Optimization and Implementation Trial of a User-Centered Emergency Care Planning Tool for Infants with Medical Complexity

项目摘要/摘要 普尔西尼博士提出了一个为期五年的研究培训计划，以支持他发展成为一名独立的 医生-科学家致力于改善对患有医疗复杂性的儿童的紧急护理，这一点说明了 约占所有儿科急诊科(ED)就诊的20%和所有医疗保健支出的33% 在孩子们中间。普尔西尼博士的项目目标是优化和实施以用户为中心的紧急护理 改善有医疗复杂性的婴儿(特别是农村地区的婴儿)结局的规划工具，a 这一患者群体中特别脆弱的一部分。根据提案的第一个目标，普尔西尼博士将 优化现有的紧急护理规划工具，尽管倡导为患有复杂医疗疾病的儿童提供服务 由两个专业协会实施，迄今执行不力。普尔西尼博士将优化紧急情况 通过迭代、半结构化和定向访谈为具有医疗复杂性的婴儿提供护理规划工具 以及对工具用户的调查：提供者、当地跨学科协作者和家庭。在第二个目标下， 普尔西尼博士将设计并进行一项以用户为中心的紧急护理计划的随机可行性试验 工具的实施，衡量由此产生的紧急医疗保健结果。作为审判的一部分 在实施过程中，普尔西尼博士将监测实施的障碍，并衡量关键的紧急情况 卫生服务研究措施与全面未来随机成本-效果分析计划 对照试验将作为R01提交。 普尔西尼博士的培训方案侧重于传播和实施(D&I)科学，并补充 通过临床试验和卫生服务措施发展方面的培训。D&I科学方面的培训建立在 普尔西尼医生之前在儿科急救医学和妇幼保健方面的培训。普尔西尼医生的 研究将得到一群经验丰富的导师的支持，这些导师在研发与创新科学、临床试验、 儿科急救医学和卫生服务研究。他的导师致力于确保他的职业生涯 通过成功实施拟议的项目发展成为独立的临床研究人员 训练计划。通过为普尔西尼博士提供完成这一任务所需的技能和指导经验 提议，他将处于有利地位，成为一名独立的科学家并显著改善 医疗复杂性儿童的急救护理。

PROJECT SUMMARY/ABSTRACT Dr. Pulcini proposes a five-year research training program to support his development into an independent physician-scientist dedicated to improving emergency care of children with medical complexity, which account for approximately 20% of all pediatric emergency department (ED) visits and 33% of all healthcare spending among children. Dr. Pulcini’s project goal is to optimize and implement a user-centered emergency care planning tool to improve outcomes for infants with medical complexity (notably those in rural areas), a particularly vulnerable subset of this patient population. Under the first aim of the proposal, Dr. Pulcini will optimize an existing emergency care planning tool that, despite advocacy for children with medical complexity by two professional societies, has been poorly implemented to date. Dr. Pulcini will optimize the emergency care planning tool for infants with medical complexity through iterative semi-structured and targeted interviews and surveys of tool users: providers, local interdisciplinary collaborators, and families. Under the second aim, Dr. Pulcini will design and conduct a randomized feasibility trial of the user-centered emergency care planning tool’s implementation, measuring resultant emergency health care outcomes. As part of the trial implementation process, Dr. Pulcini will monitor barriers to implementation, as well as measure key emergency health service research measures with plans for cost-effectiveness analysis for a full-scale future randomized controlled trial to be submitted as an R01. Dr. Pulcini’s training program is focused on dissemination and implementation (D&I) science, supplemented with training in clinical trials and health services measure development. The training in D&I science builds upon Dr. Pulcini’s previous training in pediatric emergency medicine and maternal and child health. Dr. Pulcini’s research will be supported by an accomplished group of mentors with expertise in D&I science, clinical trials, pediatric emergency medicine and health services research. His mentors are dedicated to ensuring his career development into an independent clinical investigator through successful conduct of the proposed project and training plan. By providing Dr. Pulcini with the skills and mentored experience necessary to complete this proposal, he will be well positioned to succeed as an independent scientist and significantly improve the emergency care of children with medical complexity.