Predictors of Days at Home for Children with Mechanical Ventilator Assistance

接受机械呼吸机辅助的儿童在家中度过的日子的预测因素

基本信息

批准号：
10213104
负责人：
Sarah Ann Sobotka
金额：
$ 15.79万
依托单位：
UNIVERSITY OF CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-08-01 至 2023-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10213104
关键词：
Activities of Daily Living Age Area Berry Biometry Characteristics Chicago Child Child Support Childhood Chronic lung disease Cognitive Communities Community Healthcare Complement Complex Consumption Cost Effectiveness Analysis Data Data Analyses Development Disabled Persons Discipline of Nursing Disease Education Environmental Risk Factor Epidemiology Equipment Expenditure Failure Family Family Characteristics Future Gender Genetic Diseases Geographic Locations Goals Health Care Costs Health Expenditures Health Sciences Health Services Health Services Research Healthcare Healthcare Systems Heart Diseases Home Home Care Services Home Nursing Care Hospitalization Hospitalized Child Hospitals Hypercapnic respiratory failure Insurance Insurance Claim Review Intervention Interview Investigation K-Series Research Career Programs Laboratories Lead Learning Length of Stay Life Linear Models Lung diseases Mechanical Ventilators Medicaid Medical Mentors Methodology Methods Minority Modeling Motor National Institute of Child Health and Human Development Neurodevelopmental Disability Neuromuscular Diseases Nurses Nursing Services Outcome Parents Patients Perception Population Predictive Factor Provider Public Health Public Policy Qualitative Research Research Research Methodology Research Personnel Research Project Grants Resources Role Schools Spinal cord injury Syndrome Testing Tracheostomy procedure Training Universities Wages acute care base burnout cohort community living comorbidity comparative cost effectiveness cost cost effective disability experience family support health care availability health care delivery home mechanical ventilation hospital readmission indexing informant malformation neurodevelopment patient home care pediatric patients policy implication premature prevent programs readmission rates skills success

项目摘要

Project Summary/Abstract The research component of this application proposes using a mixed-methods approach to determine the predictors of increased days at home versus days hospitalized for children with invasive home mechanical ventilator (HMV) assistance throughout the US. These patients, with complex genetic, pulmonary, cardiac, and neuromuscular disorders, have prolonged hospital stays for non-medical reasons and contribute to high percentages of overall pediatric healthcare expenditures. Aim 1 of this proposal utilizes qualitative methodology to understand parental and home nursing perspectives on which circumstances, resources, and child characteristics lead to expeditious discharge and fewer readmissions. Aim 2 will utilize national Medicaid claims to determine which patient, family, and community healthcare factors, particularly home nursing availability, predict positive outcomes including a shorter index hospital stay after tracheostomy placement, a lower likelihood of readmissions and increased days at home. Aim 3 will describe, for a pilot cohort of children with HMV assistance living in the community, functional levels within motoric, cognitive, and communicative domains. The educational component of this application provides advanced training in qualitative, Medicaid claims, and cost-effectiveness analysis. Those skills are essential for Dr. Sobotka to transition into an independent health services research expert on children with medical complexity and neurodevelopmental disabilities. Toward that end, the proposed research project is focused on determining strategies to support children with HMV: the most medically fragile, neurodevelopmentally vulnerable, and highest resource-consuming pediatric patients. Dr. Sobotka’s expertise in neurodevelopment will enable her to assess abilities and disabilities within this cohort. The coursework described will complement and enable her long-term goals by expanding her capabilities in four educational areas: 1) Qualitative research methods; 2) Medicaid Claims analysis; 3) Advanced Epidemiology and Biostatistics; 4) Public Policy. The latter will inform future proposals considering the policy implications of her research findings within the larger healthcare framework. Dr. Sobotka will be supported by investigators and resources at the University of Chicago to provide educational and analytic support, including the Medicaid Data Analysis group, the Department of Public Health Sciences, and the Biostatistics Laboratory. She will be mentored by a team with diverse expertise: primary mentor, Dr. Michael E. Msall, and co-mentors, Dr. Monica E. Peek, Dr. Lucy A. Bilaver, and Dr. Jay G. Berry. Dr. Sobotka is additionally supported by content and methodologic collaborators, Dr. Kit N. Simpson, Dr. Michael T. Quinn, Dr. Rishi K. Agrawal, and Dr. Rob J. Graham. The K23 NICHD career development award will support Dr. Sobotka’s transition to independence.

项目摘要/摘要该申请建议的研究组成部分使用混合方法来确定预测在家的天数与有侵入性家庭儿童住院的天数整个美国的机械通气（HMV）援助。这些患者，具有复杂的遗传肺，心脏和神经肌肉疾病已长时间住院治疗原因并助长了总体儿科医疗支出的高百分比。目标1 提案利用定性方法来了解父母和家庭护士的观点情况，资源和儿童特征导致迅速出院和更少的再入院。 AIM 2将利用国家医疗补助索赔来确定哪个患者，家庭和社区医疗保健因素，尤其是家庭护士的可用性，可以预测较短的指数医院的积极结果气管切开术放置后留住，再入院的可能性较低，在家中增加了天数。目标3 将描述一个居住在社区的HMV援助的飞行员队列，功能水平在摩托车，认知和通信领域内。本申请的教育部分提供了定性医疗补助的高级培训索赔和成本效益分析。这些技能对于Sobotka博士过渡为独立卫生服务研究专家医学复杂性和神经发育障碍。为此，拟议的研究项目的重点是确定支持HMV儿童的策略：医学上最脆弱的神经发育易受伤害和最高资源的儿科患者。 Sobotka博士的专业知识神经发育将使她能够评估该队列中的能力和残疾。所描述的课程将通过扩大她的长期目标来补充和实现她的长期目标在四个教育领域的能力：1）定性研究方法； 2）医疗补助索赔分析； 3）高级流行病学和生物统计学； 4）公共政策。后来将告知未来的建议考虑到她在更大的医疗保健框架内的研究结果的政策影响。 Sobotka博士将得到芝加哥大学的调查人员和资源的支持教育和分析支持，包括医疗补助数据分析小组，公众部健康科学和生物统计学实验室。她将由拥有专业知识的团队来考虑她：主要导师Michael E. Msall博士和副官员Monica E. Peek博士，Lucy A. Bilaver博士和博士杰伊·贝里（Jay G. Berry）。 Sobotka博士还得到了内容和方法合作者Kit博士的支持 N. Simpson，Michael T. Quinn博士，Rishi K. Agrawal博士和Rob J. Graham博士。 K23 NICHD 职业发展奖将支持Sobotka博士向独立的过渡。