Feasibility of a care team-focused action plan to improve quality of care for children and adolescents with inflammatory bowel disease

以护理团队为重点的行动计划的可行性，以提高炎症性肠病儿童和青少年的护理质量

• 批准号: 10724900
• 负责人: Neal deJong
• 金额: $ 15.55万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10724900
• 关键词: Accident and Emergency department; Address; Adolescence; Adolescent; Adoption; Affect; Attention; Behavioral; Caring; Child; Child Care; Child Health; Childhood; Chronic Disease; Clinic; Communication; Communities; Complex; Control Groups; Controlled Study; Data; Decision Making; Depression screen; Development; Disease; Distant; Electronic Health Record; Emergency department visit; Evaluation; Family; Feasibility Studies; Feedback; Flare; Funding; Gastroenterologist; Generations; Goals; Guidelines; Health; Health Personnel; Health system; Healthcare; Individual; Inflammatory Bowel Diseases; Information Technology; Intervention; Intervention Studies; Interview; Knowledge; Language; Learning; Measures; Medical Records; Methods; Mission; Modeling; Modernization; Mood Disorders; Moods; National Center for Advancing Translational Sciences; Online Systems; Outcome; Parents; Participant; Patients; Pregnancy; Prevalence; Preventive; Preventive care; Primary Care; Provider; Psychosocial Assessment and Care; Public Health; Quality Indicator; Quality of Care; Randomized; Randomized, Controlled Trials; Records; Reporting; Research; Risk; Role; Safety; Sampling; Self Management; Sexual Health; Site; Specialist; Specific qualifier value; Surveys; Technology; Testing; Time; Translations; Vaccines; Work; Youth; acceptability and feasibility; acute care; care coordination; care providers; clinical practice; cost; design; effective intervention; effectiveness trial; evidence base; experience; feasibility testing; health care quality; health communication; health information technology; human disease; hybrid type 1 design; implementation determinants; improved; individual patient; infection risk; innovation; intervention cost; intervention effect; member; ophthalmic examination; patient portal; peer; pilot test; point of care; primary care provider; primary care visit; prototype; psychosocial; randomized trial; recruit; smartphone application; substance use; systems research; tool; trial design

Project Summary Quality of care for youth with chronic disease suffers because of gaps in care coordination and communication among multiple health care providers. As patients with inflammatory bowel disease (IBD) have preventive and acute care needs beyond those of peers, IBD provides an excellent use case to evaluate interventions to enhance coordination and improve quality. Electronic health records (EHRs) have largely unfulfilled potential to facilitate coordination among teams of providers and families. This project leverages web-based and mobile phone app access points to share patient-specific information from the IBD center’s EHR. The intervention, myIBDplan, has been developed with systematic input from patients, families, and providers. Our objective is to assess the feasibility of delivering tailored guidance on IBD-related health needs to families and care team members using a low-cost, low-risk health communication innovation that enhances existing health information technology. The rationale is that brief, actionable, individually tailored guidance from IBD specialists to families and other providers will support decisions about seeking and providing timely preventive and acute care. Though the intervention builds on prior work and evidence and has been pilot tested, it requires feasibility testing in practice prior to large-scale evaluation. We will assess feasibility of myIBDplan through a pilot randomized, controlled trial at one site (n=60). The study has three research aims: (1) assess the feasibility of a rollout effectiveness trial design; (2) assess the feasibility and acceptability of implementing myIBDplan in a pediatric IBD clinic; (3) explore the feasibility of myIBDplan to improve (a) care quality measures collected from participants and the EHR and (b) patient self-management. In Aim 1, we will assess subject recruitment, randomization, retention, intervention completion, and contamination of control subjects using a study log. For Aim 2, we will use interviews and surveys to learn about barriers and facilitators of adoption by IBD clinics and acceptability and appropriateness from the perspectives of patients/families and care providers. For Aim 3, we will use surveys and medical record data to explore change over time in family-reported care quality, patient self-management, and completion of guideline-supported quality indicators for pediatric IBD for intervention and control groups, which could be endpoints in a subsequent randomized trial. This project is innovative in seeking to change the default ways that providers caring for the same child share information and address shared responsibilities. MyIBDplan targets well-described barriers to effective coordination and incorporates behavioral strategies of individual tailoring, family participation, expert modeling, and facilitation to streamline information delivery and enhance its relevance, accessibility, and actionability. The proposed study is significant because of its potential to improve health through a low-cost intervention to enhance use of existing health information technology. The study’s findings could provide a framework for EHR-supported quality improvements through learning health system research across a range of childhood-onset chronic diseases.

项目摘要 由于护理协调和沟通的差距，患有慢性疾病青年的护理质量受到了 在多个医疗保健提供者中。由于炎症性肠病（IBD）患者具有预防性和 IBD以外的急性护理需求，除了同龄人的需求外， 提高协调并提高质量。电子健康记录（EHRS）在很大程度上没有实现的潜力 促进提供者和家庭团队之间的协调。该项目利用基于Web的手机 电话应用程序访问点可以从IBD中心的EHR共享特定于患者的信息。干预， Myibdplan是由患者，家庭和提供者的系统投入开发的。我们的目标是 评估为家庭和护理团队提供针对IBD相关健康需求的量身定制指导的可行性 会员使用低成本，低风险的健康沟通创新，从而增强现有健康信息 技术。理由是，从IBD专家到家庭的简短，可行，单独量身定制的指导 其他提供者将支持有关寻求和提供及时的预防和急性护理的决定。 尽管干预措施以先前的工作和证据为基础，并且已经进行了试点测试，但需要可行性 在大规模评估之前在实践中进行测试。我们将通过飞行员评估MyibDplan的可行性 一个位点的随机对照试验（n = 60）。该研究具有三个研究目的：（1）评估的可行性 推出有效性试验设计； （2）评估在 小儿IBD诊所； （3）探索MyibDplan的可行性改善（a）从 参与者和EHR和（b）患者的自我管理。在AIM 1中，我们将评估主题招聘， 使用研究日志对控制受试者的随机化，保留，干预完成和污染。为了 AIM 2，我们将使用访谈和调查来了解IBD诊所和 从患者/家庭和护理提供者的角度来看，可接受性和适当性。对于目标3，我们 将使用调查和病历数据来探索家庭报告的护理质量随着时间的变化，患者 自我管理，并完成针对干预小儿IBD的指南支持的质量指标 和对照组，这可能是随后的随机试验中的终点。这个项目是创新的 寻求改变照顾同一儿童共享信息和地址的提供者的默认方式 共同的责任。 MyibDplan针对有效协调的良好描述的障碍，并结合 个人裁缝，家庭参与，专家建模和简化设施的行为策略 信息传递并增强其相关性，可访问性和可行性。拟议的研究是 意义重大，因为它具有通过低成本干预来改善健康的潜力，以增强现有的使用 健康信息技术。该研究的发现可以为EHR支持的质量提供一个框架 通过学习卫生系统研究的改进，跨儿童期慢性疾病。