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.

尽管美国国立卫生研究院 (NIH) 制定了基于证据的哮喘指南，但儿童的总体发病率并未显着下降。在美国，因哮喘住院的人数超过 150,000 人次，急诊就诊人数超过 600,000 人次。每年有近 1400 万人缺课，社会经济和种族不平等现象依然存在。资源不足的儿童哮喘发病率过高。我们的长期目标是：我们的团队将致力于改善所有儿童的健康状况并减少哮喘发病率的差异。对于实现广泛改善所有因哮喘障碍住院的儿童的结局至关重要美国，在任何情况下，该提案的总体目标都是通过开展一项研究来改善哮喘结果。以患者为中心的多成分干预，重点关注资源匮乏的哮喘儿童儿童医院 (ChH) 和社区医院 (CH) 的干预措施包括导航支持、药物治疗。出院时掌握、初级保健提供者沟通、学校治疗和家庭评估。利用利益相关者的反馈并建立远程医疗基础设施，我们将利用务实的方法有效性实施试验设计，以检验总体假设，即医院到医院的改进版本家庭 (H2H) 干预将减少 12 个月随访期内的哮喘再入院率。 (1)：让主要利益相关者参与进来，找出障碍和促进因素我们将在儿童医院 (ChH) 和社区医院 (CH) 实施 H2H 的组成部分。定性访谈，以确定障碍和促进因素，并完善每个组成部分以实现最佳实施。 (2)：与常规护理对照组相比，评估 H2H 干预的儿童健康结果在 ChH 和 CH 中心因哮喘加重住院的患者我们提出了一项多中心、随机试验。招募 340 名住院期间的看护者与儿童（4-12 岁）二人组进行多成分干预 (3)：评估 H2H 干预措施每个组成部分的实施情况并评估实施对我们将使用混合方法来评估可行性、可接受性和保真度。不同地点实施每个组成部分的差异及其对健康结果的影响关于在 ChH 和 CH 更广泛的实施，这一创新提案对改善哮喘管理并减少资源不足的学龄儿童所遭受的健康差距该提案符合 NIH 解决健康差异的使命，并将提供至关重要的帮助。在所有类型的照顾儿童的医院环境中实施干预措施的见解。哮喘儿童住院治疗服务于高危人群，否则这些人群可能难以接触到，迫切需要确定临床上最有效的方法来提供预防性卫生服务这项工作有可能将当前的住院临床实践范式从仅限于急性病转变。哮喘恶化的遭遇到更广泛的公共卫生预防管理。