Promoting Safe Transitions from Hospital to Home for Children with Medical Complexity: A Health Literacy-Informed and Family-Centered Approach

促进患有医疗复杂性的儿童从医院到家庭的安全过渡：一种以健康素养为基础、以家庭为中心的方法

• 批准号: 10610853
• 负责人: Alexander Glick
• 金额: $ 16.85万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10610853
• 关键词: Academy; Accident and Emergency department; Acute; Address; Adherence; Adult; Adverse drug event; Adverse event; Affect; Antibiotics; Appointment; Asthma; Back; Caregivers; Caring; Cellulitis; Child; Childhood; Chronic; Clinic; Communication; Complex; Comprehension; Congenital Abnormality; Counseling; Data; Dependence; Development; Diagnosis; Discharge Plannings; Education; Educational process of instructing; Electronic Health Record; Elements; Environment; Epilepsy; Equipment; Equity; Evaluation; Expenditure; Family; Family dynamics; Financial Hardship; Goals; Health; Home; Hospitalization; Hospitals; Household and Family; Individual; Infection; Inpatients; Instruction; Intervention; Interview; Joints; Knowledge; Language; Lead; Life Expectancy; Link; Liquid substance; Malignant Neoplasms; Medical; Medication Errors; Medicine; Mentors; Mentorship; Modeling; Morbidity - disease rate; Outcome; Outpatients; Parents; Patients; Pediatric Hospitals; Pharmaceutical Preparations; Physicians; Pneumonia; Process; Provider; Qualitative Methods; Qualitative Research; Randomized, Controlled Trials; Recommendation; Regimen; Research; Research Methodology; Research Personnel; Risk; Route; Sampling; Self Management; Shunt Device; Social support; Stress; Structure; Symptoms; System; Technology; Testing; Time; Training; Treatment Efficacy; United States Agency for Healthcare Research and Quality; Visit; Work; Writing; Yin; design; digital; effectiveness study; efficacy testing; evidence base; experience; family management; future implementation; health literacy; high risk; hospital readmission; implementation science; implementation study; improved; literacy; medical schools; medication administration; multidisciplinary; multiple chronic conditions; patient oriented; pediatrician; provider-level barriers; readmission rates; respiratory; side effect; skills; stakeholder perspectives; tool; tool development; usability; user centered design

PROJECT SUMMARY/ABSTRACT Children with medical complexity (CMC), or those with multiple chronic conditions, progressive conditions, or technology dependence, are at high risk for post-hospitalization morbidity. Despite representing 1% of children in the US, CMC account for 1/3 of pediatric hospital expenditures; 30-day readmission rates are ~20%. Research on post-discharge morbidity (e.g., adverse drug events, infections, unanticipated visits) has focused on adults. Few studies have assessed strategies to reduce post-discharge morbidity in CMC. Such strategies must account for 1) factors distinct to children (e.g., liquid medications, recognizing symptoms in children who cannot express what is wrong) and 2) specific needs of CMC (e.g., medical equipment, knowing which of many providers to contact, managing multiple chronic medications, complex family/household dynamics). Inadequate provider- parent communication and low parent health literacy contribute to poor comprehension of and adherence to discharge instructions, increasing risk for post-discharge morbidity. Despite recommendations from multiple national organizations for evidence-based, health literacy-informed interventions to improve communication processes, to date, a health literacy-informed approach to address post-hospitalization morbidity for CMC has not been used while also incorporating principals of family dynamics. The primary objective of this application is to support Dr. Glick’s goal of becoming an independent investigator with the aim of improving 1) parent comprehension of/adherence to discharge instructions and 2) post-discharge outcomes for CMC. This goal will be achieved through training from an expert multidisciplinary mentorship team and formal coursework. He will gain advanced skills in 1) qualitative/mixed method research, 2) family dynamics, 3) user-centered design, and 4) implementation science/design and evaluation of complex interventions. Dr. Glick will accomplish his goals at NYU School of Medicine through the following 3 aims: In Aim 1, Dr. Glick will use qualitative methods to examine barriers/facilitators for a) parents in comprehension of/adherence to discharge instructions and b) pediatricians in providing optimal discharge education for CMC. In Aim 2, Dr. Glick will use Aim 1 findings, multiple rounds of usability testing, multi-disciplinary workgroups, a national sample of discharge instructions for CMC, and an existing tool designed to improve parent adherence to discharge instructions for common pediatric diagnoses to inform the design of his new tool for CMC. In Aim 3, Dr. Glick will utilize a randomized controlled trial to examine this tool’s efficacy in improving parent comprehension of and adherence to discharge instructions and reducing post-hospitalization morbidity for CMC. Successful completion of this project will lead to an R01 application to test the efficacy of the intervention, now linked to the electronic health record, in improving parent comprehension of/adherence to discharge plans and reducing post-hospitalization morbidity for CMC.

项目概要/摘要 患有医学复杂性 (CMC) 的儿童，或患有多种慢性病、进展性疾病或 技术依赖，尽管占儿童的 1%，但住院后发病的风险很高。 在美国，CMC 占儿科医院支出的 1/3；30 天再入院率约为 20%。 关于出院后发病率（例如药物不良事件、感染、意外就诊）的研究重点关注成人。 很少有研究评估降低 CMC 出院后发病率的策略，此类策略必须考虑在内。 1) 儿童特有的因素（例如液体药物、识别无法表达的儿童的症状 出了什么问题）以及 2）CMC 的具体需求（例如医疗设备、了解众多提供商中的哪一个） 接触、管理多种慢性药物、复杂的家庭/家庭动态）。 家长沟通和家长健康素养低导致理解和遵守不佳 尽管有多个建议，但仍增加了出院后发病的风险。 国家组织开展基于证据、健康素养的干预措施，以改善沟通 迄今为止，解决 CMC 住院后发病率的基于健康素养的方法已经 没有被使用，同时也融入了家庭动态的原则。 此应用程序的主要目标是支持 Glick 博士成为独立研究者的目标 目的是提高 1) 家长对出院指示的理解/遵守程度，以及 2) 出院后 CMC 的这一目标将通过多学科专家指导团队的培训来实现。 他将获得以下方面的高级技能：1）定性/混合方法研究，2）家庭动态， 3）以用户为中心的设计，4）复杂干预措施的实施科学/设计和评估。 Glick 将通过以下 3 个目标来实现他在纽约大学医学院的目标： 在目标 1 中，Glick 博士将使用定性方法来检查 a) 父母理解方面的障碍/促进因素 b) 儿科医生为 CMC 提供最佳的出院教育。 在目标 2 中，Glick 博士将使用目标 1 的发现、多轮可用性测试、多学科工作组、 全国 CMC 出院说明样本，以及旨在提高家长依从性的现有工具 发布常见儿科诊断说明，为 CMC 新工具的设计提供信息。 在目标 3 中，Glick 博士将利用一项随机对照试验来检验该工具在改善家长方面的功效。 理解并遵守出院说明并减少 CMC 住院后发病率。 该项目的成功完成将导致 R01 申请，以测试干预措施的功效，现在 与电子健康记录关联，提高家长对出院计划的理解/遵守 降低 CMC 的住院后发病率。

项目成果

Management of Discharge Instructions for Children With Medical Complexity: A Systematic Review.

医疗复杂性儿童出院指示的管理：系统评价。

• 发表时间: 2023-11-01
• 影响因子: 8
• 作者: Glick, Alexander F;Farkas, Jonathan S;Magro, Juliana;Shah, Aashish V;Taye, Mahdi;Zavodovsky, Volmir;Rodriguez, Rachel Hughes;Modi, Avani C;Dreyer, Benard P;Famiglietti, Hannah;Yin, H Shonna
• 通讯作者: Yin, H Shonna

Pediatrician perspectives on barriers and facilitators to discharge instruction comprehension and adherence for parents of children with medical complexity.

儿科医生对医疗复杂性儿童家长理解教学和遵守教学的障碍和促进因素的看法。

• 发表时间: 2024-04
• 作者: Glick, Alexander F;Yin, H Shonna;Silva, Benjamin;Modi, Avani C;Huynh, Vincent;Goodwin, Emily J;Farkas, Jonathan S;Turock, Julia S;Famiglietti, Hannah S;Dickson, Victoria V
• 通讯作者: Dickson, Victoria V