Optimizing Pediatric Subspecialty Care Through Telemedicine and e-Consultations

通过远程医疗和电子咨询优化儿科亚专科护理

• 批准号: 9313025
• 负责人: Kristin N Ray
• 金额: $ 15.6万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 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 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9313025
• 关键词: Address; Age; Applications Grants; Attitude; Belief; Caring; Child; Child Care; Child health care; Childhood; Chronic; Chronic Disease; Clinic; Clinical Informatics; Communication; Complex; Consultations; Data; Data Set; Databases; Decision Making; Diffusion; Ensure; Ethnic Origin; Face; Future; General Practitioners; Geography; Goals; Health; Health Services; Health Services Accessibility; Healthcare; Home environment; Improve Access; Intervention; Lead; Medicaid; Medical center; Mentors; Mentorship; Methods; Mission; National Institute of Child Health and Human Development; Outcome; Parents; Patient Care; Patients; Pattern; Pennsylvania; Persons; Physicians; Population; Primary Health Care; Quality of Care; Race; Randomized Controlled Trials; Research; Research Personnel; Resources; Role; Rural; Site; Statistical Models; Surveys; System; Technology; Telemedicine; Time; Training; Underinsured; Underserved Population; United States; Visit; Visual; Vulnerable Populations; Work; base; beneficiary; care delivery; care systems; career development; cost; didactic education; disparity reduction; education research; experience; health care delivery; health disparity; implementation science; improved; improved outcome; individual patient; innovation; insight; minority children; new technology; novel; novel strategies; patient oriented; skills; socioeconomic disparity; socioeconomics; therapy design; tool

Over one quarter of children in the United States live with chronic health conditions. Many of these children require care from pediatric subspecialist physicians. However, 24% of children in need of subspecialty care have difficulty accessing this care due to geographic and socioeconomic barriers. Telemedicine is a novel approach for overcoming these barriers by delivering pediatric subspecialty across a distance using two-way audio-visual technology. Early data suggest that telemedicine has great potential to expand access and reduce disparities in pediatric subspecialty care. Yet much about telemedicine is poorly understood, with few studies examining how it is currently used or how to use it more effectively. Such data are important because uncritical expansion of telemedicine poses potential harms as well as potential benefits, including the potential for inappropriate use, unnecessary overuse, or exacerbated disparities if new technology is afforded to only a subset of the population. A critical need exists to identify current determinants of telemedicine use, barriers to use, and optimal strategies to ensure appropriate use by integrating subspecialty telemedicine into the patient- centered medical home. The overall goal of this study is to develop actionable strategies to advance the delivery of pediatric subspecialty care through telemedicine to overcome disparities and improve child health. In Aim 1, we will determine patient, subspecialist, primary care, and system-level factors associated with the use of telemedicine for ambulatory pediatric subspecialty care through analysis of a large, state-wide Medicaid database. In Aim 2, we will identify physician-perceived barriers to use of telemedicine for ambulatory pediatric subspecialty care through a national survey. In Aim 3, we will use data from prior aims along with clinician and parent input to develop a generalist-subspecialist e-consultation platform to improve appropriate use of telemedicine for ambulatory pediatric subspecialty care. Through these aims, we will significantly improve our understanding of the role of telemedicine in improving access to care for children with chronic conditions, setting the stage for future interventions to optimize outcomes through appropriate telemedicine use. With guidance from committed mentors and strong institutional support, the PI will also receive the necessary intensive mentorship, didactic education, and research experience to become an independent investigator, supporting career development objectives in advanced statistical modelling, implementation science, and clinical informatics. This work will provide essential preliminary data to support future grant applications to examine the impact of telemedicine use in observational data and to perform a pilot randomized controlled trial of the e-consultation platform developed herein. With these new skills and novel preliminary data, the PI will be poised to lead large studies to examine and improve the diffusion and impact of innovations in pediatric health care delivery, ultimately improving outcomes for children in need of subspecialty care and furthering NICHD’s mission of ensuring that all children achieve their full potential for healthy and productive lives.

美国超过四分之一的儿童患有慢性疾病。这些孩子中有很多 需要儿科专科医生的护理。然而，24% 的儿童需要亚专业护理 由于地理和社会经济障碍，难以获得这种护理。远程医疗是一本小说 通过使用双向方式远距离提供儿科专科服务来克服这些障碍的方法 视听技术。早期数据表明，远程医疗在扩大服务范围和减少医疗费用方面具有巨大潜力。 儿科专科护理方面的差异。然而，人们对远程医疗的了解还很有限，研究也很少 检查当前如何使用它或如何更有效地使用它。这些数据很重要，因为不重要 远程医疗的扩展既带来了潜在的危害，也带来了潜在的好处，包括潜在的 如果新技术仅提供给少数人，则会导致不当使用、不必要的过度使用或加剧差距 人口的子集。迫切需要确定远程医疗使用的当前决定因素、障碍 通过将专科远程医疗整合到患者中来确保适当使用的最佳策略 以医疗之家为中心。本研究的总体目标是制定可行的策略来推进 通过远程医疗提供儿科专科护理，以克服差距并改善儿童健康。 在目标 1 中，我们将确定与患者、亚专科医生、初级保健和系统级因素相关的因素。 通过对大型全州医疗补助的分析，将远程医疗用于门诊儿科专科护理 数据库。在目标 2 中，我们将确定医生认为在门诊儿科中使用远程医疗的障碍 通过全国调查进行亚专科护理。在目标 3 中，我们将与临床医生一起使用先前目标的数据 家长投入开发通才-亚专科电子咨询平台，以改善对孩子的适当使用 用于门诊儿科亚专科护理的远程医疗。通过这些目标，我们将显着提高我们的 了解远程医疗在改善患有慢性病的儿童获得护理方面的作用， 为未来的干预措施奠定基础，通过适当的远程医疗使用来优化结果。和 来自忠诚导师的指导和强大的机构支持，PI 还将获得必要的 密集的指导、教学教育和研究经验，成为一名独立调查员， 支持高级统计建模、实施科学和 临床信息学。这项工作将为支持未来的拨款申请提供必要的初步数据 检查远程医疗使用对观察数据的影响并进行试点随机对照试验 本文开发的电子咨询平台。凭借这些新技能和新颖的初步数据，PI 将 准备领导大型研究，以检查和改善儿科健康创新的传播和影响 护理服务，最终改善需要专科护理的儿童的治疗效果，并促进 NICHD 的发展 确保所有儿童充分发挥潜力，过上健康和富有成效的生活。