A clinical process support system for primary care to address family stress

用于解决家庭压力的初级保健临床流程支持系统

• 批准号: 9202638
• 负责人: Barbara Jo Howard
• 金额: $ 22.39万
• 依托单位: TOTAL CHILD HEALTH, INC.
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-16 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9202638
• 关键词: Accounting; Address; Adult; Affect; Age; Appointment; Behavior; Caring; Charge; Child; Child Abuse and Neglect; Child Behavior; Child Development; Child Rearing; Child health care; Childhood; Clinical; Communication; Computers; Consent; Counseling; Data; Data Analyses; Data Set; Development; Documentation; Early Diagnosis; Early identification; Education; Effectiveness; Electronics; Elements; Emotional; Empathy; Family; Feedback; Food; Health; Health Personnel; Human; Impairment; Internet; Intervention; Intervention Trial; Interview; Link; Medical; Mental Depression; Mental Health; Modification; National Institute of Child Health and Human Development; Outcome; Outcome Study; Parent-Child Relations; Parents; Phase; Populations at Risk; Prevention; Preventive; Primary Health Care; Process; Public Health; Punishment; Questionnaires; Randomized; Randomized Controlled Trials; Reporting; Research; Resources; Risk; Risk Factors; Safety; Secure; Social Workers; Stress; Substance abuse problem; Suggestion; Supervision; Support System; System; Testing; Text; Time; Training; Vaccines; Visit; World Health; base; behavior change; behavioral outcome; care systems; checkup examination; cognitive development; cost; design; evidence base; experience; family support; follow-up; group intervention; improved; information gathering; innovation; interest; intimate partner violence; motivational enhancement therapy; premature; programs; prototype; psychoeducation; psychosocial; resilience; response; satisfaction; screening; skills; social; social health determinants; social learning; stressor; tool; web site

Project Summary This proposal addresses the NICHD focus of specific interest for the prevention of child abuse and neglect in at risk populations. Child abuse and neglect often confers short- and long-term impairment of the physical, emotional, and cognitive development of children. The proposed project builds on promising data from previous randomized control trials, based on application of a screening tool in primary care pediatric practice that identifies the Family Stressors and use of harsh punishment, which are known to put children at risk for child abuse and neglect. Pediatric check-ups are ideal for early identification because of nearly universal and repeated access. However, these visits, also known as “child health supervision” have been charged with a heavy public health burden of early detection and preventive counseling for a wide variety of issues related to health risks, safety, and promoting child development during narrow time constraints. We have previously built a system to assist with this challenge by off-loading the burden of information gathering to an online pre- visit platform called CHADIS that has been used by over one million parents already. However, when the visit scope is broadened to addressing sensitive family stressors, the challenge for PCPs becomes one of clinical interviewing skills, that, in part, is best addressed with the evidence based approach known as motivational interviewing (MI). PCPs have not been trained for MI and it typically takes longer than the time allotted for the visit. The innovation proposed here is to collect data online before visits to not only identify problems, but also divide the interview process so that the computer collects data in a way that guides the PCP during the visit with details and suggested words (“teleprompters”) for the human elements of empathy and reflective listening that can be delivered briefly. In addition, the innovation also reduces documentation burden and creates follow-up psycho-education and tracking. This new Family Stress Module supports not only a single problem visit but also acts across visits in creating the psychosocial orientation for parents of children of all ages to confide in the PCP as well “anticipatory guidance” reinforced by “MemoryBook” and text messages. Electronic linking will be created with local referral resources, such as agencies or therapists, so when a referral is made two way communication is facilitated as well as tracking of appointment completion with the parent's consent. There are no other clinical process support systems of similar scope and none connected to an electronic system of care bridging medical and social domains. The project involves first refining a prototype with parent and doctor feedback and then conducting a cluster randomized intervention trial. Hypothesized outcomes are lower rates of child abuse and neglect reports, less harsh punishment, as well as improved developmental and behavioral outcome in the intervention group. Parent satisfaction with the enhanced clinical process and collateral benefits, such as lower rates of missed visits and delayed vaccines will also be assessed.

项目概要 该提案解决了 NICHD 对预防儿童虐待和忽视的具体关注点 受虐待和忽视的儿童往往会造成短期和长期的身体损伤， 拟议的项目建立在来自有希望的数据的基础上。 先前的随机对照试验，基于筛查工具在初级保健儿科实践中的应用 确定家庭压力源和严厉惩罚的使用，众所周知，这会使儿童面临以下风险： 儿科检查是早期识别儿童虐待和忽视的理想选择，因为其几乎普遍且普遍。 然而，这些被称为“儿童健康监督”的探视被指控有罪。 对各种相关问题进行早期发现和预防性咨询的沉重公共卫生负担 健康风险、安全以及在有限的时间限制内促进儿童发展。 建立了一个系统来帮助应对这一挑战，通过将信息收集的负担转移到在线预 访问名为 CHADIS 的平台已被超过 100 万家长使用。 范围扩大到解决敏感的家庭压力源，PCP 面临的挑战成为临床问题之一 访谈技巧，在某种程度上，最好通过称为动机的基于证据的方法来解决 PCP 没有接受过 MI 培训，并且通常需要比分配的时间更长的时间。 这里提出的创新是在访问之前在线收集数据，不仅可以发现问题，还可以发现问题。 划分访谈过程，以便计算机在访视期间以指导 PCP 的方式收集数据 包含有关同理心和反思性倾听的人为因素的详细信息和建议词语（“提词器”） 此外，该创新还减少了文档负担并创造了机会。 后续心理教育和跟踪这个新的家庭压力模块不仅支持单一问题。 访问，而且在访问中也发挥作用，为所有年龄段的孩子的父母建立社会导向 相信 PCP 以及通过“MemoryBook”和电子短信强化的“预期指导”。 将与当地转介资源（例如机构或治疗师）建立链接，因此当进行转介时 促进双向沟通，并在家长同意的情况下跟踪预约完成情况。 没有其他类似范围的临床过程支持系统，也没有连接到电子 连接医疗和社会领域的护理系统该项目首先涉及与家长一起完善原型。 和医生的反馈，然后进行整群随机干预试验。 虐待和忽视儿童的报告率较低，惩罚较轻，发育和发育得到改善 干预组的行为结果。家长对增强的临床过程的满意度和 还将评估附带好处，例如较低的错过就诊率和延迟疫苗接种率。