Maternal, Clinician & Hospital Factors in Breastmilk for Premature Infants

描述（由申请人提供）：这是一份修改后的K23奖申请，申请人是弗朗西斯科加州大学的医学家亨利·李。李医生正在建立自己作为一个年轻的研究者在临床研究的质量提高在口腔医学。这项K23奖将为李博士提供必要的支持，以实现以下目标：（1）成为调查和定性研究方法的专家;（2）对影响早产儿母乳喂养的因素进行临床调查;（3） 收集数据，以设计一种干预措施，促进早产儿母乳喂养;（4）在产科质量改进研究中发挥领导作用;（5）发展独立的临床研究生涯。为了实现这些目标，李博士组建了一个由主要导师R。亚当斯达德利，医学和卫生政策教授在加州大学旧金山分校，在大规模的卫生服务研究的领导者;两个共同导师：杰弗里古尔德博士，一个病理学家和教授在斯坦福大学， 杰出的领导者和研究人员在质量改进和主任的加州围产期质量护理协作，和博士丹尼尔Dohan，在定性研究方法的专家在卫生政策研究所在加州大学旧金山分校;和四个科学顾问：简·莫顿博士，母乳喂养和早产儿母乳供应专家，孙耀博士，加州大学旧金山分校新生儿科医学主任和信息技术专家，关注患者安全和护理质量，加州大学旧金山分校医学和流行病学与生物统计学教授拉尔夫冈萨雷斯，实施科学专家，和安娜N博士波兰人，一位研究医疗保健中民族和种族差异的专家。母乳被确定为早产儿的最佳喂养选择，因为它可以预防严重的疾病，如坏死性小肠结肠炎。然而，许多早产儿在出院回家时没有母乳喂养。早产儿的母乳供应因社会人口和医疗因素而异，因医院而异。李博士的研究将集中在影响早产儿母乳喂养的母亲，临床医生和医院因素。他的研究结果将为干预措施的设计提供信息， 促进早产儿母乳喂养。在目标1中，李博士将使用半结构化访谈和母亲调查研究进行定性研究，以探讨与抽水/喂养实践相关的母亲因素，重点是早期咨询和环境因素的影响。在目标2中，李博士将使用高绩效和低绩效医院的案例研究方法来确定哪些医院因素影响早产儿的母乳喂养。在目标3中，李博士 将对加州的100多家医院进行全州范围的调查，其中他将研究哪些临床实践与早产儿母乳供应率的较高或较低相关。这项研究将成为K奖期间R 03赠款申请中提出的试点干预措施的基础，以及随后的多中心干预措施，以促进早产儿母乳喂养，并在K奖结束时提出R 01赠款申请。

DESCRIPTION (provided by applicant): This is a revised application for a K23 award for Dr. Henry Chong Lee, a neonatologist at the University of California, San Francisco. Dr. Lee is establishing himself as a young investigator in clinical research of quality improvement in neonatology. This K23 award will provide Dr. Lee with the support necessary to accomplish the following goals: (1) to become expert at survey and qualitative research methods; (2) to conduct clinical investigations of the factors influencing breast milk feeding in premature infants; (3) to gather data for the purpose of designing an intervention to promote breast milk feeding in premature infants; (4) to progress in leadership in quality improvement research in neonatology; and (5) to develop an independent clinical research career. To achieve these goals, Dr. Lee has assembled a mentoring team comprised of primary mentor Dr. R. Adams Dudley, Professor of Medicine and Health Policy at UCSF, a leader in largescale health services research; two co-mentors: Dr. Jeffrey Gould, a neonatologist and Professor at Stanford, a distinguished leader and researcher in quality improvement and Director of the California Perinatal Quality Care Collaborative, and Dr. Daniel Dohan, an expert in qualitative research methods in the Institute of Health Policy Studies at UCSF; and four scientific advisors: Dr. Jane Morton, an expert in breastfeeding and breast milk provision for premature infants, Dr. Yao Sun, Medical Director of the Division of Neonatology at UCSF and expert in information technology, who is concerned with patient safety and quality of care, Ralph Gonzales, Professor of Medicine and Epidemiology & Biostatics at UCSF, an expert in Implementation Sciences, and Dr. Anna N¿poles, an expert in ethnic and racial disparities in medical care. Breast milk is established as the optimal feeding choice for premature infants as it prevents serious morbidities such as necrotizing enterocolitis. Nevertheless, many premature infants are not being fed breast milk by the time they are discharged home from the hospital. Breast milk provision for premature infants varies by socio-demographic and medical factors and varies widely by hospital. Dr. Lee's research will focus on the maternal, clinician, and hospital factors that impact breast milk feeding of premature infants. The results of his study will inform the design of an intervention to promote breast milk feeding in premature infants. In Aim 1, Dr. Lee will perform a qualitative study using semi-structured interviews and a survey study of mothers to probe maternal factors related to pumping/feeding practices, focusing on the impact of early counseling and environmental factors. In Aim 2, Dr. Lee will use a case study approach of high-performing and low-performing hospitals to determine what hospital factors impact breast milk feeding of premature infants. In Aim 3, Dr. Lee will perform a statewide survey of more than 100 hospitals in California, in which he will study what clinical practices were associated with higher or lower rates of breast milk provision in premature infants. This research will form the basis for development of a pilot intervention to be proposed in an R03 grant application during the K award, and a subsequent multi-center intervention to promote breast milk feeding in premature infants, to be proposed in an R01 grant application at the end of the K award.