An Innovative Tailored Intervention for Improving Children's Postoperative Recovery

改善儿童术后康复的创新定制干预措施

基本信息

批准号：
10077791
负责人：
Zeev Kain
金额：
$ 58.55万
依托单位：
UNIVERSITY OF CALIFORNIA-IRVINE
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-12-12 至 2022-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10077791
关键词：
7 year old Address Adoption Adult Age Ambulatory Surgical Procedures Anxiety Attention Award Behavioral Caring Characteristics Charge Child Client satisfaction Clinical Clinical Trials Coping Skills Cost Control Crying Data Delirium Development Educational process of instructing Emotional Family Grant Growth Health Care Reform Health Personnel Health Policy Health Technology Healthcare Home Hospitals Impairment Intervention Lead Measures Medicaid Modeling National Institute of Child Health and Human Development Online Systems Operative Surgical Procedures Outcome Outcome Measure Pain Parents Patients Pediatric Surgical Procedures Perioperative Perioperative Care Postoperative Pain Postoperative Period Preparation Process Public Health Recovery Relaxation Techniques Resources Services Site Syndrome Testing Text United States animation arm attentional control base care costs chronic pain clinical care cost design efficacy evaluation experience formative assessment handheld mobile device hospital performance improved innovation mHealth mobile computing pain reduction postoperative recovery psychologic satisfaction success surgical pain tool treatment as usual usability usual care arm

项目摘要

Abstract Every year about 3 million children in the United States experience significant anxiety prior to surgery and pain following surgery. Not only are these high levels of pain and anxiety emotionally traumatic to the child and family, but also recent data indicate that high levels of anxiety and pain will lead to impaired psychological and clinical recovery following the surgery. Over the past 2 decades, a number of hospital-based interventions have been shown to be effective in the treatment of perioperative anxiety and pain. Unfortunately, use of these interventions has decreased significantly over the past decade, most likely due to both the dramatic shift toward low-cost outpatient surgery and other cost-containment efforts. The recent healthcare reform and poor financial performance by hospitals over the past few years have further accelerated this process. The growing emphasis on health technology provides an opportunity to transform preparation and management of surgery with the use of mobile-based, tailored interventions. Previously, the NICHD awarded the PI of this application a 2-year grant to focus on the development of a web- based tailored intervention (WebTIPS) directed at children age 2-7 years who are undergoing outpatient surgery and their family as well as the involved healthcare providers. To date, the PI has developed the intervention and has demonstrated through a formative evaluation process high usability and likeability of the intervention. The PI also conducted a feasibility RCT and demonstrated, using a usual care control group, that WebTIPS is effective in reduction of preoperative anxiety and postoperative emergence delirium. The purpose of this R01 application is to examine the efficacy of WebTIPS in a large scale clinical trial using an attention control RCT design and validated 30-days outcome measures that are framed within the recently introduced conceptual framework of the “Triple Aim”. This framework calls for new interventions to be evaluated within the context of: better clinical outcomes, better patient satisfaction and lower resource utilization. We submit that WebTIPS has the potential to transform current perioperative care of millions of children and their families with an enhanced perioperative journey.

抽象的每年在美国大约有300万儿童在手术和疼痛之前都会出现重要的动画手术后。这些高水平的痛苦和焦虑对孩子的情感创伤和家庭，但最近的数据表明，高水平的动画和疼痛将导致心理和手术后的临床恢复。在过去的20年中，许多基于医院的干预措施被证明可以有效治疗周期性的动画和疼痛。不幸的是，使用这些在过去的十年中，干预措施极大地有效，很可能是由于戏剧性的转变采取低成本门诊手术和其他成本维护工作。最近的医疗改革和差在过去的几年中，医院的财务绩效进一步加速了这一过程。成长强调卫生技术为改变手术的准备和管理提供了机会使用基于移动的，量身定制的干预措施。以前，NICHD授予了本申请的PI一项为期2年的赠款，以关注网络的开发针对2-7岁儿童的基于量身定制的干预措施（WebTips）正在接受门诊病人手术及其家人以及参与的医疗保健提供者。迄今为止，PI已经开发了干预，并通过形成性评估过程表明了高可用性和可爱性干涉。 PI还进行了可行性RCT，并使用通常的护理对照组证明了 Webtips有效地减少了术前动画和术后出现del妄。目的此R01应用程序是在大规模临床试验中检查WebTIP的有效性控制RCT设计和经过验证的30天结局指标，这些度量在最近引入的 “三重目标”的概念框架。该框架要求在此内评估新干预措施上下文：更好的临床结果，更好的患者满意度和降低资源利用率。我们提交 WebTips有可能改变数百万儿童及其家人的当前时期增强的周期性旅程。