An Innovative Tailored Intervention for Improving Children's Postoperative Recovery

摘要 在美国，每年约有300万儿童在手术前经历严重的焦虑和疼痛。 手术后。这些高水平的疼痛和焦虑不仅对孩子造成情感创伤， 家庭，而且最近的数据表明，高度的焦虑和痛苦将导致受损的心理和 手术后的临床恢复。在过去的20年里，一些以医院为基础的干预措施， 已被证明是有效的治疗围手术期焦虑和疼痛。不幸的是，使用这些 在过去十年中，干预措施显著减少，最有可能是由于 低成本门诊手术和其他成本控制措施。最近的医疗改革和穷人 医院在过去几年的财务表现进一步加快了这一进程。日益增长的 对卫生技术的重视为改变外科手术的准备和管理提供了机会 使用基于移动设备的量身定制的干预措施。 此前，NICHD授予本申请的PI为期2年的资助，专注于开发一个网络- 基于定制干预（WebTIPS），针对2 - 7岁正在接受门诊治疗的儿童 手术和他们的家人以及相关的医疗服务提供者。到目前为止，PI已经开发了 干预，并通过形成性评价过程证明了高可用性和可爱的 干预PI还进行了一项可行性RCT，并使用常规护理对照组证明， WebTIPS能有效减少术前焦虑和术后苏醒期谵妄。目的 该R 01应用程序的目的是使用注意力在大规模临床试验中检查WebTIPS的功效 对照RCT设计和经验证的30天结局指标，这些指标是在最近引入的 “三重目标”的概念框架。这一框架要求对新的干预措施进行评估， 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。我们认为， WebTIPS有可能改变目前数百万儿童及其家庭的围手术期护理， 一次增强的围手术期之旅

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.