A novel telemedicine optimized burn intervention (TOBI) for pediatric burn-injured patients and their caregivers

摘要摘要 这个K23奖项的目标是提供必要的培训和研究经验，使我成为一名 开发以技术为基础的资源以提高护理质量的领先研究人员 儿科外科患者及其家属。因为烧伤患者和他们的照顾者通常活得很长 由于距离区域烧伤中心很远，获得专家烧伤护理的机会有限，从而对 坚持治疗，伤口并发症的风险更高。根据我们门诊的临床经验 在烧伤诊所，我设计并试用了TOBI，这是一款智能手机应用程序，旨在使烧伤专家能够指导烧伤 当病人和护理人员在家时，通过短信和视频会议进行伤口护理。 作为南卡罗来纳医科大学的普通科和胸科双证书儿科外科医生 (MUSC)，我在临床实践中有广泛的经验，从常规的门诊程序到 婴儿期有复杂的先天性问题，对儿童烧伤特别感兴趣。我的临床经验 治疗儿童烧伤和对以患者为中心的结果研究的兴趣导致了这一K23建议。我 建议接受以下方面的额外培训：1)移动健康培训和评估；2)质量 数据收集和分析；3)生物统计学和临床试验设计；4)远程医疗监测 执行；5)赠款编写和项目管理技能；6)道德操守和负责任的行为 在这些领域内进行研究。我的指导团队包括高级调查人员和活跃的联邦- 资助的研究项目，指导早期职业调查人员的丰富经验，以及 以下领域：基于技术的卫生保健干预措施的迭代设计、开发和评估 (Ruggiero)、定性研究方法(Barroso)、临床试验设计和评估(Mueller)，以及 实施外科疾病中的mHealth平台(Evans)。首先，我建议使用以下工具来优化TOBI 针对利益相关者反馈的定性研究。第二，我将进行可行性随机对照试验 患者/照顾者二人组从我们烧伤门诊招募并随机分配到TOBI与 标准的面对面烧伤护理。主要结果(伤口愈合、并发症和感染)将是 在烧伤治疗过程中进行评估。最后，将通过定性的方式评估实施战略 方法与其他儿科烧伤中心的利益相关者合作，他们将在赠款期间试验TOBI。这 将为这项研究的下一阶段提供信息，这将是一项大规模的混合有效性-实施 TOBI试验(NIH R01)。这项研究补充了我的培训和职业轨迹，并最终将， 提供有价值的数据，帮助了解移动健康如何改善以下领域的医疗保健服务 弱势群体。

Abstract Summary The goal of this K23 award is to provide the training and research experience necessary for me to become a leading researcher in the development of technology-based resources that improve the quality of care for pediatric surgical patients and their families. Because burn patients and their caregivers often live long distances from regional burn centers, access to expert burn care is limited, resulting in a negative effect on adherence to treatment and a higher risk of wound complication. Based on clinical experience in our outpatient burn clinic, I designed and piloted TOBI, a smartphone app aimed at enabling burn experts to direct burn wound care while the patient and caregiver are home through text messaging and video-conferencing. As a dual board-certified General and Thoracic Pediatric Surgeon at the Medical University of South Carolina (MUSC), I have a broad-based experience in clinical practice ranging from routine outpatient procedures to complex congenital problems in infancy, with a special interest in pediatric burn injury. My clinical experience treating pediatric burn injury and interest in patient-centered outcome research led to this K23 proposal. I propose to receive additional training in the following areas: 1) mHealth training and evaluation; 2) qualitative data collection and analysis; 3) biostatistics and clinical trial design; 4) remote healthcare monitoring implementation; 5) grant writing and project management skills; and 6) ethics and the responsible conduct of research within these domains. My mentorship team includes senior level investigators with active federally- funded research projects, extensive experience mentoring early-career investigators, and expertise in the following areas: iterative design, development, and evaluation of technology-based MH interventions (Ruggiero), qualitative research methods (Barroso), clinical trial design and evaluation (Mueller), and implementation of mHealth platforms in surgical disease (Evans). First, I propose to refine TOBI using qualitative research directed at stakeholder feedback. Second, I will perform a feasibility RCT conducted with 64 patient/caregiver dyads recruited from our outpatient burn clinic and randomly assigned to TOBI vs standard face-to-face burn care. Primary outcomes (wound healing, complications, and infection) will be assessed over the course of burn treatment. Last, strategies for implementation will be assessed via qualitative methods with stakeholders from other pediatric burn centers who will trial TOBI during the grant period. This will inform the next phase of this research, which will be a large-scale hybrid effectiveness-implementation trial of TOBI (NIH R01). This research complements my training and career trajectory, and will, ultimately, provide valuable data toward understanding how mHealth can improve access to healthcare for vulnerable populations.