An Innovative Tailored Intervention for Improving Children's Postoperative Recovery

摘要 每年，美国约有300万儿童在手术前经历严重的焦虑和疼痛 在手术后。这些高度的痛苦和焦虑不仅会对儿童造成情感上的创伤，而且 但最近的数据也表明，高水平的焦虑和疼痛会导致心理和心理上的损害 术后临床恢复情况。在过去的20年里，许多基于医院的干预措施 在治疗围手术期焦虑和疼痛方面被证明是有效的。不幸的是，使用这些 干预措施在过去十年中显著减少，很可能是由于这两个戏剧性的转变 转向低成本的门诊手术和其他控制成本的努力。最近的医疗改革和贫困 医院过去几年的财务业绩进一步加快了这一进程。不断增长的 对卫生技术的重视为改变手术准备和管理提供了机会 通过使用基于移动的量身定做的干预措施。 在此之前，NICHD授予这项申请的PI为期两年的拨款，以专注于开发一个网络- 针对2-7岁正在接受门诊治疗的儿童的基于定制的干预(WebTips) 外科医生和他们的家人以及相关的医疗保健提供者。到目前为止，PI已经开发了 并通过形成性评估过程展示了高可用性和亲和性 干预。PI还进行了可行性RCT，并使用通常的护理控制组进行了演示， WebTips能有效地减少术前焦虑和术后惊醒妄想。目的 此R01应用程序的目的是在使用注意事项的大规模临床试验中检查WebTips的有效性 控制随机对照试验设计和经过验证的30天结果测量，这些测量是在最近引入的 “三个目标”的概念框架。这一框架要求在 背景：更好的临床结果，更好的患者满意度和更低的资源利用率。我们提出， WebTips有可能改变目前数百万儿童及其家庭的围手术期护理 一次强化的围手术期旅程。

Abstract Every year about 3 million children in the United States experience significant anxiety prior to surgery and pain following surgery. Not only are these high levels of pain and anxiety emotionally traumatic to the child and family, but also recent data indicate that high levels of anxiety and pain will lead to impaired psychological and clinical recovery following the surgery. Over the past 2 decades, a number of hospital-based interventions have been shown to be effective in the treatment of perioperative anxiety and pain. Unfortunately, use of these interventions has decreased significantly over the past decade, most likely due to both the dramatic shift toward low-cost outpatient surgery and other cost-containment efforts. The recent healthcare reform and poor financial performance by hospitals over the past few years have further accelerated this process. The growing emphasis on health technology provides an opportunity to transform preparation and management of surgery with the use of mobile-based, tailored interventions. Previously, the NICHD awarded the PI of this application a 2-year grant to focus on the development of a web- based tailored intervention (WebTIPS) directed at children age 2-7 years who are undergoing outpatient surgery and their family as well as the involved healthcare providers. To date, the PI has developed the intervention and has demonstrated through a formative evaluation process high usability and likeability of the intervention. The PI also conducted a feasibility RCT and demonstrated, using a usual care control group, that WebTIPS is effective in reduction of preoperative anxiety and postoperative emergence delirium. The purpose of this R01 application is to examine the efficacy of WebTIPS in a large scale clinical trial using an attention control RCT design and validated 30-days outcome measures that are framed within the recently introduced conceptual framework of the “Triple Aim”. This framework calls for new interventions to be evaluated within the context of: better clinical outcomes, better patient satisfaction and lower resource utilization. We submit that WebTIPS has the potential to transform current perioperative care of millions of children and their families with an enhanced perioperative journey.