Promoting Safe Transitions from Hospital to Home for Children with Medical Complexity: A Health Literacy-Informed and Family-Centered Approach

促进医疗复杂性的儿童从医院到家庭的安全过渡：一种以健康素养为基础、以家庭为中心的方法

• 批准号: 10378647
• 负责人: Alexander Glick
• 金额: $ 16.88万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10378647
• 关键词: Academy; Accident and Emergency department; Acute; Address; Adherence; Adult; Adverse drug event; Adverse event; Affect; Antibiotics; Appointment; Asthma; Caregivers; Caring; Cellulitis; Child; Childhood; Chronic; Clinic; Communication; Complex; Comprehension; Congenital Abnormality; Counseling; Data; Dependence; Development; Diagnosis; Discharge Plannings; Education; Electronic Health Record; Elements; Environment; Epilepsy; Equipment; Evaluation; Expenditure; Family; Family dynamics; Financial Hardship; Foundations; Goals; Health; Home; Hospitalization; Hospitals; Household and Family; Individual; Infection; Inpatients; Instruction; Intervention; Interview; Joints; Knowledge; Language; Lead; Life Expectancy; Link; Liquid substance; Malignant Neoplasms; Medical; Medication Errors; Medicine; Mentors; Mentorship; Modeling; Morbidity - disease rate; Outcome; Outpatients; Parents; Patients; Pediatric Hospitals; Pharmaceutical Preparations; Physicians; Pneumonia; Process; Provider; Qualitative Methods; Qualitative Research; Randomized Controlled Trials; Recommendation; Regimen; Research; Research Methodology; Research Personnel; Risk; Route; Sampling; Self Management; Shunt Device; Social support; Stress; Structure; Symptoms; System; Technology; Testing; Time; Training; Treatment Efficacy; United States Agency for Healthcare Research and Quality; Visit; Work; Yin; design; digital; effectiveness study; efficacy testing; evidence base; experience; family management; future implementation; health literacy; high risk; hospital readmission; implementation science; implementation study; improved; literacy; medical schools; medication administration; multidisciplinary; multiple chronic conditions; patient oriented; pediatrician; provider-level barriers; readmission rates; respiratory; side effect; skills; stakeholder perspectives; tool; tool development; usability; user centered design

PROJECT SUMMARY/ABSTRACT Children with medical complexity (CMC), or those with multiple chronic conditions, progressive conditions, or technology dependence, are at high risk for post-hospitalization morbidity. Despite representing 1% of children in the US, CMC account for 1/3 of pediatric hospital expenditures; 30-day readmission rates are ~20%. Research on post-discharge morbidity (e.g., adverse drug events, infections, unanticipated visits) has focused on adults. Few studies have assessed strategies to reduce post-discharge morbidity in CMC. Such strategies must account for 1) factors distinct to children (e.g., liquid medications, recognizing symptoms in children who cannot express what is wrong) and 2) specific needs of CMC (e.g., medical equipment, knowing which of many providers to contact, managing multiple chronic medications, complex family/household dynamics). Inadequate provider- parent communication and low parent health literacy contribute to poor comprehension of and adherence to discharge instructions, increasing risk for post-discharge morbidity. Despite recommendations from multiple national organizations for evidence-based, health literacy-informed interventions to improve communication processes, to date, a health literacy-informed approach to address post-hospitalization morbidity for CMC has not been used while also incorporating principals of family dynamics. The primary objective of this application is to support Dr. Glick’s goal of becoming an independent investigator with the aim of improving 1) parent comprehension of/adherence to discharge instructions and 2) post-discharge outcomes for CMC. This goal will be achieved through training from an expert multidisciplinary mentorship team and formal coursework. He will gain advanced skills in 1) qualitative/mixed method research, 2) family dynamics, 3) user-centered design, and 4) implementation science/design and evaluation of complex interventions. Dr. Glick will accomplish his goals at NYU School of Medicine through the following 3 aims: In Aim 1, Dr. Glick will use qualitative methods to examine barriers/facilitators for a) parents in comprehension of/adherence to discharge instructions and b) pediatricians in providing optimal discharge education for CMC. In Aim 2, Dr. Glick will use Aim 1 findings, multiple rounds of usability testing, multi-disciplinary workgroups, a national sample of discharge instructions for CMC, and an existing tool designed to improve parent adherence to discharge instructions for common pediatric diagnoses to inform the design of his new tool for CMC. In Aim 3, Dr. Glick will utilize a randomized controlled trial to examine this tool’s efficacy in improving parent comprehension of and adherence to discharge instructions and reducing post-hospitalization morbidity for CMC. Successful completion of this project will lead to an R01 application to test the efficacy of the intervention, now linked to the electronic health record, in improving parent comprehension of/adherence to discharge plans and reducing post-hospitalization morbidity for CMC.

项目摘要/摘要 患有医疗复杂性的儿童（CMC）或患有多种慢性病，进行性疾病或的儿童 技术依赖性是院后发病率的高风险。尽管代表1％的孩子 在美国，CMC占儿科医院支出的1/3； 30天的再入院率约为20％。研究 出院后发病率（例如不良药物事件，感染，意外访问）都集中在成年人上。 很少有研究评估了降低CMC入院后发病率的策略。这样的策略必须说明 1）与儿童不同的因素（例如，液体药物，识别无法表达的儿童的症状 错误的）和2）CMC的特定需求（例如，医疗设备，知道许多提供者的哪个提供者 接触，管理多种慢性药物，复杂的家庭/家庭动态）。提供商不足 - 父母沟通和父母健康素养较低有助于对 放电指示，增加了入院后发病率的风险。尽管有多个建议 国家组织用于循证，健康素养的干预措施，以改善沟通 迄今 在编码家庭动态原理时未使用。 该应用的主要目的是支持Glick博士成为独立研究者的目标 目的是改善1）父母理解/依从性排除说明和2）分期后 CMC的结果。将通过专业的多学科指导团队的培训来实现此目标 和正式课程。他将在1）定性/混合方法研究中获得高级技能，2）家庭动态， 3）以用户为中心的设计，以及4）实施科学/设计与复杂干预措施的评估。博士 Glick将通过以下三个目标在纽约大学医学院实现他的目标： 在AIM 1中，Glick博士将使用定性方法来检查障碍/促进者 /依从性出院指示和b）儿科医生为CMC提供最佳出院教育。 在AIM 2中，Glick博士将使用AIM 1调查结果，多轮可用性测试，多学科工作组，一个 全国CMC的出院指令样本，以及一种旨在提高父母依从性的现有工具 为了解除常见儿科诊断的说明，以告知其新工具CMC的设计。 在AIM 3中，Glick博士将利用一项随机对照试验来检查该工具在提高父母方面的效率 理解和依从性排放指示和减少CMC的院后发病率。 该项目的成功完成将导致R01应用程序测试干预效率，现在 与电子健康记录相关联，以提高父母对排放计划的遵守/依从性的理解和 减少CMC的院后发病率。