Home Oxygen Use for Infants with Bronchopulmonary Dysplasia: Balancing Infant, Family, and Health System Outcomes

支气管肺发育不良婴儿的家庭供氧：平衡婴儿、家庭和卫生系统的结果

• 批准号: 10326808
• 负责人: Joanne M Lagatta
• 金额: $ 16.2万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-01-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10326808
• 关键词: 2 year old; Adopted; Advisory Committees; Affect; Age; Air; Award; Bioethics; Bronchopulmonary Dysplasia; Caring; Child; Child Health; Childhood; Chronic Disease; Clinical; Clinical Investigator; Complex; Data; Data Analyses; Databases; Development; Development Plans; Developmental Delay Disorders; Diagnosis; Discharge Plannings; Education; Epidemiology; Equilibrium; Family; Family health status; Goals; Guidelines; Health; Health Benefit; Health Information System; Health Services; Health system; Home; Hospitalization; Hospitals; Infant; Infant Care; Infant Development; Infant Health; Insurance; Intervention; Knowledge; Lead; Leadership; Length of Stay; Life; Link; Logistics; Lung diseases; Measurement; Measures; Medical; Mentors; Mentorship; Neonatal; Neonatal Intensive Care Units; Neonatology; Outcome; Outcomes Research; Outpatients; Oxygen; Oxygen Therapy Care; Parents; Pathway interactions; Patients; Pediatric Hospitals; Positioning Attribute; Premature Infant; Prospective Studies; Pulmonary Hypertension; Quality of life; Quality-of-Life Assessment; Research; Resources; Risk Factors; Savings; Severity of illness; Testing; Time; Training; Training Programs; Variant; Visit; Wisconsin; acute care; adverse outcome; career development; cohort; comorbidity; cost; evidence base; experience; family burden; health care service utilization; health related quality of life; high risk; hospital readmission; infant outcome; medical schools; prospective; prospective test; respiratory; secondary analysis; shared decision making; skills

PROJECT SUMMARY/ABSTRACT The goal of this proposal is to provide a pathway to independence as a clinical investigator in healthcare utilization and health-related quality of life (HRQL) assessment, applied to outcomes research for infants with bronchopulmonary dysplasia (BPD). Infants with BPD are at high risk for prolonged NICU stays, readmissions, and developmental delay. Home oxygen is used commonly to facilitate earlier hospital discharge, but there is wide variation across U.S. hospitals in use of this therapy. My recent study showed that infants with BPD in centers using more frequent home oxygen had a 1.2-week shorter average NICU stay than infants in centers using less frequent home oxygen, adjusted for illness severity. There is a gap in knowledge of how home oxygen impacts infant outcomes after NICU discharge, and how it affects their families. I would like to develop a unique niche assessing healthcare utilization and HRQL after NICU discharge, to generate evidence-based NICU discharge guidelines that optimize infant health outcomes with minimal undue burden on families. I will begin to achieve these goals by engaging in a career development plan that logically extends my prior training in neonatology and epidemiology. I will build skills in prospective study leadership, health services outcomes measurement, and developmental and HRQL assessment. This career development plan will be guided by experienced mentors and a scientific advisory committee at the Medical College of Wisconsin with expertise in pediatric healthcare utilization, HRQL for children with chronic illness, BPD clinical outcomes research, advanced quantitative analysis, developmental assessment, and neonatal bioethics. This mentorship and career development plan are integrated with research investigating outcomes of infants with BPD after NICU discharge, focusing on differences following home oxygen use. The first aim seeks to determine whether home oxygen use for infants with BPD is associated with increased readmissions in the year after NICU discharge, matched on illness severity and demographic risk factors. This will be assessed via a secondary analysis of data from the Children’s Hospitals Neonatal Database, a multi-center cohort of 25 Level IV children’s hospital NICUs with linked post-discharge readmission data available via the Pediatric Health Information System. The second aim will prospectively compare infant and parent outcomes for infants with BPD discharged from the Children’s Hospital of Wisconsin NICU with and without home oxygen from NICU discharge through 2 years of age. The prospective study will measure infant healthcare utilization and parent HRQL over time after NICU discharge, and study the relationship between those factors and 2-year outcomes. Results will provide outcome comparisons for infants with BPD discharged with and without home oxygen therapy, and assess how a specific NICU therapy affects parent HRQL over time. This can be used in making evidence-based decisions about NICU discharge planning. Results and expertise acquired during this award will be used to test the impact of a multi-center intervention implementing consistent guidelines for home oxygen use.

项目概要/摘要 该提案的目标是提供一条作为医疗保健临床研究者独立的途径 利用率和健康相关生活质量（HRQL）评估，应用于患有以下疾病的婴儿的结果研究 支气管肺发育不良（BPD）。患有 BPD 的婴儿面临长时间 NICU 住院、再次入院、 和发育迟缓。通常使用家庭氧气来促进提早出院，但也有 美国各医院使用这种疗法的情况差异很大。我最近的研究表明，患有 BPD 的婴儿 使用更频繁的家庭氧气的中心的婴儿平均 NICU 停留时间比中心的婴儿短 1.2 周 使用较少频率的家庭氧气，并根据疾病严重程度进行调整。对于如何回家的知识存在差距 氧气会影响 NICU 出院后的婴儿结局及其对家人的影响。我想发展 评估 NICU 出院后医疗保健利用率和 HRQL 的独特利基，以生成基于证据的 NICU 出院指南可优化婴儿健康结果，同时最大限度地减少家庭的过度负担。我会 通过参与职业发展计划来开始实现这些目标，该计划逻辑上扩展了我之前的培训 在新生儿学和流行病学方面。我将培养前瞻性研究领导力、卫生服务成果方面的技能 测量、发展和 HRQL 评估。该职业发展计划将遵循 威斯康星医学院经验丰富的导师和科学咨询委员会在以下方面拥有专业知识 儿科医疗保健利用、慢性病儿童的 HRQL、BPD 临床结果研究、 先进的定量分析、发育评估和新生儿生物伦理学。此次辅导和 职业发展计划与 NICU 后 BPD 婴儿结局的研究相结合 放电，重点关注家庭氧气使用后的差异。第一个目标是确定家是否 患有 BPD 的婴儿的氧气使用与 NICU 出院后一年内再入院的增加有关， 与疾病严重程度和人口危险因素相匹配。这将通过二次分析来评估 数据来自儿童医院新生儿数据库，这是一个由 25 家 IV 级儿童医院组成的多中心队列 NICU 可以通过儿科健康信息系统获取链接的出院后再入院数据。这 第二个目标是前瞻性地比较 BPD 婴儿出院后的婴儿和父母的结局 威斯康星州儿童医院新生儿重症监护室 (NICU) 从 NICU 出院到 2 年期间使用或不使用家庭氧气 年龄。这项前瞻性研究将衡量新生儿重症监护室 (NICU) 后一段时间内婴儿医疗保健利用率和家长 HRQL 出院，并研究这些因素与 2 年结果之间的关系。结果将提供 对接受和不接受家庭氧疗出院的 BPD 婴儿进行结果比较，并评估如何 随着时间的推移，特定的 NICU 治疗会影响父母的 HRQL。这可用于做出基于证据的决策 关于 NICU 出院计划。在此奖项期间获得的成果和专业知识将用于测试 实施一致的家庭氧气使用指南的多中心干预的影响。

项目成果

Implementation of a pilot electronic parent support tool in and after neonatal intensive care unit discharge.

• DOI: 10.1038/s41372-021-01303-3
• 发表时间: 2022-08
• 期刊: Journal of perinatology : official journal of the California Perinatal Association
• 作者: Lagatta J;Malnory M;Fischer E;Davis M;Radke-Connell P;Weber C;Cohen S
• 通讯作者: Cohen S

Room air challenge predicts duration of supplemental respiratory support for infants with bronchopulmonary dysplasia.

• DOI: 10.1038/s41372-021-00958-2
• 发表时间: 2021-04
• 期刊: Journal of perinatology : official journal of the California Perinatal Association
• 作者: Arora P;Dahlgren A;Dawson S;Leuthner J;Lagatta J
• 通讯作者: Lagatta J

Actual and Potential Impact of a Home Nasogastric Tube Feeding Program for Infants Whose Neonatal Intensive Care Unit Discharge Is Affected by Delayed Oral Feedings.

• DOI: 10.1016/j.jpeds.2021.03.046
• 发表时间: 2021-07
• 期刊: The Journal of pediatrics
• 作者: Lagatta JM;Uhing M;Acharya K;Lavoie J;Rholl E;Malin K;Malnory M;Leuthner J;Brousseau DC
• 通讯作者: Brousseau DC

The Impact of Pulmonary Hypertension in Preterm Infants with Severe Bronchopulmonary Dysplasia through 1 Year.

• DOI: 10.1016/j.jpeds.2018.07.035
• 发表时间: 2018-12
• 期刊: The Journal of pediatrics
• 作者: Lagatta JM;Hysinger EB;Zaniletti I;Wymore EM;Vyas-Read S;Yallapragada S;Nelin LD;Truog WE;Padula MA;Porta NFM;Savani RC;Potoka KP;Kawut SM;DiGeronimo R;Natarajan G;Zhang H;Grover TR;Engle WA;Murthy K;Children's Hospital Neonatal Consortium Severe BPD Focus Group
• 通讯作者: Children's Hospital Neonatal Consortium Severe BPD Focus Group

Parent Health-Related Quality of Life for Infants with Congenital Anomalies Receiving Neonatal Intensive Care.

• DOI: 10.1016/j.jpeds.2022.02.008
• 发表时间: 2022-06
• 期刊: The Journal of pediatrics
• 作者: Acharya K;Rholl E;Malin K;Malnory M;Leuthner J;Leuthner SR;Lagatta J
• 通讯作者: Lagatta J