Transforming Hospitalizations of Autistic Adolescents via a Novel ABA Telehealth Platform

通过新型 ABA 远程医疗平台改变自闭症青少年的住院治疗

• 批准号: 10760972
• 负责人: Ronald Oberleitner
• 金额: $ 74.08万
• 依托单位: CARING TECHNOLOGIES, INC.
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-05 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10760972
• 关键词: Adoption; Behavior; Behavioral; Caregivers; Caring; Child; Clinical; Communication; Communities; Cost Analysis; Custom; Data; Evaluation; Family; Feedback; Geographic Locations; Guidelines; Health Insurance Portability and Accountability Act; Health system; Home; Hospitalization; Hospitals; Human; Hybrids; Instruction; Insurance Claim Review; Intelligence; Intervention; Length; Measures; Mediating; Medical; Medical Staff; Medicine; Outcome; Parents; Patients; Pattern; Persons; Phase; Positioning Attribute; Process; Provider; Report (document); Research; Resource-limited setting; Resources; Sampling; Schools; Security; Sedation procedure; Services; Structure; System; Technology; Testing; Time; Videoconferencing; Work; adolescent with autism spectrum disorder; applied behavior analysis; autistic children; care providers; care systems; clinical decision support; commercialization; design; digital health; experience; feasibility testing; hospital care; hospital readmission; improved; individuals with autism spectrum disorder; innovation; novel; prototype; recruit; restraint; satisfaction; skills; success; support tools; telehealth; telehealth systems; trend; usability

PROJECT SUMMARY There is an increasing trend for children with ASD with primary behavioral challenges to be hospitalized in medical facilities because accessible behavioral support resources are not available in local communities. Unfortunately, most community-based hospitals are not well equipped to meet optimal behavioral care with families consequently experiencing prolonged/protracted hospitalizations where behaviors may not be adequately treated and could potentially worsen. Further, the specific inability to adequately respond to challenging behaviors may limit the ability of children to be accepted into step-down facilities or return home safely and contribute to extremely stressful aspects of care. Prolonged hospitalizations also result in significant negative financial return for hospitals (un/under-reimbursement). In prior work, deploying a specialized brief Applied Behavioral Analysis (ABA) assessment and intervention explicitly designed for use during hospitalizations demonstrated improvements in challenging behaviors, decreases in restraint and staffing, and high levels of family satisfaction. Unfortunately, community access to this type of intervention is extremely limited by geographic location and provider availability. Appropriate telehealth and digital health systems that can facilitate tele-mediated support may hold great potential for increasing the availability of such care to children, families, and the providers and hospitals responsible for their care. While many technologies for real- time video conferencing are available (e.g. zoom), in order to be able to accurately support understanding of precursors and the context of key behaviors technologies capable of supporting intelligent surveillance, data- flagging, and efficient communication of key behaviors across human support teams (both expert and non- expert) over substantial periods of time (including when experts are not present) are needed to enable meaningful telemediated ABA service. The current project creates and tests the potential clinical value of an innovative telehealth platform to facilitate appropriate, efficacious ABA tele-assessment and intervention for adolescents with ASD displaying challenging behaviors during hospitalizations and post-discharge transition. In the first phase of this work, we propose co-design of the novel system with key stakeholders and feasibility testing to demonstrate both technical capacity and potential clinical value. In the second phase of this work, we hone the systems commercial value and conduct a rigorous trial to demonstrate clinical utility and financial return for children, families, systems of care, and payers.

项目概要 患有主要行为障碍的 ASD 儿童住院治疗的趋势不断增加 医疗设施，因为当地社区没有可用的行为支持资源。 不幸的是，大多数社区医院没有足够的能力来满足最佳的行为护理 因此，家庭会经历长期住院，其行为可能不符合 得到充分治疗，并且可能会恶化。此外，具体无法充分应对 具有挑战性的行为可能会限制儿童进入降级设施或返回家园的能力 安全并有助于承受极大压力的护理方面。长期住院也会造成严重的后果 医院的财务回报为负（未报销/报销不足）。在之前的工作中，部署了专门的简报 应用行为分析 (ABA) 评估和干预明确设计用于 住院治疗表现出挑战性行为的改善、约束和人员配备的减少以及 高水平的家庭满意度。不幸的是，社区获得此类干预的机会极其有限 受地理位置和提供商可用性的限制。适当的远程医疗和数字医疗系统 可以促进远程支持，可能在增加此类护理的可及性方面具有巨大潜力 儿童、家庭以及负责照顾他们的提供者和医院。虽然许多技术确实 时间视频会议可用（例如缩放），以便能够准确地支持理解 能够支持智能监视、数据收集的关键行为技术的前兆和背景 人类支持团队（专家和非专家）之间关键行为的标记和有效沟通 需要在相当长的一段时间内（包括专家不在场时）进行 有意义的远程媒介 ABA 服务。当前的项目创建并测试了一种潜在的临床价值 创新的远程医疗平台，以促进适当、有效的 ABA 远程评估和干预 患有 ASD 的青少年在住院期间和出院后过渡期间表现出具有挑战性的行为。 在这项工作的第一阶段，我们建议与主要利益相关者共同设计新系统并探讨可行性 进行测试以证明技术能力和潜在的临床价值。在这项工作的第二阶段中， 我们磨练系统的商业价值并进行严格的试验以证明临床效用和财务 儿童、家庭、护理系统和付款人的回报。