The Family Bridge Program to Address Communication and Navigation-Related Inequities for Minority Children and Families: A Randomized Controlled Trial

解决少数族裔儿童和家庭与通讯和导航相关的不平等问题的家庭桥梁计划：一项随机对照试验

• 批准号: 10650280
• 负责人: Katherine Casey Lion
• 金额: $ 78.31万
• 依托单位: SEATTLE CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-20 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10650280
• 关键词: Acute Pain; Address; Adverse event; Advocacy; Asthma; Attention; Caregivers; Caring; Child; Child health care; Clinical; Collaborations; Communication; Comprehension; Diagnosis; Disease; Disparate; Education; Elements; Emotional; Enrollment; Family; Future; Health; Health Personnel; Health system; Healthcare; Healthcare Systems; Heterogeneity; Home; Hospitalization; Hospitalized Child; Hospitals; Household; Human; Immigrant; Inequity; Inpatients; Intervention; Limited English Proficiency; Link; Logistics; Low Income Population; Low income; Maps; Mediating; Medical; Modeling; Nurses; Outcome; Pain management; Parents; Participant; Patients; Persons; Play; Population Heterogeneity; Process; Provider; Randomized; Randomized, Controlled Trials; Reporting; Research Methodology; Resources; Role; Severity of illness; Site; Stress; Subgroup; System; Telephone; Testing; Time; Training; Trust; United States; Visit; Work; Writing; barrier to care; bridge program; care coordination; children of color; comparison control; cost; cultural competence; design; effectiveness testing; effectiveness trial; experience; flexibility; follow-up; food insecurity; health care disparity; health inequalities; health literacy; improved; innovation; interest; leukemia; lower income families; minority children; novel; outcome disparities; patient navigation; patient navigator; patient-clinician communication; perceived stress; pilot test; preference; primary outcome; programs; screening; secondary outcome; skills; social; treatment as usual; treatment effect

Project Summary Pediatric healthcare inequities in the United States (US) remain persistent and pervasive. Suboptimal patient-provider communication plays an important role in creating and maintaining disparate outcomes; this is compounded by mismatches between a family’s skills and resources and demands imposed by the complexity of the health system (such as health literacy and system navigation). Few interventions exist to address inequities related to communication and system navigation in the inpatient setting; given t he established links between these inequities and disparate clinical outcomes, such interventions are needed. To address this gap, the study team collaborated with parents/caregivers, staff, and providers to develop and pilot-test a novel program to improve navigation ability, communication, and hospital-to-home transition for a diverse population of children and their families, The Family Bridge Program (FBP). The FBP combines principles of effective patient navigation and communication coaching interventions into a brief and targeted inpatient program. It is designed for a broad population of low-income children of color, is not disease-specific, is not limited to English-proficient families, and is less time-intensive than traditional navigation, to enable provision of support to more families. The FBP, delivered in-person by a trained lay navigator, includes: (1) hospital orientation; (2) unmet social needs screening (e.g., food insecurity); (3) parent communication and cultural preference assessment, relayed to the medical team; (4) communication coaching for parents; (5) emotional support; (6) assistance with care coordination and logistics; and (7) a phone call 2 days post-discharge. Program elements are flexibly delivered based on parent need and interest. In pilot testing, the program was feasible to deliver, acceptable to parents and providers, and significantly improved parent-reported system navigation ability. The current R01 proposes a two-site randomized controlled trial (RCT) of the effectiveness of FBP among 728 families of low-income children of color. Enrolled families will be randomized 1:1 (stratified by site) to FBP or usual care plus written resources. The specific aims of the study are to (1) Adapt the FBP to a new site using a rigorous and replicable process, Socio- Technical Analysis, which will also result in an implementation guide for future adaptations; (2) Test the effect of the FBP on parent-reported system navigation ability, quality of hospital-to-home transition, diagnosis comprehension, observed communication quality, perceived stress and revisits for families of low-income children of color; (3) Examine whether changes in parent-reported barriers and needs mediate program effects; and (4) Identify subgroups of parents among whom the FBP is more effective. The proposed RCT will use a rigorous design to test a feasible, innovative program to address a critical national problem. If effective, the Family Bridge Program would provide a scalable model for improving health care experiences and outcomes for families of low-income children of color, including those with LEP.

项目摘要 美国（美国）的小儿医疗保健不平等仍然持久和普遍存在。次优 患者支持者的沟通在创造和维持不同的结果中起着重要作用；这是 由于家庭技能和资源的不匹配而加重了复杂性施加的要求 卫生系统（例如卫生素养和系统导航）。很少有干预措施可以解决 与住院环境中的通信和系统导航有关的不平等；鉴于建立的链接 在这些不平等和不同的临床结果之间，需要进行此类干预措施。要解决这个差距， 研究团队与父母/照顾者，员工和提供者合作开发和试验一项小说 提高潜水员人口的导航能力，沟通和住院过渡的计划 儿童及其家人，家庭桥梁计划（FBP）。 FBP结合了有效的患者导航和沟通教练干预措施的原则 进入简短而有针对性的住院计划。它是为广泛的低收入儿童而设计的 颜色不是特定于疾病的颜色，不仅限于英语的家庭，而且时间密集于 传统导航，为更多家庭提供支持。 FBP，由 训练有素的外行导航器包括：（1）医院定向； （2）未满足的社会需求筛查（例如粮食不安全）； （3）父母的沟通和文化偏好评估，转达给医疗团队； （4）交流 为父母指导； （5）情感支持； （6）协助护理协调和物流； （7）a 打电后2天打电话。根据父母的需求和兴趣，灵活地交付了程序元素。 在试点测试中，该计划是可行的，可以为父母和提供者接受，并且很重要 提高了父母报告的系统导航能力。当前的R01提案一个随机的两个站点 在728个低收入有色人种家庭中，FBP有效性的对照试验（RCT）。注册 家庭将被随机分为1：1（按场地分层）为FBP或通常的护理以及书面资源。具体 该研究的目的是（1）使用严格且可复制的过程，社会 - 技术分析，这也将导致未来适应的实施指南； （2）测试效果 FBP关于父母报告的系统导航能力，医院到家过渡的质量，诊断 理解，观察到的沟通质量，感知到低收入家庭的压力和重新审视 有色的孩子； （3）检查父母报告的障碍的变化是否需要调解程序效应； （4）确定FBP更有效的父母的子组。拟议的RCT将使用 严格的设计，以测试可行的创新计划，以解决关键的国家问题。如果有效， 家庭桥梁计划将为改善医疗保健经验和成果提供可扩展的模型 适用于有色人种的低收入儿童，包括LEP的孩子。