Risk Stratification Using Physiologic Markers and Mobile Health-Facilitated Specialist Management to Improve Outcomes in Pediatric Concussion Patients

使用生理标志物和移动健康促进的专家管理进行风险分层，以改善小儿脑震荡患者的预后

• 批准号: 10673916
• 负责人: Daniel Corwin
• 金额: $ 21.56万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10673916
• 关键词: 18 year old; Accident and Emergency department; Acute; Adoption; Age; Applied Research; Area; Award; Biometry; Brain Concussion; Caring; Child; Childhood; Clinic; Clinical; Clinical Trials; Cognitive; Continuity of Patient Care; Data; Dedications; Development; Diagnosis; Discrimination; Early Intervention; Ecological momentary assessment; Ecosystem; Educational process of instructing; Emergency Care; Emergency Department Physician; Emergency Department patient; Emergency Medicine; Emotional; Enrollment; Environment; Family; Female; Functional disorder; Goals; Health Technology; Health system; Hour; Incidence; Individual; Injury; Institution; Intervention; Judgment; Measures; Mentors; Methodology; Methods; Modeling; Monitor; Morbidity - disease rate; Nature; Observational Study; Outcome; Patients; Pediatric Hospitals; Pennsylvania; Performance; Persons; Philadelphia; Physicians; Physiological; Population; Positioning Attribute; Post-Concussion Syndrome; Prevention; Provider; ROC Curve; Recommendation; Recovery; Registries; Research; Resources; Rest; Risk; Risk Assessment; Risk Factors; Science; Scientist; Specialist; Sports Medicine; Symptoms; System; Time; Training; Underrepresented Minority; Universities; Work; Youth; barrier to care; career; career development; clinical center; clinical epidemiology; comorbidity; cost; design; disability; effectiveness evaluation; efficacy evaluation; efficacy outcomes; evidence base; experience; health communication; health economics; high risk; improved; improved outcome; innovation; mHealth; male; medical specialties; novel; novel therapeutics; patient oriented research; pediatric emergency; persistent symptom; predictive modeling; prevent; prospective; public health insurance; reduce symptoms; research and development; risk stratification; sex; skills; standard of care; symptomatology; targeted delivery; telehealth; tool; usability

Candidate: My long-term career goal is to reduce the cognitive, physical, and emotional morbidity following pe- diatric concussion by implementing early interventions to those at highest risk for persistent post-concussion symptoms (PPCS). With 75% of my time dedicated to patient-oriented research and career development, my short-term goals are to develop a predictive model to most accurately identify those patients at highest risk of developing PPCS, and to use a novel mobile health (mHealth) intervention to improve specialist access from the emergency department (ED) setting. This proposal builds on my prior work in researching objective mark- ers of dysfunction following concussion, and will position me to gain skills in advanced predictive modeling to facilitate early risk stratification, utilizing advanced mHealth-based interventions to facilitate care continuity and positioning such interventions for adoption and sustainability, and designing and leading clinical trials from the ED setting that utilize innovative methods to create the evidence base for mHealth intervention adoption. Environment: This proposal leverages the substantial resources available to me at Children’s Hospital of Phila- delphia, through the Division of Emergency Medicine, Center for Injury Research and Prevention, Innovation Ecosystem, and Sports Medicine and Performance Center; at The University of Pennsylvania, through the Center for Clinical Epidemiology and Biostatistics, The Penn Injury Science Center, and the Leonard Davis In- stitute of Health Economics; and through the Pediatric Emergency Care Applied Research Network. The men- tored research experience and formal didactic training, in addition to the clinical experience of practicing in a quaternary care pediatric ED, create an ideal environment for my ongoing career development. Research: Concussions are prevalent injuries in the pediatric population. While the majority of symptoms in concussed youth resolve within 1 month, a significant proportion (30%) experience symptoms lasting months to even years. Several observational studies have identified risk factors associated with PPCS, however the best current methods to risk stratify concussed youth do so with only moderate discrimination, and are heavily reliant on subjective symptoms. In addition, while traditionally, pediatric concussions were managed with pas- sive rest, more recently, active therapies have become the standard of care in the specialty setting. However, the traditional referral model presents several barriers to care continuity and specialist access for ED concus- sion patients. Novel mHealth interventions have the potential to improve care continuity, serving as a bridge between care settings for concussed youth. In order to facilitate improved care and ultimately reduce symptom burden to highest risk children, this proposal aims to: (1) Improve accuracy of concussion risk stratification from the ED using physiologic markers of injury; and (2) Assess the feasibility of a mHealth tool to facilitate specialist access and care continuity. Study results will allow me to develop a R01 proposal of a clinical trial evaluating the effectiveness of mHealth-facilitated targeted referral to reduce the incidence of PPCS.

候选人：我的长期职业目标是减少以下方面的认知、身体和情感发病率： 通过对那些持续脑震荡后风险最高的人实施早期干预来预防糖尿病脑震荡 我将 75% 的时间用于以患者为中心的研究和职业发展。 短期目标是开发一个预测模型，以最准确地识别那些处于最高风险的患者 开发 PPCS，并使用新型移动医疗 (mHealth) 干预措施来改善专家访问 该提案建立在我之前研究客观标记的工作的基础上。 脑震荡后功能障碍的患者，将使我获得高级预测模型的技能 促进早期风险分层，利用先进的基于移动医疗的干预措施来促进护理连续性和 定位此类干预措施的采用和可持续性，并设计和领导临床试验 急诊室环境利用创新方法为移动医疗干预措施的采用创建证据基础。 环境：该提案利用了我在费城儿童医院可用的大量资源 delphia，通过急诊医学部、伤害研究和预防中心、创新 宾夕法尼亚大学生态系统和运动医学与表现中心； 临床流行病学和生物统计学中心、宾夕法尼亚大学损伤科学中心和伦纳德·戴维斯研究所 卫生经济学研究所；并通过儿科紧急护理应用研究网络。 除了在医院实践的临床经验之外，还需要丰富的研究经验和正式的教学培训 四级护理儿科急诊科，为我持续的职业发展创造了理想的环境。 研究：脑震荡是儿科人群中常见的伤害，而大多数症状是在儿童中发生的。 脑震荡青少年会在 1 个月内痊愈，很大一部分 (30%) 的症状会持续数月 几项观察性研究已经确定了与 PPCS 相关的危险因素，但是 当前对脑震荡青少年进行风险分层的最佳方法仅具有中等程度的歧视，而且严重 此外，传统上，儿童脑震荡是通过主观症状来治疗的。 充分休息，最近，积极治疗已成为专业环境中的护理标准。 传统的转诊模式对 ED 脑震荡的护理连续性和专家获取存在一些障碍 新型移动医疗干预措施有可能改善护理连续性，发挥桥梁作用。 为脑震荡青少年提供护理服务，以促进改善护理并最终减轻症状。 为了减轻最高风险儿童的负担，该提案旨在： (1) 提高脑震荡风险分层的准确性 急诊室使用损伤生理标志物进行评估；(2) 评估移动医疗工具的可行性，以促进 专家访问和护理连续性研究结果将使我能够制定临床试验的 R01 提案。 评估移动医疗促进的有针对性的转诊以降低 PPCS 发生率的有效性。