Defining the Natural History and Drivers of Surgical Referral of Pediatric Umbilical Hernias to Reduce Unnecessary Surgery

定义小儿脐疝的自然史和手术转诊的驱动因素以减少不必要的手术

• 批准号: 10314578
• 负责人: Katherine He
• 金额: --
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-01 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10314578
• 关键词: Defining; Natural; History; Drivers; Surgical

Project Summary/Abstract The objectives of the proposed study are: 1) to define the rate of spontaneous closure over time for asymptomatic umbilical hernias (UHs) in children, and 2) to characterize the drivers of early surgical referral for asymptomatic UHs by primary care providers (PCPs). UHs are common in children and most will spontaneously close by 4-5 years of age. Repair is generally recommended after this age based on the risk of enlargement and development of symptoms. Based on these observations, the American Academy of Pediatrics (AAP) recommends delaying surgical referral and repair until 4-5 years of age to allow for spontaneous closure. Despite these guidelines, many children with asymptomatic UHs are referred for early surgery (i.e. at 3 years of age or younger), with 30% ultimately undergoing repair. Available data indicate that early repair is not benign, and may be associated with potentially preventable caregiver anxiety, lost days away from work and school, increased health care costs, increased hospital revisits, recurrence, and potentially unnecessary surgery. Early referral is an obligatory step in the “exposure” to early surgery. We hypothesize that the lack of compliance with AAP referral guidelines is driven by lack of sound epidemiologic data. Although there is general consensus that spontaneous closure after age 5 is unlikely, the rate of spontaneous closure between 3 and 5 years of age is not well characterized. In our prior survey of pediatric surgeons, the most common reason for variability in preferred age at repair was differences among surgeons in the perceived rate of spontaneous closure between 3 and 5 years of age. It is our hypothesis that similar PCP beliefs drive early referral for surgical repair. To address the existing knowledge gap, we will use large database analysis with natural language processing and mixed methods techniques to define the rate of spontaneous resolution of asymptomatic UH and reasons for early PCP referral, respectively. This project aims to elucidate the natural history of UH and drivers of surgical referral to reduce the burden of unnecessary referrals and surgeries on patients, caregivers, and the healthcare system. The fellowship will take place in the Boston Children’s Hospital (BCH) under the sponsorship of Dr. Shawn Rangel as part of the Health Services Research (HSR) Fellowship. BCH is affiliated with Harvard Medical School and provides unparalleled opportunities for collaboration across Harvard schools, hospitals, and research sites. The three main areas of fellowship development are 1) technical skills to design and execute health outcomes research, 2) leadership and soft skills necessary to run a research laboratory, and 3) policy skills to strategically drive evidence-based clinical care. These goals will be supported by the sponsor and collaborators in natural language processing, biostatistical methods, electronic medical record database management, and mixed methods. The goal of the fellowship training plan is to prepare the grant recipient for a successful career as an academic pediatric surgeon and rigorous health services researcher.

项目概要/摘要 拟议研究的目标是：1）定义随时间推移的自发闭合率 儿童无症状脐疝 (UH)，以及 2) 描述早期手术转诊的驱动因素 初级保健提供者 (PCP) 的无症状 UH。 UH 在儿童中很常见，大多数人都会 4-5岁时自然闭合。根据以下风险，通常建议在此年龄之后进行修复： 症状的扩大和发展。根据这些观察，美国科学院 儿科 (AAP) 建议将手术转诊和修复手术推迟到 4-5 岁，以便 自发闭合。尽管有这些指导方针，许多无症状 UH 的儿童仍被转诊至早期医院 手术（即 3 岁或以下），30% 最终接受修复。现有数据表明 早期修复并不是良性的，可能与护理人员的焦虑、失去的日子有关，这些焦虑是可以预防的 工作和上学的时间增加，医疗费用增加，医院复诊、复发和潜在的风险增加 不必要的手术。早期转诊是“接触”早期手术的必要步骤。 我们假设，不遵守 AAP 转诊指南是由于缺乏健全的制度造成的。 流行病学数据。尽管人们普遍认为 5 岁后不太可能自发闭合，但 3 至 5 岁之间的自发闭合率尚不明确。在我们之前的调查中 对于小儿外科医生来说，首选修复年龄变化的最常见原因是不同年龄组之间的差异 外科医生对 3 至 5 岁之间自然闭合率的感知。我们的假设是 类似的 PCP 信念推动早期转诊进行手术修复。为了解决现有的知识差距，我们将使用 使用自然语言处理和混合方法技术进行大型数据库分析来定义比率 无症状 UH 的自发缓解和早期 PCP 转诊的原因。该项目旨在 阐明 UH 的自然史和手术转诊的驱动因素，以减少不必要的负担 对患者、护理人员和医疗保健系统的转诊和手术。 该奖学金将在波士顿儿童医院 (BCH) 进行，由 Dr. Shawn Rangel 是健康服务研究 (HSR) 奖学金的一部分。 BCH隶属于哈佛大学 医学院并提供无与伦比的跨哈佛学校、医院、 和研究地点。奖学金发展的三个主要领域是 1) 设计和开发的技术技能 执行健康成果研究，2) 运行研究实验室所需的领导力和软技能，以及 3) 战略性推动循证临床护理的政策技能。这些目标将得到赞助商的支持 以及自然语言处理、生物统计方法、电子病历数据库方面的合作者 管理、混合方法。奖学金培训计划的目标是帮助受助者做好准备 作为一名学术儿科外科医生和严格的卫生服务研究员，他的职业生涯很成功。