The Hospital to Home Study: A Pragmatic Trial to Optimize Transitions and Address Disparities in Asthma Care

从医院到家庭研究：优化过渡和解决哮喘护理差异的务实试验

基本信息

批准号：
10583611
负责人：
Kavita Parikh
金额：
$ 90.7万
依托单位：
CHILDREN'S RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-01-01 至 2027-12-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10583611
关键词：
Academic achievement Acute Address Admission activity Adolescent Adult Affect American Asthma COVID-19 pandemic effects Caregivers Caring Child Child Care Child health equity Childhood Childhood Asthma Chronic Disease Clinical Cognition Community Hospitals Dedications Disease Disparity Emergency department visit Face Feedback Goals Guidelines Hand Health Home Hospitalization Hospitalized Child Hospitals Individual Infrastructure Inpatients Intervention Interview Methods Mission Morbidity - disease rate National Heart, Lung, and Blood Institute Outcome Participant Pediatric Hospitals Pediatric Research Pharmaceutical Preparations Prevention Preventive Health Services Public Health Quality of Care Reduce health disparities Research Resources School Drop-Outs School-Age Population Schools Site Student Dropouts Testing United States National Institutes of Health Update Variant Work Youth acceptability and feasibility aged asthma exacerbation child services clinical practice community engagement comparison intervention disorder control disparity reduction effectiveness/implementation trial evidence base follow-up group intervention health care disparity health care service utilization health disparity health equity promotion health outcome disparity high risk high risk population hospital readmission implementation evaluation implementation facilitators implementation intervention improved improved outcome innovation insight interdisciplinary approach mortality multi-component intervention novel patient oriented pilot trial pragmatic trial premature primary care provider programs provider communication racial disparity randomized trial recruit socioeconomics standardize guidelines successful intervention telehealth trial design trial enrollment usual care arm

项目摘要

Despite evidence-based NIH guidelines for asthma, overall morbidity among children has not significantly decreased. In the US, asthma accounts for >150,000 hospitalizations, >600,000 emergency department visits, and nearly 14 million missed school days annually. Striking socioeconomic and racial inequities persist with under-resourced children incurring a disproportionate share of asthma morbidity. Our long-term goal is to improve health outcomes and reduce disparities in asthma morbidity for all children. Our team will address critical barriers to achieving broad-scale improvements in outcomes for all children hospitalized with asthma in the US, in any setting. This proposal’s overall objective is to improve asthma outcomes by conducting a patient-centered, multicomponent intervention focusing on under-resourced children with asthma at both children’s (ChH) and community hospitals (CH). Intervention components are navigation support, medications in-hand at discharge, primary care provider communication, school-based therapy, and home assessment. Leveraging feedback from stakeholders and building on the telehealth infrastructure, we will utilize a pragmatic effectiveness-implementation trial design to test the overall hypothesis that a refined version of the Hospital-to- Home (H2H) intervention will reduce asthma readmissions over a 12-month follow-up period. The hypothesis will be tested in the following aims. (1): Engage key stakeholders to identify barriers and facilitators for implementation of the components of H2H at children’s (ChH) and community hospitals (CHs). We will conduct qualitative interviews to identify barriers and facilitators and refine each component for optimal implementation. (2): Evaluate health outcomes of the H2H intervention compared to usual care control group for children hospitalized with an asthma exacerbation at ChH and CH sites. We propose a multi-center, randomized trial enrolling 340 caregiver-child (aged 4-12yrs) dyads during hospitalization to a multi-component intervention. (3): Evaluate implementation of each component of the H2H intervention and assess impact of implementation on health outcomes. We will evaluate feasibility, acceptability, and fidelity using mixed-methods to assess variation in implementation of each component across sites and their impact on health outcomes. By focusing on broader implementation at both ChHs and CHs, this innovative proposal has significant implications for improving asthma management and reducing health disparities incurred by under-resourced school-aged children. This proposal is aligned with NIH’s mission to address health disparities and will provide crucial insights in intervention implementation at all types of hospital settings that care for children. Because the hospitalization for children with asthma serves a high-risk population who may otherwise be difficult to reach, identifying the most clinically effective method by which to deliver a preventative health service is urgently needed. This work has the potential to shift current hospitalization clinical practice paradigms from only acute encounters for asthma exacerbations to the broader management of public health prevention.

尽管基于证据的NIH哮喘指南，但儿童的总体发病率并未显着在美国，哮喘的住院率> 150,000，> 600,000次紧急部门访问，每年有近1400万个上学日。惊人的社会经济和种族不平等持续存在资源不足的儿童因哮喘发病率而产生不成比例的份额。我们的长期目标是改善健康结果并减少所有儿童哮喘发病率的分布。我们的团队将解决对于所有患有哮喘住院的儿童的结果的关键障碍美国，在任何情况下。该提议的总体目标是通过进行一次以患者为中心的多组分干预措施，重点是资源不足的哮喘儿童儿童（CHH）和社区医院（CH）。干预组件是导航支持，药物出院时，初级保健提供者沟通，基于学校的治疗和房屋评估。利用利益相关者的反馈和在远程医疗基础设施上的构建方面，我们将利用务实的有效实施试验设计，以测试总体假设，即医院到医院的精致版本家庭（H2H）干预将在12个月的随访期内减少哮喘再入院术。假设将在以下目标中进行测试。（1）：让主要利益相关者确定障碍和促进者在儿童（CHH）和社区医院（CHS）上实施H2H的组件。我们将进行定性访谈以识别障碍和促进者，并完善每个组件以进行最佳实施。（2）：评估H2H干预措施的健康结果与通常的儿童护理对照组在CHH和CH站点因哮喘加重而住院。我们提出了一个多中心的随机试验在住院期间，将340个照顾者 - 儿童（4-12岁）纳入多组分干预措施。（3）：评估H2H干预措施的每个组成部分的实施以及实施的评估影响健康结果。我们将使用混合方法评估可行性，可接受性和忠诚度来评估跨站点实施的实施变化及其对健康结果的影响。通过聚焦关于CHHS和CHS的更广泛实施，这项创新的建议对改善哮喘管理并减少资源不足的学龄孩子们。该建议与NIH解决健康差异的使命保持一致，并将提供至关重要的在所有照顾儿童的医院环境下进行干预实施的见解。因为哮喘儿童的住院服务为高风险人口服务，否则他们可能难以到达，确定提供预防卫生服务的最有效的方法是需要。这项工作有可能将目前的住院临床实践范式从急性转移哮喘加剧了对公共卫生预防的更广泛管理。