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.

项目概要 健康儿童保育 (WCC) 就诊对于生命头三年的儿童预防性保健至关重要 因为它们可能是孩子进入学前班之前识别和解决重要问题的唯一机会 可能产生重大影响和长期影响的社会、发展、行为和健康问题 不幸的是，低收入儿童常常错过这个机会。 美国的 WCC 结构无法满足这些社区的大量 WCC 需求。 弱势儿童及其家庭的主要结构性问题包括 (a) 依赖医生提供基本的、 妨碍常规护理服务，(b) 仅限于 15 分钟的面对面临床医生指导的健康访问 需要广泛的教育和指导服务，以及 (c) 缺乏系统的、以患者为主导的方法 访问定制以满足家庭的需求这些结构性问题导致了广泛的差异。 护理流程和预防性护理结果，导致 WCC 质量较差，甚至健康状况可能更差 我们之前使用了严格的、结构化的、以社区为基础的参与方法，以关键为指导。 WCC 利益相关者和专家小组方法开发和测试 WCC 交付的新创新模式 满足低收入社区儿童的需求：以家长为中心的相遇重新设计， 新生儿到幼儿（家长）是一种由健康教育者以团队为基础的护理方法。 （“家长教练”）提供大部分 WCC 服务，解决低收入家庭面临的特定需求 在初步试点中，减少对临床医生作为 WCC 服务主要提供者的依赖。 在两个城市地区儿科诊所的 251 个低收入家庭中进行的 PARENT 随机对照试验， 我们发现干预措施对向家庭提供的预防性护理的质量产生了强大而一致的影响，并且 关于减少急诊室 (ED) 使用率的一项针对多个诊所的大型试验正在进行中。 需要将 PARENT 定位为基于证据的、财务上可持续的 WCC 交付模式 可以由全国范围内的诊所和诊所实施。 在 PARENT 的临床随机对照试验中， 我们将检查家长报告的护理质量和医疗保健利用率（例如急诊室利用率），进行成本评估 分析，并使用直接观察来评估由家长教练主导的医生时间分配的变化 该研究将与 12 家诊所及其健康计划付款人合作进行，并解决 具体目标如下： 目标 1：衡量家长对接受国家推荐的 WCC 服务和家长的影响 护理经历。 目标#2：确定 PARENT 对 WCC、紧急护理、急诊室利用率以及净成本的影响。 目标 #3：检查 PARENT 对 WCC 和紧急护理就诊的医生时间分配的影响。 目标#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。