HOMeVent4Kids: Home-based Optimization of Mechanical Ventilation for Children

项目摘要/摘要 候选人：卡罗琳·福斯特，医学博士，MSHS，是一名儿科医生和初级临床研究员，专注于改善 需要护理的早产儿慢性肺病(CLD)的循证护理 有创家庭机械通气(HMV)。福斯特博士的长期职业目标是成为一名独立的 医生-调查员，在跨学科团队中工作，设计和评估循证健康 为需要居家服务的依赖医疗技术的儿童提供护理服务干预。 研究背景/目的：早产儿CLD是一个日益增长的、代价高昂的患者群体 卫生保健资源使用率高，家庭照顾者负担沉重。不存在基于经验的参数 指导这些人群如何停止侵袭性HMV，导致缺乏适当、及时的 停止使用HMV。因此，这个奖项的目的是让福斯特博士学习如何评估 影响HMV持续时间的多方面因素，并初步测试这些因素与临床的整合 管理早产儿慢性阻塞性肺疾病，以安全地缩短HMV的使用时间。 具体目标：1)确定哪些患者水平因素与HMV持续时间有关；2)确定哪些因素与HMV持续时间有关 家庭照顾者和健康服务因素与HMV支持的断奶有关；3)发展和试点 将患者、家庭和健康服务数据元素集成到 临床管理仪表板设计，以优化HMV在早产儿CLD儿童中的使用。 研究计划：福斯特博士将回顾分析现有患者的临床数据，以评估 患者医疗因素(如呼吸机设置、氧气使用、体重、呼气末二氧化碳)与HMV的关系 持续时间(目标1)；前瞻性收集患者报告结果(PRO)措施(即，验证调查)以 阐明哪些照顾者和系统因素与当前人群中HMV支持的撤机相关 HMV患者(目标2)；并使用利益攸关方参与的学习卫生系统方法来开发和试点 临床HMV仪表板的可行性、可接受性和可用性(实施)(目标3)。 职业发展计划/环境：通过地方和国家教学活动相结合， 体验式学习、研讨会、研讨会和专业活动，福斯特博士将获得以下方面的专业知识 评估纵向健康结果和医疗保健利用；患者报告的结果(PRO)健康 测量科学；干预设计和中试。福斯特博士将加强她的专业能力 通过由经验丰富的、 由NIH资助的团队导师、顾问和合作者组成的互补团队。西北大学和 Lurie儿童医院将提供卓越的研究基础设施，以使成功的奖项和 坚定地致力于福斯特博士向研究独立的过渡。

PROJECT SUMMARY/ABSTRACT Candidate: Carolyn Foster, MD, MSHS is a pediatrician and junior clinical investigator focused on improving the evidence-based for the care of children with chronic lung disease (CLD) of prematurity who require invasive home mechanical ventilation (HMV). Dr. Foster’s long-term career goal is to become an independent physician-investigator who works in cross-disciplinary teams to design and evaluate evidence-based health care delivery interventions for children with medical technology dependence who require in-home services. Research Context/Objective: Children with CLD of prematurity are a growing, costly group of patients with high health care resource use and significant family caregiver burden. No empirically based parameters exist to guide how this population is discontinued from invasive HMV, leading to lack of appropriate, timely discontinuation of HMV. Therefore, the objective of this award is for Dr. Foster to learn how to assess the multifaceted factors that contribute to HMV duration, and to pilot test the integration of these factors into clinical management of children with CLD of prematurity, to safely shorten duration of HMV use. Specific Aims: 1) Determine which patient level factors are associated with HMV duration; 2) Determine which family caregiver and health service factors are associated with weaning of HMV support; 3) Develop and pilot the feasibility, acceptability, and usability of integrating patient, family, and health service data elements into a clinical management dashboard design to optimize HMV use in children with CLD of prematurity. Research Plan: Dr. Foster will retrospectively analyze existing patients’ clinical data to evaluate the association of patient medical factors (e.g., ventilator settings, oxygen use, weight, end-tidal CO2,) with HMV duration (Aim 1); prospectively collect patient reported outcome (PRO) measures (i.e., validated surveys) to elucidate which caregiver and system factors are associated with weaning of HMV support among current HMV patients (Aim 2); and use a stakeholder-engaged Learning Health System approach to develop and pilot the feasibility, acceptability, and usability (implementation) of a clinical HMV dashboard (Aim 3). Career Development Plan/Environment: Through a combination of local and national didactic activities, experiential learning, workshops, seminars, and professional activities, Dr. Foster will acquire expertise in evaluating longitudinal health outcomes and health care utilization; patient-reported outcome (PRO) health measurement science; and intervention design and pilot testing. Dr. Foster will strengthen her professional skills needed for an independent physician-investigator career through close mentorship by an experienced, complementary team of NIH-funded team mentors, advisors, and collaborators. Northwestern University and Lurie Children’s Hospital will provide outstanding research infrastructures to enable a successful award and are strongly committed to Dr. Foster’s transition to research independence.