Access to Pediatric Voice Therapy: A Telehealth Solution

描述（由申请人提供）：患有声音障碍（语音障碍）的儿童在社会和教育方面处于明显的劣势，并且很难获得适当的诊断和治疗服务。儿童语音障碍与社会退缩和抑郁有关，对社会、情感、教育和职业结果产生负面影响。声音（语音）和视觉数据的安全互联网传输正在成为增加患者获得专业联合卫生服务的有效手段，但儿童声音障碍的治疗尚不包括在内。鉴于需要获得高度专业化的临床技能，个别语音治疗适合这种成人护理模式，将远程医疗概念扩展到儿科语音障碍的治疗是一个新颖的，尽管合乎逻辑的步骤。本研究的目的是确定通过安全电话会议和基于web的系统使用远程医疗解决方案提供儿科语音治疗的可行性。我们还将收集初步疗效数据，并仔细评估患者、家属和儿科语音护理专家对远程医疗的使用情况。激励假设是，通过远程医疗对儿科语音护理采取知情、可行和个性化的方法是可能的，并将改善患者获得高质量护理的机会，并为自我管理和临床监测提供更大的机会。该应用程序响应PAR-08-269列出的文档标准。它旨在支持以病人为中心的护理和跨环境提供护理（例如，从医院到家庭的服务）。这项调查旨在为更大的R01应用程序收集初步数据。从长远来看，我们的目标是证明这种服务提供模式可以标准化，并用于始终如一地提供高水平的护理，评估治疗结果并减少儿童声音障碍的慢性性质。随着时间的推移，它可以应用于其他儿童交流障碍。我们预计，远程保健方法还将减轻家庭在就医、旅行和治疗方面的负担

DESCRIPTION (provided by applicant): Children with voice disorders (dysphonia) are at a distinct social and educational disadvantage and access to adequate services for diagnosis and treatment can be difficult. Childhood dysphonia is associated with social withdrawal and depression that can negatively influence social, emotional, educational and occupational outcomes. Secure Internet transmission of voice (speech) and visual data is emerging as an effective means by which to increase patient access to specialized allied health services but treatment of childhood voice disorders is not yet among them. Given the need for access to highly specialized clinical skills, the documented suitability of individual voice therapy to this model of care in adults, extending the telehealth concept to treatment of pediatric voice disorders is a novel, albeit logical step. The purpose of this study is to determine the feasibilit of using a telehealth solution for delivering pediatric voice therapy via secure teleconferencing and Web-based systems. We will also gather preliminary efficacy data and carefully evaluate the use of telehealth by patients, families and pediatric voice care specialists. The motivating hypothesis is that an informed, feasible and personalized approach to pediatric voice care via telehealth is possible and will result in improved patient access to quality care and result in greater opportunity for self management and clinical monitoring. This application responds to the documented criteria listed for PAR-08-269. It aims to support patient centered care and the delivery of care across settings (e.g., hospital based service to home). This investigation is intended to collect preliminary data for a larger R01 application. Long-term we aim to prove that this model of service delivery can be standardized and used to consistently deliver a high level of care, evaluate treatment outcomes and reduce the chronic nature of childhood voice disorders. In time its application to other childhood communication disorders can be made. We expect that a telehealth approach will also relieve a family's burden related to access, travel and the complex nature of family schedules and scheduling therapy. We plan to accomplish the objectives of this application by the following specific aims: 1). Test a pilot program of personalized voice therapy in ten children using a telehealth approach. Assessing the quality and stability of synchronous Internet and Web-based audio/video data transmission and measuring progress in therapy will be the principal components of this aim; and 2). Explore the personal and interpersonal benefits and obstacles surrounding delivery of pediatric voice therapy using telehealth. Outcome measures will include satisfaction, compliance, and cost. We will also seek to identify what adaptations are needed to deliver voice therapy via the Internet. Our findings will provide proof of systems capability and reliability relative to the needed technical equipment, reliability of Internet operations and Web-portal access for this type of patient care. At the conclusion of this project we will be able to inform traditional healthcare an telehealth professionals about the ability of our patients to the use technology as an essential ingredient of their care. We will have the necessary preliminary data to develop a large outcomes based efficacy study that compares face to face (FTF) and telehealth (TH) options for this important population.