Implementation of an Evidence Based Parentally Administered Intervention for Preterm Infants.
Implementation of an Evidence Based Parentally Administered Intervention for Preterm Infants.
批准号:
10388294
负责人:
DEBRA H BRANDON
金额:
$62.54万
依托单位国家:
美国
项目类别:
财政年份:
2020
资助国家:
美国
项目状态:
未结题
起止时间:
2020-04-15 至 2025-03-31
关键词:
AddressAffectAgeAuditoryBehaviorBehavior TherapyBrainCharacteristicsChronologyConsolidated Framework for Implementation ResearchCost SavingsDataDevelopmentEarly InterventionEffectivenessEnrollmentEnvironmentEyeFundingGrowthGrowth and Development functionHealthHealth Care CostsHealthcareHomeHospital CostsHospitalizationHospitalsHybridsIndividualInfantInfant BehaviorInfant CareInfant DevelopmentInterventionInterviewInvestmentsLength of StayMassageMeasuresMethodsModelingMothersNeonatalNeonatal Intensive Care UnitsOutcomeOutcomes ResearchParentsPatient Self-ReportPatientsPhasePremature InfantProtocols documentationPublic HealthRecordsReportingResearchSafetyServicesSiteSocial InteractionSocial supportStandardizationStressStructureTactileTestingTimeTouch sensationUnited States National Institutes of HealthVariantVisitVisualVoiceacute carebaseclinical practiceclinical research sitecohortcostdesigneffectiveness evaluationeffectiveness outcomeevidence baseexperiencehealth care service utilizationimplementation evaluationimplementation frameworkimplementation outcomesimplementation processimplementation scienceimplementation strategyimprovedinfant outcomemultisensorypost implementationprimary outcomeprogramsstandard of caresuccess
中文摘要
摘要
早期发展为基础的行为干预具有良好的积极作用,建议
作为支持早期大脑成熟、健康和发育的标准护理。然而,少数新生儿
重症监护室(NICU)提供了这种早期干预。H-HOPE(医院到家庭:优化
早产儿的环境)已经确立了疗效,并有一个标准化的协议,使其准备好
广泛实施。H-HOPE的婴儿导向组件提供听觉(声音)、触觉
(适度触摸按摩),视觉(眼对眼)和前庭(摇摆)刺激,从婴儿出生时开始
准备好社交互动。H-HOPE的家长指导部分包括参与性指导,
支持帮助父母在NICU中与婴儿接触并过渡到家中。在我们的NIH资助的
研究表明,H-HOPE改善了生长、发育成熟和母婴互动,
住院费用和6周矫正年龄的急性护理访视。这项研究测试了H-
HOPE可以在五个不同的NICU中实施和维持,使用3型混合设计来评估
执行过程和有效性。具体目标是:1)确定
实施成功; 2)评估H-HOPE对婴儿的有效性,H-HOPE的住院费用
与实施前比较队列相比,入组至出院和父母;以及3)
确定与实施成功和H-HOPE相关的影响因素(促进因素和障碍)
在实施研究综合框架(CFIR)的指导下,有效性。一个不完整
阶梯楔形设计指导五个临床站点的交错展开。每个NICU完成CFIR
实施步骤(规划和参与,执行,反思和评估),然后是6
几个月的支持。对于目标1,每两个月确定一次执行成功的程度,
可持续性(仍提供H-HOPE)、覆盖范围(接受H-HOPE的合格父母/婴儿的百分比)和学位
(每个父母-婴儿单位接受的平均H-HOPE服务)(初步实施
成果)。对于目标2,使用广义线性混合模型对婴儿、成本和
父母结局(主要结局:出院时的婴儿生长和从出院到6岁的急性护理访视)
周校正年龄)。倾向得分分析用于使前,后实施
可比性对于目标3,我们使用混合方法分析来识别H-HOPE记录的影响,
与每个站点和跨站点的实施成功和有效性相关的访谈。
这是第一次在NICU中实施以循证CFIR框架为指导,结果
将对执行科学做出重大贡献。这项研究将产生一个基于证据的
执行战略和工具包。H-HOPE的广泛实施将使
临床实践的重大变化,改善早产儿的健康和医疗保健费用。
英文摘要
ABSTRACT
Early developmentally-based behavioral intervention has well-established positive effects and is recommended
as the standard of care to support early brain maturation, health, and development. However, few neonatal
intensive care units (NICUs) provide this early intervention. H-HOPE (Hospital to Home: Optimizing the
Preterm Infant’s Environment) has established efficacy, and has a standardized protocol, making it ready for
widespread implementation. The infant-directed component of H-HOPE provides Auditory (voice), Tactile
(moderate touch massage), Visual (eye to eye), and Vestibular (rocking) stimulation starting when infants are
ready for social interaction. The parent-directed component of H-HOPE includes participatory guidance and
support to help parents engage with their infants in the NICU and the transition to home. In our NIH-funded
research, H-HOPE improved growth, developmental maturity and mother-infant interaction, and reduced initial
hospitalization costs and acute care visits through 6-weeks corrected age. This research tests whether H-
HOPE can be implemented and sustained in five diverse NICUs, using a Type 3 Hybrid design to evaluate
both implementation processes and effectiveness. The specific aims are to: 1) Identify the degree of
implementation success; 2) Evaluate the effectiveness of H-HOPE for infants, hospital costs from H-HOPE
enrollment until discharge, and parents, compared to a pre-implementation comparison cohort; and 3)
Determine influences (facilitators and barriers) associated with implementation success and H-HOPE
effectiveness, guided by the Consolidated Framework for Implementation Research (CFIR). An incomplete
stepped-wedge design guides staggered roll-out for five clinical sites. Each NICU completes the CFIR
implementation steps (Planning and Engaging, Executing, and Reflecting and Evaluating), followed by 6
months of Sustaining. For Aim 1, degree of implementation success is determined every two months as
Sustainability (still offering H-HOPE), Reach (% of eligible parent/infant dyads receiving H-HOPE) and Degree
of Implementation (mean H-HOPE services received per parent-infant unit) (primary implementation
outcomes). For Aim 2, effectiveness is analyzed using generalized linear mixed models for infant, cost, and
parent outcomes (primary outcomes: infant growth at discharge and acute care visits from discharge to 6-
weeks corrected age). Propensity score analysis is used to make the pre- and post-implementation
comparable. For Aim 3, we use mixed methods analyses to identify influences from H-HOPE records and
interviews that are associated with implementation success and effectiveness at each site and across sites.
This is the first time implementation in a NICU is guided by the evidence-based CFIR framework, and results
will make a major contribution to implementation science. This study will produce an evidence-based
implementation strategy and Toolkit to disseminate nationwide. Widespread H-HOPE implementation will make
a significant change in clinical practice and improve preterm infant health and health care costs.
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Implementation of an Evidence Based Parentally Administered Intervention for Preterm Infants.
-
批准号:9896415
-
项目类别:
-
资助金额:$66.49万
-
财政年份:2020
-
负责人:DEBRA H BRANDON
-
依托单位:
Implementation of an Evidence Based Parentally Administered Intervention for Preterm Infants.
-
批准号:10611428
-
项目类别:
-
资助金额:$58.76万
-
财政年份:2020
-
负责人:DEBRA H BRANDON
-
依托单位:
MSN Nursing Program Partnership for Bridges to the Doctorate
-
批准号:8707494
-
项目类别:
-
资助金额:$28.77万
-
财政年份:2012
-
负责人:DEBRA H BRANDON
-
依托单位:
MSN Nursing Program Partnership for Bridges to the Doctorate
-
批准号:8871732
-
项目类别:
-
资助金额:$28.28万
-
财政年份:2012
-
负责人:DEBRA H BRANDON
-
依托单位:
MSN Nursing Program Partnership for Bridges to the Doctorate
-
批准号:8537481
-
项目类别:
-
资助金额:$22.87万
-
财政年份:2012
-
负责人:DEBRA H BRANDON
-
依托单位:
MSN Nursing Program Partnership for Bridges to the Doctorate
-
批准号:8368232
-
项目类别:
-
资助金额:$25.8万
-
财政年份:2012
-
负责人:DEBRA H BRANDON
-
依托单位:
Preterm Infants: Light Effects on Health and Development
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批准号:6698108
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项目类别:
-
资助金额:$35.42万
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财政年份:2003
-
负责人:DEBRA H BRANDON
-
依托单位:
Preterm Infants: Light Effects on Health and Development
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批准号:7017091
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项目类别:
-
资助金额:$31.13万
-
财政年份:2003
-
负责人:DEBRA H BRANDON
-
依托单位:
Preterm Infants: Light Effects on Health and Development
-
批准号:7172600
-
项目类别:
-
资助金额:$20.15万
-
财政年份:2003
-
负责人:DEBRA H BRANDON
-
依托单位:
Preterm Infants: Light Effects on Health and Development
-
批准号:6574128
-
项目类别:
-
资助金额:$34.08万
-
财政年份:2003
-
负责人:DEBRA H BRANDON
-
依托单位:
Preterm Infants: Light Effects on Health and Development
-
批准号:6848342
-
项目类别:
-
资助金额:$35.42万
-
财政年份:2003
-
负责人:DEBRA H BRANDON
-
依托单位:
CYCLED LIGHT VERSUS NEAR DARKNESS IN THE PRETERM INFANT
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批准号:2714362
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项目类别:
-
资助金额:$1.57万
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财政年份:1998
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负责人:DEBRA H BRANDON
-
依托单位:
CYCLED LIGHT VERSUS NEAR DARKNESS IN THE PRETERM INFANT
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批准号:2431059
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项目类别:
-
资助金额:$1.55万
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财政年份:1997
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负责人:DEBRA H BRANDON
-
依托单位:
CYCLED LIGHT VERSUS NEAR DARKNESS IN THE PRETERM INFANT
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批准号:2259191
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项目类别:
-
资助金额:$1.4万
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财政年份:1996
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负责人:DEBRA H BRANDON
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依托单位:
海外基金