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: 9895472
• 负责人: Kristin N Ray
• 金额: $ 5.2万
• 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/9895472
• 关键词: Address; Applications Grants; Attitude; Belief; Caring; Child; Child Care; Child Health; 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.

在美国，超过四分之一的儿童患有慢性疾病。其中许多儿童 需要儿科专科医生的护理。然而，24%需要专科护理的儿童 由于地理和社会经济障碍，难以获得这种护理。远程医疗是一部小说 通过使用双向远程提供儿科专科来克服这些障碍的方法 视听技术早期数据表明，远程医疗在扩大获得和减少 儿科专科护理的差异。然而，人们对远程医疗知之甚少，几乎没有研究 研究目前如何使用它或如何更有效地使用它。这些数据之所以重要，是因为 远程医疗的扩展既有潜在的好处，也有潜在的危害，包括 不适当的使用，不必要的过度使用，或者如果新技术只提供给一个 人口的子集。迫切需要确定目前远程医疗使用的决定因素、 使用和最佳策略，以确保通过将专科远程医疗整合到患者体内来进行适当使用- 中心医疗之家本研究的总体目标是制定可行的战略， 通过远程医疗提供儿科专科护理，以克服差距，改善儿童健康。 在目标1中，我们将确定患者、亚专科医生、初级保健和系统层面的因素， 通过对一项大型的全州范围的医疗补助计划的分析，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的障碍，以使用远程医疗门诊儿科 通过全国性调查进行专科护理。在目标3中，我们将使用来自先前目标的数据，沿着临床医生和 家长意见，以开发一个全科医生-专科医生电子咨询平台， 用于门诊儿科专科护理的远程医疗。通过这些目标，我们将大大提高我们的 了解远程医疗在改善慢性病儿童获得护理方面的作用， 为今后的干预措施奠定基础，以便通过适当使用远程医疗来优化成果。与 从承诺导师的指导和强大的机构支持，PI也将获得必要的 密集的指导，教学教育和研究经验，成为一个独立的调查员， 支持高级统计建模、实施科学方面的职业发展目标， 临床信息学这项工作将提供必要的初步数据，以支持未来的赠款申请， 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 在此开发的电子咨询平台。有了这些新技能和新的初步数据，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 提供护理，最终改善需要专科护理的儿童的结局，并促进NICHD的 我们的使命是确保所有儿童都能充分发挥其健康和有所作为的潜力。

项目成果

General and subspecialist pediatrician perspectives on barriers and strategies for referral: a latent profile analysis.

• DOI: 10.1186/s12887-023-04400-8
• 发表时间: 2023-11-18
• 期刊: BMC PEDIATRICS
• 影响因子: 2.4
• 作者: Bohnhoff, James C.;Guyon-Harris, Katherine;Schweiberger, Kelsey;Ray, Kristin N.
• 通讯作者: Ray, Kristin N.

Use of telemedicine for initial outpatient subspecialist consultative visit: A national survey of general pediatricians and pediatric subspecialists.

• DOI: 10.1016/j.hjdsi.2021.100600
• 发表时间: 2022-03
• 期刊: Healthcare (Amsterdam, Netherlands)
• 作者: Ray KN;Bohnhoff JC;Schweiberger K;Sequeira GM;Hanmer J;Kahn JM
• 通讯作者: Kahn JM