Risk Stratification Using Physiologic Markers and Mobile Health-Facilitated Specialist Management to Improve Outcomes in Pediatric Concussion Patients

使用生理标志物和移动健康促进的专家管理进行风险分层，以改善小儿脑震荡患者的预后

• 批准号: 10506503
• 负责人: Daniel Corwin
• 金额: $ 21.55万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10506503
• 关键词: 18 year old; Accident and Emergency department; Acute; Adoption; Age; Applied Research; Area; Award; Biometry; Brain Concussion; Caring; Child; Childhood; Clinic; Clinical; Clinical Trials; Cognitive; Communication; Continuity of Patient Care; Data; Development; Diagnosis; Discrimination; Early Intervention; Ecological momentary assessment; Ecosystem; Emergency Care; Emergency Department Physician; Emergency Department patient; Emergency Medicine; Emotional; Enrollment; Environment; Family; Female; Functional disorder; Goals; Hand; Health Technology; Health system; Hour; Incidence; Individual; Injury; Institution; Intervention; Judgment; Measures; Mentors; Methodology; Methods; Modeling; Monitor; Morbidity - disease rate; Nature; Observational Study; Outcome; Patients; Pediatric Hospitals; Pennsylvania; Performance; Persons; Philadelphia; Physicians; Physiological; Population; Positioning Attribute; Post-Concussion Syndrome; Prevention; Provider; ROC Curve; Recommendation; Recovery; Registries; Research; Resources; Rest; Risk; Risk Assessment; Risk Factors; Science; Scientist; Specialist; Sports Medicine; Symptoms; System; Time; Training; Underrepresented Minority; Universities; Work; Youth; barrier to care; base; career; career development; clinical center; clinical epidemiology; comorbidity; cost; design; disability; effectiveness evaluation; efficacy evaluation; efficacy outcomes; evidence base; experience; health economics; high risk; improved; improved outcome; innovation; mHealth; male; medical specialties; novel; novel therapeutics; patient oriented research; pediatric emergency; persistent symptom; predictive modeling; prevent; prospective; public health insurance; reduce symptoms; research and development; risk stratification; sex; skills; standard of care; symptomatology; targeted delivery; telehealth; tool; usability

Candidate: My long-term career goal is to reduce the cognitive, physical, and emotional morbidity following pe- diatric concussion by implementing early interventions to those at highest risk for persistent post-concussion symptoms (PPCS). With 75% of my time dedicated to patient-oriented research and career development, my short-term goals are to develop a predictive model to most accurately identify those patients at highest risk of developing PPCS, and to use a novel mobile health (mHealth) intervention to improve specialist access from the emergency department (ED) setting. This proposal builds on my prior work in researching objective mark- ers of dysfunction following concussion, and will position me to gain skills in advanced predictive modeling to facilitate early risk stratification, utilizing advanced mHealth-based interventions to facilitate care continuity and positioning such interventions for adoption and sustainability, and designing and leading clinical trials from the ED setting that utilize innovative methods to create the evidence base for mHealth intervention adoption. Environment: This proposal leverages the substantial resources available to me at Children’s Hospital of Phila- delphia, through the Division of Emergency Medicine, Center for Injury Research and Prevention, Innovation Ecosystem, and Sports Medicine and Performance Center; at The University of Pennsylvania, through the Center for Clinical Epidemiology and Biostatistics, The Penn Injury Science Center, and the Leonard Davis In- stitute of Health Economics; and through the Pediatric Emergency Care Applied Research Network. The men- tored research experience and formal didactic training, in addition to the clinical experience of practicing in a quaternary care pediatric ED, create an ideal environment for my ongoing career development. Research: Concussions are prevalent injuries in the pediatric population. While the majority of symptoms in concussed youth resolve within 1 month, a significant proportion (30%) experience symptoms lasting months to even years. Several observational studies have identified risk factors associated with PPCS, however the best current methods to risk stratify concussed youth do so with only moderate discrimination, and are heavily reliant on subjective symptoms. In addition, while traditionally, pediatric concussions were managed with pas- sive rest, more recently, active therapies have become the standard of care in the specialty setting. However, the traditional referral model presents several barriers to care continuity and specialist access for ED concus- sion patients. Novel mHealth interventions have the potential to improve care continuity, serving as a bridge between care settings for concussed youth. In order to facilitate improved care and ultimately reduce symptom burden to highest risk children, this proposal aims to: (1) Improve accuracy of concussion risk stratification from the ED using physiologic markers of injury; and (2) Assess the feasibility of a mHealth tool to facilitate specialist access and care continuity. Study results will allow me to develop a R01 proposal of a clinical trial evaluating the effectiveness of mHealth-facilitated targeted referral to reduce the incidence of PPCS.

候选人：我的长期职业目标是减少体育运动后的认知、身体和情绪方面的发病率。 对持续性脑震荡高危人群实施早期干预治疗儿童脑震荡 症状(PPCS)。我75%的时间都致力于以患者为中心的研究和职业发展，我的 短期目标是开发一种预测模型，以最准确地识别那些风险最高的患者 开发PPCS，并使用一种新的移动健康(MHealth)干预措施来改善专家从 急诊科(ED)设置。这项建议建立在我之前研究客观标志的工作基础上- 脑震荡后的功能障碍者，并将使我获得高级预测建模方面的技能 促进早期风险分层，利用基于mHealth的高级干预措施促进护理连续性和 将这些干预措施定位为采用和可持续发展，并设计和领导来自 ED设置，利用创新的方法为mHealth干预措施的采用创造证据基础。 环境：这项建议利用了我在菲拉儿童医院的大量资源- 德尔菲亚，通过损伤研究和预防中心急诊医学部，创新 生态系统、运动医学和运动表现中心；在宾夕法尼亚大学，通过 临床流行病学和生物统计中心，宾夕法尼亚伤害科学中心，以及伦纳德·戴维斯在- 卫生经济研究所；并通过儿科急救应用研究网络。男人们- 有丰富的研究经验和正规的教学培训，以及在医院实习的临床经验。 第四届儿科护理教育，为我的职业发展创造了一个理想的环境。 研究：脑震荡是儿科人群中常见的伤害。而大多数的症状在 脑震荡青年在1个月内消退，有相当比例(30%)的人症状持续数月 甚至是几年。一些观察性研究已经确定了与PPCS相关的风险因素，然而 目前对脑震荡青年进行风险分层的最佳方法只有中度歧视，而且严重 依赖于主观症状。此外，虽然传统上，儿科脑震荡是通过PAS- 最近，积极的休息疗法已经成为专科环境中的标准护理。然而， 传统的转诊模式对急诊中心的护理连续性和专科医生准入构成了几个障碍。 锡安病人。新的移动健康干预措施有可能提高护理的连续性，成为一座桥梁 在脑震荡青少年的护理环境之间。为了促进改善护理并最终减少症状 为了给高危儿童带来负担，这项建议旨在：(1)提高脑震荡风险分层的准确性 使用损伤的生理标记从ED获得；以及(2)评估mHealth工具的可行性，以促进 专科医生准入和护理连续性。研究结果将使我能够制定一项临床试验的R01建议 评估mHealth促进的定向转诊降低PPCS发生率的有效性。