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PE的认知，身体和情感发病率 通过对持续脑后风险最高风险的人实施早期干预措施，脑震荡 症状（PPC）。我有75％的时间致力于以患者为导向的研究和职业发展，我 短期目标是开发一个预测模型，以最准确地确定那些具有最高风险的患者 开发PPC，并使用新颖的移动健康（MHealth）干预来改善专家的访问 急诊科（ED）设置。这项建议是基于我先前在研究客观标记的工作的基础 咨询后的功能障碍者，并将使我能够获得高级预测建模的技能 使用基于MHealth的先进干预措施促进早期风险分层，以促进护理连续性和 将这种干预措施定位以采用和可持续性，并设计和领导临床试验 ED设置利用创新方法来创建采用MHealth干预的证据基础。 环境：该提案利用Phila-儿童医院可获得的大量资源 Delphia，通过急诊医学司，伤害研究与预防中心，创新 生态系统以及运动医学和表演中心；在宾夕法尼亚大学通过 临床流行病学与生物统计学中心，宾夕法尼亚州伤害科学中心和伦纳德·戴维斯（Leonard Davis） 健康经济学；并通过小儿急诊应用研究网络。男人 - 除了在临床经验的临床经验中，在 第四纪护理儿科ED，为我正在进行的职业发展创造一个理想的环境。 研究：脑震荡是小儿人群普遍的伤害。而大多数症状 脑震荡的青年在1个月内解决，持续数月的显着比例（30％）经历症状 到几年。几项观察性研究已经确定了与PPC相关的危险因素，但是 风险将脑震荡的最佳当前方法仅在中等歧视下进行，并且很严重 依靠主观症状。此外，虽然传统上，小儿咨询与PAS- 最近，Sive Rest在专业环境中已经成为护理标准。然而， 传统的推荐模型为护理连续性和专家访问Ed Consus-构成了几个障碍 - 锡安患者。新型MHealth干预措施有可能改善护理连续性，作为桥梁 在脑震荡的青年的护理环境之间。为了促进改善护理并最终减轻症状 最高风险儿童的负担，该提议的目的是：（1）提高咨询风险分层的准确性 使用损伤的生理标记从ED来看； （2）评估MHealth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开发R01的临床试验提案 评估MHealth-辅助靶向推荐的有效性，以减少PPC的事件。