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

抽象概括 这个K23奖的目标是提供必要的培训和研究经验，使我成为一个 领先的研究人员在技术为基础的资源，提高护理质量的发展 儿科手术患者及其家属。因为烧伤病人和他们的照顾者通常活得很长 距离区域烧伤中心的距离，获得专家烧伤护理的机会有限，导致对 坚持治疗和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直接烧伤 在患者和护理人员在家时通过短信和视频会议进行伤口护理。 作为南卡罗来纳州医科大学获得双重委员会认证的全科和胸儿科外科医生 （MUSC），我在临床实践中有广泛的经验，从常规门诊程序到 婴儿期复杂的先天性问题，特别关注小儿烧伤。我的临床经验 治疗小儿烧伤和对以患者为中心的结果研究的兴趣导致了K23的提议。我 建议在以下领域接受额外培训：1）移动健康培训和评估; 2）定性 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）赠款写作和项目管理技能; 6）道德和负责任的行为 在这些领域的研究。我的导师团队包括高级调查员，他们是活跃的联邦- 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：迭代设计、开发和评估以技术为基础的卫生保健干预措施 （Ruggiero），定性研究方法（Barroso），临床试验设计和评价（Mueller），以及 在外科疾病中实施移动健康平台（Evans）。首先，我建议使用 针对利益相关者反馈的定性研究。其次，我将进行一项可行性RCT， 从我们的门诊烧伤诊所招募了64名患者/护理人员配对，并随机分配至TOBI组与 标准的面对面烧伤护理主要结局（伤口愈合、并发症和感染）将 在烧伤治疗过程中进行评估。最后，实施战略将通过定性评估， 与其他儿科烧伤中心的利益相关者合作，他们将在资助期间试用TOBI。这 将告知这项研究的下一阶段，这将是一个大规模的混合有效性实施 TOBI试验（NIH R 01）。这项研究补充了我的培训和职业轨迹，并将最终， 提供有价值的数据，以了解移动医疗如何改善医疗保健的可及性， 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.