Comparing Family Decision Making Engagement in Telehealth versus In-person Primary Care for Children with Chronic Conditions

比较慢性病儿童家庭决策参与远程医疗与现场初级保健的情况

• 批准号: 10560396
• 负责人: Ellen A Lipstein
• 金额: $ 40万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2025-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10560396
• 关键词: Comparing; Family; Decision; Making; Engagement

PROJECT SUMMARY/ABSTRACT The COVID-19 pandemic led to unprecedented changes to healthcare delivery during the spring of 2020, including the rapid and wide implementation of telehealth. This expansion included areas in which telehealth had not previously been broadly applied, such as pediatric primary care. By its very nature, telehealth changes the communication and structure of the healthcare interaction, perhaps especially in pediatrics where both the parent and patient need to be engaged in the visit. Such changes may directly affect shared decision making, an essential component of high-quality care and a strategy to improve outcomes. Children with asthma and attention deficit hyperactivity disorder, the most common chronic conditions in pediatric primary care, are especially vulnerable to changes in health care delivery. These conditions are highly prevalent among urban, underserved children and while some barriers to care are alleviated by telehealth new ones may emerge. Understanding the impact of telehealth on an underserved, inner-city, primary care population is critical to prevent worsening disparities. Our long-term goal is to improve pediatric primary care by ensuring delivery of chronic disease care that meets families’ goals and improves children’s health and well-being. The overall objective of this proposal is to compare the decision-making processes and outcomes between telehealth and in-person pediatric primary care for children with chronic conditions. This proposal consists of three distinct aims that build upon one another by triangulating perceived and observed decision-making, parents’ and adolescent patients’ perceptions, and quantitative and qualitative data to achieve breadth and depth of understanding about shared decision making in pediatric primary care. In Aims 1 and 2 we will evaluate the quality of pediatric primary care delivered via telehealth compared to in-person care. Aim 1 will use rigorous survey methods to understand families’ perceptions of decision making that occurs during either a telehealth or in-person pediatric primary care visit. This will be coupled with chart review to understand the contribution of telehealth or in-person care to clinical outcomes. Aim 2 will build upon the first by video-recording healthcare visits so the extent of observed shared decision making can be assessed both quantitatively and qualitatively. Finally, in aim 3 we will use qualitative interviews to “feed forward” the data from aims 1 and 2 to parents, adolescents and healthcare providers to gain a more in-depth understanding regarding experiences of decision making in telehealth compared to in-person care. The expected outcome of this proposal is an understanding of the impact of telehealth delivery in pediatric primary care on decision making processes for children with chronic conditions. These results will have a positive impact on care delivery by facilitating the development of targeted approaches to supporting shared decision making as healthcare systems continue evolve and integrate telehealth.

项目总结/摘要 2019冠状病毒病疫情于二零二零年春季导致医疗服务出现前所未有的变化， 包括迅速和广泛地实施远程保健。这一扩展包括远程保健 以前没有广泛应用，例如儿科初级保健。就其本质而言，远程医疗改变了 医疗保健互动的沟通和结构，也许特别是在儿科， 父母和病人都需要参与到这次访问中来。这些变化可能直接影响共同决策， 这是高质量护理的重要组成部分，也是改善结果的战略。哮喘儿童和 注意力缺陷多动障碍是儿科初级保健中最常见的慢性疾病， 尤其容易受到医疗服务变化的影响。这些情况在城市、 获得服务不足的儿童，虽然远程保健缓解了一些护理障碍，但可能会出现新的障碍。 了解远程医疗对服务不足的市中心初级保健人群的影响， 防止差距扩大。我们的长期目标是改善儿科初级保健， 慢性病护理，满足家庭的目标，改善儿童的健康和福祉。整体 本提案的目的是比较远程保健和远程保健之间的决策过程和结果， 为患有慢性病的儿童提供面对面的儿科初级保健。该提案包括三个不同的 通过对感知和观察到的决策、父母的决策和 青少年患者的看法，定量和定性数据，以实现广度和深度的 了解儿科初级保健中的共同决策。在目标1和2中，我们将评估 通过远程保健提供的儿科初级保健质量与亲自护理相比。目标1将使用严格的 调查方法，以了解家庭对远程医疗或 亲自进行儿科初级保健访问。这将与图表审查相结合，以了解 远程医疗或现场护理与临床结果的关系。Aim 2将在第一个基础上通过视频记录医疗保健 访问，以便可以定量和定性地评估所观察到的共同决策的程度。 最后，在目标3中，我们将使用定性访谈将目标1和目标2的数据“反馈”给家长， 青少年和医疗保健提供者，以获得更深入的了解有关决策的经验， 与面对面护理相比，这项建议的预期结果是达成一项谅解 儿科初级保健中的远程医疗服务对患有 慢性病这些结果将对提供保健服务产生积极影响， 随着医疗保健系统的不断发展， 综合远程保健。