Hospital Management of Acute Respiratory Illness in Children with Neurologic Impairment.

神经损伤儿童急性呼吸系统疾病的医院管理。

• 批准号: 9282865
• 负责人: Joanna Thomson
• 金额: $ 14.85万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-04-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9282865
• 关键词: Hospital; Management; Acute; Respiratory; Illness

PROJECT SUMMARY Joanna Thomson, MD, MPH is a pediatrician in hospital medicine whose overarching career goal is to optimize the care and outcomes of children with neurologic impairment (NI). Acute respiratory illnesses (ARI, e.g., pneumonia, bronchiolitis) are among the most common reasons for hospitalization, intensive care unit admission and death for children with NI. Yet, there are currently no evidence-based or consensus-driven recommendations to guide hospital management of this population. In this proposal, Dr. Thomson seeks to identify management practices (e.g., airway clearance strategies) associated with better hospital outcomes and to then develop and implement care recommendations for the hospital management of ARI in children with NI. Recommendations for hospital management of ARI in children with NI will allow for standardization of care and optimization of patient outcomes. Such standardization for otherwise healthy children has resulted in decreased unwarranted testing and therapies while improving patient outcomes and decreasing cost of care Candidate: Dr. Thomson is an Assistant Professor of Pediatrics in the Division of Hospital Medicine and James M. Anderson Center for Health Systems Excellence at Cincinnati Children's Hospital Medical Center (CCHMC). She completed a four-year combined Hospital Medicine and NRSA General Academic Pediatrics Research fellowship. As part of her fellowship training, she obtained a Master of Public Health degree in Clinical Effectiveness at the Harvard University School of Public Health. She has conducted multiple studies focused on the care and outcomes of children with NI. The proposed K08 career development plan will build upon her fellowship training to address four areas where she requires additional development to enhance her trajectory toward becoming an independent investigator: 1) comparative effectiveness research methods, 2) patient-centered participatory research methods, 3) design and study of complex clinical interventions, and 4) the conduct of multicenter research. The proposed training will provide Dr. Thomson with the necessary expertise and skills to conduct multicenter clinical trials implementing evidence-based care recommendations. Mentors/Environment: Dr. Thomson has assembled a mentorship team with clinical expertise in pediatric ARI (Shah) and chronic and complex care (Britto, Berry). Her mentors additionally provide methodologic expertise in comparative effectiveness research (Shah, Berry), patient-centered participatory research (Shah, Britto), implementation science (Britto, Srivastava), and multicenter pediatric research (Shah, Berry, Srivastava). The proposed career development plan utilizes the broad intellectual resources available through CCHMC and the University of Cincinnati, as well as focused national seminars to complement local training. CCHMC is committed to supporting junior faculty members through structured opportunities for education, networking, and internal grant funding. The Division of Hospital Medicine at CCHMC provides Dr. Thomson with extensive support including computers and software, biostatistical advisors, data management support, clinical research coordinators, grants management support, and discretionary funds. Dr. Thomson is also a member of CCHMC's James M. Anderson Center for Health Systems Excellence, a nationally renowned for its research on improving pediatric health care delivery. Research: Despite the importance of ARI to health outcomes of children with NI, there are currently no recommendations to guide hospital management of ARI for this high-risk population. This proposal will begin to fill that gap. Aim 1 will augment the AHRQ-funded Pediatric Health Information Systems Plus (PHIS+) database with target medical record review to compare the effectiveness of common hospital management practices (e.g., airway clearance strategies, inhaled beta agonists, corticosteroids). Aim 2 will bring together parents of children with NI and expert clinicians to critically review existing evidence and develop care recommendations for hospital management of ARI using the RAND-UCLA Appropriateness Method. Aim 3 will test the face validity, acceptability, and feasibility of implementing the care recommendations at a single hospital as well as evaluate the preliminary efficacy of care recommendations. This research will result in family and clinician co-developed care recommendations and tools for effective implementation into the clinical care of children with NI hospitalized with ARI. Summary: This proposed innovative research will expand the evidence base for the management of ARI in children with NI. Partnering with families of children with NI and clinical experts, care recommendations will be developed and implemented. The resulting set of tested implementation strategies will facilitate efficient spread of clinical change in future work. Aligned with AHRQ's mission, this work will be an important contribution to improving the quality, efficiency, and effectiveness of care delivered to children with NI. Dr. Thomson's research and clinical training, prior research experiences, and dedicated mentorship team make her ideally suited to pursue this research. This award will facilitate Dr. Thomson's continued development into an independent investigator in the conduct of multicenter patient-centered outcomes research and a national leader in optimizing the care and outcomes of children with NI.

项目摘要 乔安娜汤姆森，医学博士，公共卫生硕士是在医院医学儿科医生，其首要的职业目标是优化 儿童神经功能缺损（NI）的护理和结果。急性呼吸道疾病（ARI，例如， 肺炎、细支气管炎）是住院、重症监护室 新生儿的入院和死亡。然而，目前还没有基于证据或共识的 建议指导医院对这一人群的管理。在这份提案中，汤姆森博士试图 确定管理实践（例如，气道清除策略）与更好的医院结局相关， 然后制定和实施护理建议，医院管理急性呼吸道感染的儿童与NI。 建议医院管理急性呼吸道感染的儿童与NI将允许标准化的护理， 优化患者治疗效果。这种对健康儿童的标准化导致了 减少不必要的检查和治疗，同时改善患者的预后并降低护理成本 候选人：汤姆森博士是医院医学部儿科助理教授， James M.辛辛那提儿童医院医疗中心的安德森卫生系统卓越中心 （CCHMC）。她完成了为期四年的综合医院医学和NRSA一般学术儿科 研究奖学金。作为她的奖学金培训的一部分，她获得了公共卫生硕士学位， 哈佛大学公共卫生学院的临床有效性。她进行了多项研究， 重点关注NI儿童的护理和结果。建议的K 08职业发展计划将 在她的奖学金培训，以解决四个领域，她需要额外的发展，以提高她的 成为独立研究者的轨迹：1）比较有效性研究方法，2） 以患者为中心的参与式研究方法，3）设计和研究复杂的临床干预措施，以及4） 进行多中心研究。拟议的培训将为汤姆森博士提供必要的 专业知识和技能，进行多中心临床试验，实施循证护理建议。 导师/环境：Thomson博士组建了一个具有儿科ARI临床专业知识的导师团队 （沙阿）和慢性和复杂的护理（布里托，贝瑞）。她的导师还提供方法论方面的专业知识 比较有效性研究（Shah，Berry），以患者为中心的参与性研究（Shah，Britto）， 实施科学（Britto，Srivastava）和多中心儿科研究（Shah，Berry，Srivastava）。的 拟议的职业发展计划利用了CCHMC和 辛辛那提大学，以及重点国家研讨会，以补充当地培训。CCHMC是 致力于通过结构化的教育机会，网络， 内部资助。CCHMC的医院医学部为Thomson博士提供了广泛的 支持，包括计算机和软件、生物统计顾问、数据管理支持、临床研究 协调员、赠款管理支助和自由支配资金。汤姆森博士也是 CCHMC的James M.安德森卫生系统卓越中心，一个全国著名的研究 致力于改善儿科医疗服务。 研究：尽管ARI对NI儿童的健康结果很重要，但目前还没有 建议，以指导该高危人群的ARI医院管理。这项提案将开始， 填补这个空白。Aim 1将加强AHRQ资助的儿科健康信息系统（PHIS+） 数据库与目标病历回顾比较普通医院管理的效果 实践（例如，气道清除策略、吸入性β激动剂、皮质类固醇）。目标2将汇集 NI儿童的父母和专家临床医生批判性地审查现有证据并制定护理 使用RAND-UCLA适当方法对ARI的医院管理提出建议。目标3将 测试表面有效性，可接受性，以及在一个单一的实施护理建议的可行性 医院以及评估护理建议的初步疗效。这项研究将导致 家庭和临床医生共同制定护理建议和工具，以便有效实施到临床中 护理因ARI住院的NI儿童。 总结：这项创新性研究将扩大急性呼吸道感染管理的证据基础， 孩子们与你与NI儿童家庭和临床专家合作，将提供护理建议， 制定并实施。由此产生的一套经过测试的实施战略将有助于有效传播 未来工作中的临床变化。这项工作符合人权咨商局的使命，将对下列工作作出重要贡献： 提高为患NI的儿童提供的护理的质量、效率和有效性。汤姆森博士 研究和临床培训，先前的研究经验，以及专门的导师团队使她成为理想的 适合从事这项研究。该奖项将促进汤姆森博士继续发展成为 进行多中心以患者为中心的结局研究的独立研究者和国家 在优化NI儿童的护理和成果方面的领导者。