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: 10215966
• 负责人: Alexander Glick
• 金额: $ 16.89万
• 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/10215966
• 关键词: Academy; Accident and Emergency department; Acute; Address; Adherence; Adult; Adverse drug event; Adverse event; Affect; Antibiotics; Appointment; Asthma; Caregivers; Caring; Cellulitis; Child; Childhood; Chronic; Clinic; Communication; Complex; Comprehension; Congenital Abnormality; Counseling; Data; Dependence; Development; Diagnosis; Discharge Plannings; Education; Electronic Health Record; Elements; Environment; Epilepsy; Equipment; Evaluation; Expenditure; Family; Family dynamics; Financial Hardship; Foundations; Future; 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; Yin; design; digital; effectiveness study; efficacy testing; evidence base; experience; family management; 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.

项目总结/摘要 患有医学复杂性（CMC）的儿童，或患有多种慢性疾病、进行性疾病或 技术依赖，住院后发病的风险很高。尽管有1%的儿童 在美国，CMC占儿科住院费用的1/3; 30天再入院率约为20%。研究 关于出院后发病率（例如，药物不良事件、感染、意外就诊）的患者集中在成人。 很少有研究评估降低CMC出院后发病率的策略。这些战略必须考虑到 对于1）与儿童不同的因素（例如，液体药物，识别无法表达的儿童的症状 出了什么问题）和2）CMC的特定需求（例如，医疗设备，知道哪些供应商， 接触，管理多种慢性药物，复杂的家庭/家庭动态）。供应商不足- 父母沟通和父母健康素养低导致对 出院指导，增加出院后发病的风险。尽管多个国家提出了建议， 国家组织开展基于证据的、了解卫生知识的干预措施，以改善沟通 到目前为止，一个健康素养知情的方法，以解决住院后发病率的CMC已经 没有被使用，同时也纳入了家庭动力学的原则。 本申请的主要目的是支持格利克博士成为一名独立调查员的目标 目的是提高1）父母对出院指示的理解/遵守，2）出院后 CMC的成果。这一目标将通过多学科专家指导小组的培训来实现 和正式的课程他将获得1）定性/混合方法研究，2）家庭动态， 3)以用户为中心的设计，以及4）复杂干预措施的实施科学/设计和评价。博士 Glick将通过以下3个目标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）父母理解的障碍/促进因素 遵守出院指导和B）儿科医生为CMC提供最佳出院教育。 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， CMC出院指导的全国样本，以及旨在提高父母依从性的现有工具 出院说明常见的儿科诊断通知他的新工具CMC的设计。 在目标3中，Glick博士将利用随机对照试验来检查该工具在改善父母 理解和遵守出院指示，减少CMC的住院后发病率。 成功完成此项目将导致R 01应用程序，以测试干预的有效性，现在 与电子健康记录相关联，以提高父母对出院计划的理解/遵守， 降低CMC的住院后发病率。