Parents as their Child's Certified Nursing Aide: Evaluation of a Unique Home Health Care Model for Children with Medical Complexity

父母作为孩子的认证护理助手：针对医疗复杂性儿童的独特家庭保健模式的评估

• 批准号: 10025664
• 负责人: Mark Brittan
• 金额: $ 19.44万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-26 至 2022-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10025664
• 关键词: Accident and Emergency department; Address; Administrator; Affect; Caregiver Burden; Caregivers; Caring; Characteristics; Child; Child health care; Childhood; Chronic; Chronic Disease; Cohort Analysis; Colorado; Communities; Complex; Data; Discipline of Nursing; Emergency department visit; Emotional; Employment; Employment Status; Evaluation; Family; Family Caregiver; Funding Opportunities; Future; Health; Health Care Costs; Health Services; Home Care Services; Home Health Agency; Home environment; Hospitalization; Hospitalized Child; Hospitals; Individual; Interview; Knowledge; Length of Stay; Link; Measures; Medicaid; Medical; Medical Records; Medical Technology; Methods; Mission; Modeling; Nurses' Aides; Occupations; Outcome; Parents; Patient-Focused Outcomes; Patients; Perception; Population; Publishing; Quality of life; Research; Research Proposals; Research Support; Resources; Retrospective cohort; Self Care; Self Efficacy; Self Management; Service delivery model; Services; Sleep disturbances; Stress; Structure; Testing; Visiting Nurse; care coordination; care providers; caregiving; cost; cost effectiveness; design; health care delivery; health care model; health care service; health care service utilization; hospital readmission; improved; innovation; interest; multiple chronic conditions; pediatric patients; pragmatic trial; pressure; primary outcome; programs; readmission rates; response; satisfaction; secondary outcome; self-management program; service coordination; tool

Project Summary/Abstract Children with medical complexity (CMC) are the most resource intensive pediatric patients and have high unmet home health care needs. Their family caregivers incur significant stress related to chronic caregiving, with associated adverse impacts on quality of life, financial and employment status, and physical and emotional health. Innovative health care delivery paradigms are sorely needed to improve quality of life and health outcomes for patients and their families. One such program already exists: Colorado’s Parents as their Child’s Certified Nursing Aide (pCNA) program. This model allows eligible parents to be compensated by Medicaid as their medically complex child’s CNA offsetting financial pressures associated with employment disruption when these parents have to stay home to take care of their children. While the program seems advantageous in many ways, it has never been studied, despite allocation of considerable resources to its administration. This mixed methods proposal will address the current evidence gap by assessing stakeholders’ perspectives of the benefits and drawbacks of the pCNA program, and by quantifying its impact on health care utilization and costs in CMC. In Aim 1 we will interview family caregivers, primary care providers, and home health agency administrators of CMC who receive pCNA services. Semi-structured interviews will explore perceptions of the program’s impact on patients’ and caregivers’ quality of life with specific focus on potential benefits such as improved caregiver self-efficacy, and potential pitfalls such as increased caregiver burden. We will use qualitative content analysis methods to generate themes to characterize pCNA model benefits, drawbacks, and impacts on caregivers’ and patients’ quality of life. In Aim 2, we will perform a retrospective cohort analysis to assess the hypothesis that healthcare utilization and costs are lower for hospitalized CMC with parents or relatives as their CNA (pCNA) compared with those who have non-relatives as their CNA (rCNA). We will use hospital administrative data linked to Medicaid claims data in order to obtain robust analyses of the outcomes of interest. The primary outcome is hospital readmission within 60 days, and secondary outcomes are emergency department use and cumulative healthcare costs within 60 days of discharge. We hypothesize that pCNA recipients will have lower readmission rates, fewer emergency department visits, and lower cumulative healthcare costs within 60 days of discharge compared with rCNA recipients. This proposal addresses the lack of evidence for the pCNA model, a family-centered self-management program for CMC, and will identify strengths and weaknesses of the program. The findings will be used to design improvements to the pCNA model for future testing in a pragmatic effectiveness trial, and to disseminate this promising pediatric home health care paradigm for CMC. This research proposal aligns with the NINR’s mission to support research on patient-focused self-management programs for chronic conditions, provide caregivers with better tools to fulfill their caregiving responsibilities, and to improve quality of life for individuals with chronic illness.

项目摘要/摘要 患有医疗复杂性的儿童（CMC）是资源最密集的PATRIC患者，很高 未满足的家庭保健需求。 对生活质量，财务和就业状况以及身体和情感的不利影响 健康的卫生保健范围是迫切需要改善生活质量的 患者和家庭的结果已经存在：科罗拉多州的父母 经过认证的护理助手（PCNA）计划。 他们的医学复杂儿童的CNA抵消了与就业中断相关的压力 当父母必须留下来照顾孩子时。 尽管有大量资源，但从未研究过许多方式 提案的混合方法将通过评估利益相关者的观点来解决当前的证据差距 PCNA计划的好处和缺点，并通过量化其对医疗保健利用和成本的影响 在AIM 1中，我们将采访家庭护理人员，初级保健提供者和家庭保健机构 获得PCNA服务的CMC的管理员。 计划对患者和看护人的生活质量的影响，特别关注潜在的好处，例如 iWill，我们将使用的是自我效能感和潜在的陷阱，例如增加护理人员的负担 定性内容分析方法生成主题以表征PCNA模型的好处，缺点和 影响护理人员和患者的生活质量 评估以下假设：医疗保健利用和成本是与父母住院的CMC或 将亲戚作为CNA（PCNA）与非差异作为CNA（RCNA）相比 与医疗补助索赔数据有关的医院行政数据，以获取对结果的强大分析 感兴趣的主要结果是在60天内的Hosspital再入院 急诊室使用和累积医疗保健费用在出院后60天内 PCNA收件人的再入院率较低，急诊室就诊和累积较低 与RCNA相比，该提案的保健费用在60天内。 PCNA模型的证据，PCNA模型是一个以家庭为中心的CMC的自我管理计划，并将确定 该计划的优势和缺点将用于设计PCNA的改进 在务实的有效性试验中进行未来测试的模型，并传播该小儿房屋 CMC的卫生保健范式。 针对慢性病的患者以患者为中心的自我管理计划，为护理人员提供履行工具 他们的照料责任，并改善患有慢性疾病的人的生活。