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A Systems Approach to Improve Safe Medication Management for Children with Medical Complexity

改善医疗复杂性儿童安全用药管理的系统方法

基本信息

批准号：
10449831
负责人：
Ephrem Abebe
金额：
$ 12.98万
依托单位：
PURDUE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-05-13 至 2026-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10449831
关键词：
Academy Address Adopted Adult American Award Behavioral Model Caregivers Caring Child Childhood Complex Consolidated Framework for Implementation Research Data Discharge Plannings Effectiveness Engineering Ensure Evaluation Research Failure Family Family Caregiver Foundations Future Goals Health Personnel Healthcare Healthcare Systems Home Hospitals Human Hybrids Individual Intervention Interview Joints Knowledge Laws Literature Maps Measures Medicaid Medical Medication Management Modeling Output Participant Patient Self-Report Patients Pediatrics Performance Persons Pharmaceutical Preparations Phase Professional Role Randomized Controlled Trials Recommendation Regimen Reporting Research Research Personnel Resources Risk Role Safety Schedule Solid Specific qualifier value Statutes and Laws System Technology Testing Training United States National Institutes of Health Work base care coordination career development cost design evidence base experience future implementation high risk hospital readmission human centered design implementation research improved medication safety patient oriented patient population patient safety pediatric patients prevent prototype safe patient skill acquisition success successful intervention therapy design therapy development tool usability

项目摘要

PROJECT SUMMARY The proposed research addresses a key patient safety gap among children with medical complexity (CMC) transitioning between hospital and home—medication related harm. CMC are often on multiple and complex medication regimens and have intensive healthcare needs. As a result, they experience frequent transitions of care, across professional roles and care settings and during these transitions, CMC are at great risk for medication-related harm. Most transitional care interventions have been adopted from adult care settings and may not be adequate to address the unique needs of CMC and their family caregivers. Interventions that are grounded in the unique situations and complexities of such patients are needed to improve medication use safety and family experience of care. This proposal describes the PI’s plan to transition into an independent investigator by developing expertise in 1) participatory, human centered design to co-develop useful interventions, and 2) implementing and evaluating interventions. The proposal also describes a 4-year project for developing a prototype care transition medication safety intervention and generating early evidence on its usability and potential factors influencing its future implementation. Aim 1: Patient journey mapping—will be used to elucidate medication safety risks and contexts during the hospital-to-home transition period. Journey maps will be used to capture and visually represent the medication use experience of families across professional settings and boundaries. The output of this aim will inform prototype design under Aim 2. Aim 2: Participatory, human centered design to co-design a prototype medication safety intervention. Through multiple, iterative co-design sessions involving healthcare workers and family caregivers, a team will design a prototype medication safety intervention informed by journey maps from Aim 1, current literature, and participant elicitations. The result will be a composite prototype ready for usability testing. Aim 3: Will test usability of prototype intervention with healthcare workers and family caregivers. Additionally, barriers and facilitators that may be anticipated during future prototype implementation will be explored. Taken together, all 3 aims will yield a final, refined prototype intervention designed to improve medication use safety during care transitions. Future work will include a randomized controlled trial of the prototype medication safety intervention to formally evaluate it effectiveness in preventing or reducing medication related harm as well as improving the medication use experience of CMC and their family caregivers.

项目概要拟议的研究解决了患有医疗复杂性 (CMC) 的儿童中关键的患者安全差距在医院和家庭之间的过渡——药物相关的伤害。 CMC 往往是多重且复杂的药物治疗方案并有强烈的医疗保健需求。结果，他们经历了频繁的转变护理、跨专业角色和护理环境，在这些转变过程中，CMC 面临着巨大的风险药物相关的伤害。大多数过渡性护理干预措施都是从成人护理机构中采用的可能不足以满足 CMC 及其家庭护理人员的独特需求。干预措施是需要基于此类患者的独特情况和复杂性来改善药物使用安全和家庭护理经验。该提案描述了 PI 计划通过发展以下领域的专业知识来转型为独立调查员： 1) 参与式、以人为本的设计，共同制定有用的干预措施，以及 2) 实施和评估干预措施。该提案还描述了一个为期 4 年的项目，用于开发原型护理过渡药物安全干预并生成有关其可用性和潜在因素的早期证据影响其未来的实施。目标 1：患者旅程图——将用于阐明治疗期间的用药安全风险和背景医院到家庭的过渡期。旅程地图将用于捕获和直观地表示药物使用跨专业环境和界限的家庭经验。该目标的输出将告知目标 2 下的原型设计。目标 2：参与式、以人为本的设计，共同设计药物安全干预原型。通过涉及医疗工作者和家庭护理人员的多次迭代协同设计会议，一个团队将设计一个原型药物安全干预措施由目标 1 的旅程图、当前文献和参与者启发。结果将是一个可供可用性测试的复合原型。目标 3：将测试医疗工作者和家庭护理人员原型干预的可用性。此外，将探讨未来原型实施过程中可能出现的障碍和促进因素。采取所有 3 个目标将共同产生最终的、完善的原型干预措施，旨在提高用药安全性在护理过渡期间。未来的工作将包括原型药物安全干预的随机对照试验正式评估其在预防或减少药物相关伤害以及改善 CMC 及其家庭照顾者的用药经验。