Maternal, Clinician & Hospital Factors in Breastmilk for Premature Infants

描述(由申请人提供)：这是加州大学旧金山分校的新生儿专家Henry Chong Lee博士的K23奖项的修改后的申请。李博士在新生儿质量改进的临床研究中确立了自己作为一名年轻研究员的地位。K23奖项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方面的专家；(2)对早产儿母乳喂养的影响因素进行临床调查；(3) 收集数据的目的是设计促进早产儿母乳喂养的干预措施；(4)在新生儿质量改进研究方面取得进展；(5)发展独立的临床研究事业。为了实现这些目标，Lee博士组建了一个导师团队，成员包括主要导师R·亚当斯·达德利博士，加州大学旧金山分校医学和卫生政策教授，大型卫生服务研究的领导者；两名共同导师：新生儿专家兼斯坦福大学教授杰弗里·古尔德博士 他们有三位杰出的科学家和专家：加州大学旧金山分校质量改进和研究中心主任及加州大学附属医院围产期质量护理合作中心主任And Daniel Dohan博士；以及四位科学顾问：加州大学旧金山分校母乳喂养和母乳供应专家Jane Morton博士、关心患者安全和护理质量的加州大学旧金山分校新生儿科医务主任和信息技术专家孙瑶博士、加州大学旧金山分校医学和流行病学及生物统计学教授Ralph Gonzales和医疗护理中种族差异问题专家Anna Népoles博士。母乳被确定为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。尽管如此，许多早产儿出院回家时还没有喂奶。为早产儿提供的母乳因社会人口和医疗因素而异，并因医院而异。Lee博士的研究将侧重于影响早产儿母乳喂养的产妇、临床医生和医院因素。他的研究结果将为设计干预措施提供参考 促进早产儿母乳喂养。在目标1中，Lee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，以探索与抽吸/喂养做法有关的母亲因素，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会影响早产儿的母乳喂养。在《目标3》中，李博士 他将对加利福尼亚州的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的高低有关。这项研究将形成将在K奖期间R03拨款申请中提出的试点干预措施，以及随后将在K奖结束时R01拨款申请中提议的促进早产儿母乳喂养的多中心干预措施的开发基础。

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.