是，低收入儿童通常会错过这个机会 社区。 WCC在美国的结构无法支持这些WCC的广泛需求 脆弱的儿童及其家人。关键的结构问题包括（a）依赖基本医生， 常规的预防保健服务，（b）限制15分钟的面对面临床指导 需要广泛的教育和指导服务，以及（c）缺乏系统的，患者驱动的方法 访问定制以满足家庭需求。这些结构性问题导致了广泛的变化 护理和预防性护理结果的过程，导致WCC质量较差，健康状况较差 结果。我们以前使用了由密钥指导的严格，结构化的基于社区的参与方法 WCC利益相关者和专家小组方法开发和测试WCC交付的新的创新模型 满足低收入社区儿童的需求：以父母为中心的重新设计相遇， 新生儿到幼儿（父母）。父母是使用健康教育者的基于团队的护理方法 （“家长教练”）为提供大部分WCC服务，以满足低收入家庭面临的特定需求 社区，减少对WCC服务的主要提供商的临床救济。在最初的飞行员 在两个城市地区儿科实践中251个低收入家庭中父母的随机对照试验， 我们发现对提供给家庭提供的预防保健质量的强烈而一致的干预影响以及 关于减少急诊室（ED）利用。多个诊所的父母的更大试验是 需要将父母定位为WCC交付的基于证据的经济可持续性模型 可以通过全国实践和诊所实施。在父母的诊所随机对照试验中 我们将检查父母报告的护理和医疗保健利用质量（例如ED利用率） 分析，并使用直接观察来评估由母公司主教练的物理时间分配的变化 visit。这项研究将与12个诊所及其健康计划付款人合作进行，并致辞 以下具体目的： 目的＃1：衡量父母在收到全国性的WCC服务和父母的效果 护理经验。 目标＃2：确定父母对WCC，紧急护理和ED利用的影响以及净成本。 目标＃3：检查父母对WCC和紧急护理访问的物理时间分配的影响。 AIM＃4：在探索性分析中评估父母对以父母为中心的结果的影响。