Maternal, Clinician & Hospital Factors in Breastmilk for Premature Infants

产妇、临床医生

• 批准号: 8598488
• 负责人: Henry Chong Lee
• 金额: $ 13.01万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-01-05 至 2015-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8598488
• 关键词: Address; Adopted; Age; Applications Grants; Behavioral; Birth; Breast; Breast Feeding; California; Caring; Case Study; Clinical; Clinical Research; Clinical Trials; Counseling; Data; Data Collection; Data Set; Demographic Factors; Development; Education; Environmental Risk Factor; Epidemiology; Equipment; Failure; Goals; Growth; Health Policy; Health Services Research; Home environment; Hospitalization; Hospitals; Hour; Human Milk; Immune; Infant; Infant Care; Information Technology; Institutes; Intervention; Intervention Trial; Interview; K-Series Research Career Programs; Knowledge; Lactation; Lead; Leadership; Left; Link; Literature; Maintenance; Medical; Medicine; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Milk; Modeling; Morbidity - disease rate; Mothers; Necrotizing Enterocolitis; Neonatal Intensive Care Units; Neonatology; Observational Study; Patients; Perinatal; Persons; Pharmaceutical Preparations; Physical activity; Physician Executives; Policies; Population; Premature Birth; Premature Infant; Procedures; Property; Publishing; Pump; Qualitative Research; Quality of Care; Race; Research; Research Methodology; Research Personnel; Resources; Retinopathy of Prematurity; Risk; San Francisco; Structure; Surveys; System; Techniques; Testing; The Sun; Time; Training; Universities; Variant; base; career; clinical practice; design; effective intervention; feeding; high risk; implementation science; improved; innovation; medically underserved; nutrition; patient safety; prevent; professor; racial and ethnic disparities; success; therapy design

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.

描述（由申请人提供）：这是加州大学旧金山分校的新生儿学家 Henry Chong Lee 博士的 K23 奖项的修订申请。李博士正在将自己定位为新生儿学质量改进临床研究的年轻研究者。该K23奖项将为李博士提供实现以下目标所需的支持：（1）成为调查和定性研究方法方面的专家； （二）开展早产儿母乳喂养影响因素的临床调查； (3) 至 收集数据以设计促进早产儿母乳喂养的干预措施； (4) 在新生儿学质量改进研究方面取得领导地位； (5)发展独立的临床研究事业。为了实现这些目标，李博士组建了一个指导团队，由主要导师 R. Adams Dudley 博士组成，他是加州大学旧金山分校医学与卫生政策教授，大规模卫生服务研究领域的领导者；两位共同导师：Jeffrey Gould 博士，新生儿学家和斯坦福大学教授， 质量改进方面的杰出领导者和研究员、加州围产期质量护理合作组织主任，以及加州大学旧金山分校卫生政策研究所定性研究方法专家 Daniel Dohan 博士；以及四位科学顾问：Jane Morton 博士（早产儿母乳喂养和母乳供应方面的专家）、Yao Sun 博士（加州大学旧金山分校新生儿科医学主任、信息技术专家，关心患者安全和护理质量）、Ralph Gonzales（加州大学旧金山分校医学、流行病学和生物统计学教授、实施科学专家）和 Anna N?poles 博士（美国加州大学旧金山分校新生儿科专家）。 医疗保健中民族和种族差异方面的专家。母乳被认为是早产儿的最佳喂养选择，因为它可以预防坏死性小肠结肠炎等严重疾病。然而，许多早产儿在出院回家时还没有接受母乳喂养。早产儿的母乳供应因社会人口和医疗因素而异，并且因医院而异。李博士的研究将重点关注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对母亲的调查研究进行定性研究，以探讨与吸乳/喂养实践相关的母亲因素，重点关注早期咨询和环境因素的影响。在目标 2 中，李博士将采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 100 多家医院进行全州范围的调查，研究哪些临床实践与早产儿母乳供应率较高或较低相关。这项研究将构成制定试点干预措施的基础，该试点干预措施将在 K 奖期间的 R03 拨款申请中提出，以及随后在 K 奖结束时的 R01 拨款申请中提出的促进早产儿母乳喂养的多中心干预措施。