Evaluating Implementation of a Patient Navigator Intervention to Improve Access to Diagnostic and Treatment Services for Children with Autism Spectrum Disorder

评估患者导航干预的实施情况，以改善自闭症谱系障碍儿童获得诊断和治疗服务的机会

• 批准号: 9768553
• 负责人: Sarabeth Broder-Fingert
• 金额: $ 17.3万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-26 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9768553
• 关键词: Administrator; Adopted; Award; Caring; Case Management; Characteristics; Clinic; Clinical; Clinical Trials; Code; Complex; Data; Diagnostic Services; Disease; Effectiveness; Elements; Ensure; Environment; Failure; Family; Funding; Future; Goals; HIV; Health Services; Health Services Accessibility; Healthcare; Healthcare Systems; Hybrids; Improve Access; Infrastructure; Institution; Intervention; Interview; Investigation; Lead; Learning; Logistics; Low income; Malignant Neoplasms; Measures; Mental Health; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Minority; Modeling; Morbidity - disease rate; National Institute of Mental Health; Navigation System; Outcome; Parents; Patients; Pattern; Policies; Population; Positioning Attribute; Process; Provider; Qualitative Methods; Randomized Controlled Trials; Research; Series; Services; Site; Statistical Models; Structure; Surveys; Techniques; Testing; Time; Training; Vulnerable Populations; Work; attenuation; autism spectrum disorder; autistic children; base; care systems; clinical implementation; clinical practice; design; disparity reduction; ethnic disparity; evidence base; experience; health disparity; implementation science; implementation strategy; implementation trial; improved; innovation; multidisciplinary; multilevel analysis; navigator intervention; novel; practice setting; psychologic; racial disparity; socioeconomic disparity; success; therapy design; treatment services; uptake

PROJECT SUMMARY Significant racial, ethnic, and socioeconomic disparities exist in access to diagnostic and treatment services for children with autism spectrum disorder (ASD). Because earlier access to ASD services improves long-term outcomes, delayed engagement with these services can be responsible for substantial morbidity. This pattern of health service break-down – delay in care, leading to preventable morbidity – exists in many sectors of the US health care system. One promising solution, which has been studied extensively over the past ten years, is patient navigation. Patient navigation is a lay-delivered case management strategy designed to reduce health disparities by helping vulnerable populations overcome psychological and logistical hurdles to care. Navigation has proven effectiveness in multiple disorders such as cancer and HIV, and early data support its use as a strategy to promote timely engagement with evidence-based services among children with ASD. However, despite navigation's substantial effectiveness data, multiple studies demonstrate the attenuation of its impact, and variable success, when implemented in real-world practice. This “research-practice” gap – whereby effective clinical innovations fail to be adopted (or practiced with appropriate fidelity) within real-world clinical practice – is ubiquitous in healthcare; but it is particularly problematic for low-income and minority populations and the institutions that serve them. Furthermore, despite guidance to the contrary, few clinical trials proactively collect data on the complex patient, provider, and organizational factors that impact subsequent implementation of the clinical innovations being tested. As a result of this missed opportunity, implementation strategies are often arbitrary and prone to failure. Therefore, in this K23 application, I propose to use emerging techniques in the field of dissemination and implementation science to evaluate key implementation processes of patient navigation in the context of an ongoing, NIMH-funded, multi-site randomized controlled trial of a patient navigation system designed to improve access to care for low-income children with ASD (R01MH104355, Feinberg). The goal of this work is to elucidate factors that can increase the likelihood of rapid and sustained uptake of patient navigation in diverse, real-world practice settings. My educational objectives are to gain training and experience in dissemination and implementation science through the following goals: to learn process mapping and analysis; to learn new qualitative methods; and to learn and apply a new quantitative technique - multilevel modeling. The research in this proposal builds directly on my prior work, which focused on using multidisciplinary teams to improve access to services for children with ASD and their families. I have identified an experienced mentoring team and a supportive research environment, which will ensure that I attain my immediate and long-term goals. At the end of the award, I will be position to develop a testable data-driven implementation strategy to promote the rapid dissemination and implementation of patient navigation to vulnerable children with ASD.

项目总结 在获得诊断和治疗服务方面存在显著的种族、民族和社会经济差异。 自闭症谱系障碍(ASD)儿童。因为更早地获得ASD服务可以改善长期 结果，延迟参与这些服务可能会导致严重的发病率。这种模式 卫生服务故障--护理延误，导致可预防的发病率--存在于许多部门 美国的医疗保健系统。在过去十年中得到了广泛研究的一个有希望的解决方案是 病人导航。患者导航是一种外行提供的病例管理策略，旨在降低健康 通过帮助弱势群体克服护理的心理和后勤障碍，消除贫富差距。通航 已被证明对癌症和艾滋病毒等多种疾病有效，早期数据支持将其用作 促进自闭症儿童及时参与循证服务的战略。然而， 尽管导航有大量的有效性数据，但多项研究表明，其影响有所减弱， 和可变的成功，当在现实世界的实践中实施时。这种“研究-实践”的鸿沟-- 有效的临床创新未能在现实世界的临床中被采用(或以适当的保真度实施) 实践--在医疗保健中无处不在；但对于低收入和少数群体来说，这尤其是个问题 以及为他们服务的机构。此外，尽管有相反的指导，但很少有临床试验是主动的 收集有关影响后续工作的复杂患者、提供者和组织因素的数据 正在测试的临床创新的实施情况。由于错过了这个机会，实施 战略往往是武断的，容易失败。因此，在这个K23应用程序中，我建议使用Emerging 传播和执行科学领域的技术，以评估关键的执行进程 在NIMH资助的正在进行的、由NIMH资助的多地点随机对照试验的背景下 患者导航系统旨在改善低收入自闭症儿童的护理机会 (R01MH104355，Feinberg)这项工作的目标是阐明可以增加快速发病可能性的因素。 并在不同的真实实践环境中持续使用患者导航。我的教育目标 通过以下目标获得传播和实施科学方面的培训和经验： 学习过程映射和分析；学习新的定性方法；学习并应用新的 定量技术--多水平建模。这项提案中的研究直接建立在我之前的工作基础上， 它的重点是使用多学科团队来改善自闭症儿童及其子女获得服务的机会 家人。我已经确定了一支经验丰富的指导团队和支持性的研究环境，这将 确保我能实现我的近期和长期目标。在奖项结束时，我将担任制定一项 可测试的数据驱动实施战略，促进患者快速传播和实施 导航到患有自闭症的弱势儿童。