HOMeVent4Kids: Home-based Optimization of Mechanical Ventilation for Children

HOMeVent4Kids：基于家庭的儿童机械通气优化

• 批准号: 10669146
• 负责人: Carolyn C. Foster
• 金额: $ 13.82万
• 依托单位: LURIE CHILDREN'S HOSPITAL OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-05 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10669146
• 关键词: Accident and Emergency department; Active Learning; Acute; Affect; Award; Birth; Breathing; Bronchopulmonary Dysplasia; Carbon Dioxide; Caregiver Burden; Caregivers; Caring; Categories; Child; Child Care; Child Health; Chronic lung disease; Clinical; Clinical Data; Clinical Investigator; Clinical Management; Data; Data Element; Dependence; Development Plans; Discipline of Nursing; Educational workshop; Emergency department visit; Enrollment; Environment; Equilibrium; Extended Family; Family; Family Caregiver; Fatigue; Fostering; Foundations; Frequencies; Funding; Gestational Age; Goals; Growth; Health; Health Benefit; Health Care Costs; Health Services; Health system; Healthcare; Height; Home; Hospitalization; Hospitals; Institution; Learning; Life; Logistics; Lung; Measurable; Measurement; Measures; Mechanical ventilation; Medical; Medical Technology; Medicine; Mental Health; Mentors; Mentorship; Methods; Modeling; Monitor; Nurses; Outcome; Outcome Measure; Oxygen; Parents; Patient Outcomes Assessments; Patients; Pediatric Hospitals; Physical Function; Physicians; Physiological; Population; Private Duty Nursing; Process; Provider; Psyche structure; Publishing; Pulmonary Hypertension; Research; Research Infrastructure; Research Personnel; Resources; Risk; Safety; Science; Self Efficacy; Services; Severity of illness; Social Environment; Surveys; Testing; Time; Titrations; Tracheostomy procedure; Training; United States National Institutes of Health; Universities; Ventilator; Weaning; Weight; Work; care burden; care giving burden; care systems; career; career development; clinical care; cost; dashboard; design; evidence base; experience; health care delivery; health care service utilization; health determinants; home mechanical ventilation; hospital services; improved; innovation; intervention delivery; learning engagement; mortality risk; patient population; pediatrician; perinatal period; physical conditioning; pilot test; pressure; programs; prospective; respiratory; sex; skills; therapy design; usability; ventilation

PROJECT SUMMARY/ABSTRACT Candidate: Carolyn Foster, MD, MSHS is a pediatrician and junior clinical investigator focused on improving the evidence-based for the care of children with chronic lung disease (CLD) of prematurity who require invasive home mechanical ventilation (HMV). Dr. Foster’s long-term career goal is to become an independent physician-investigator who works in cross-disciplinary teams to design and evaluate evidence-based health care delivery interventions for children with medical technology dependence who require in-home services. Research Context/Objective: Children with CLD of prematurity are a growing, costly group of patients with high health care resource use and significant family caregiver burden. No empirically based parameters exist to guide how this population is discontinued from invasive HMV, leading to lack of appropriate, timely discontinuation of HMV. Therefore, the objective of this award is for Dr. Foster to learn how to assess the multifaceted factors that contribute to HMV duration, and to pilot test the integration of these factors into clinical management of children with CLD of prematurity, to safely shorten duration of HMV use. Specific Aims: 1) Determine which patient level factors are associated with HMV duration; 2) Determine which family caregiver and health service factors are associated with weaning of HMV support; 3) Develop and pilot the feasibility, acceptability, and usability of integrating patient, family, and health service data elements into a clinical management dashboard design to optimize HMV use in children with CLD of prematurity. Research Plan: Dr. Foster will retrospectively analyze existing patients’ clinical data to evaluate the association of patient medical factors (e.g., ventilator settings, oxygen use, weight, end-tidal CO2,) with HMV duration (Aim 1); prospectively collect patient reported outcome (PRO) measures (i.e., validated surveys) to elucidate which caregiver and system factors are associated with weaning of HMV support among current HMV patients (Aim 2); and use a stakeholder-engaged Learning Health System approach to develop and pilot the feasibility, acceptability, and usability (implementation) of a clinical HMV dashboard (Aim 3). Career Development Plan/Environment: Through a combination of local and national didactic activities, experiential learning, workshops, seminars, and professional activities, Dr. Foster will acquire expertise in evaluating longitudinal health outcomes and health care utilization; patient-reported outcome (PRO) health measurement science; and intervention design and pilot testing. Dr. Foster will strengthen her professional skills needed for an independent physician-investigator career through close mentorship by an experienced, complementary team of NIH-funded team mentors, advisors, and collaborators. Northwestern University and Lurie Children’s Hospital will provide outstanding research infrastructures to enable a successful award and are strongly committed to Dr. Foster’s transition to research independence.

项目概要/摘要 候选人：Carolyn Foster，医学博士、MSHS 是一名儿科医生和初级临床研究员，专注于改善 患有慢性肺病 (CLD) 的早产儿的循证护理 有创家庭机械通气 (HMV)。福斯特博士的长期职业目标是成为一名独立的 在跨学科团队中设计和评估循证健康的医师研究员 为需要家庭服务的具有医疗技术依赖的儿童提供护理干预。 研究背景/目标：患有早产慢性肺病 (CLD) 的儿童是一个不断增长且成本高昂的患者群体 医疗保健资源使用率高，家庭护理人员负担沉重。不存在基于经验的参数 指导该人群如何停止接触侵入性 HMV，从而导致缺乏适当、及时的治疗 停止使用 HMV。因此，该奖项的目的是让福斯特博士学习如何评估 影响 HMV 持续时间的多方面因素，并初步测试将这些因素整合到临床中 早产儿 CLD 儿童的管理，以安全地缩短 HMV 使用时间。 具体目标： 1) 确定哪些患者水平因素与 HMV 持续时间相关； 2）确定哪个 家庭照顾者和卫生服务因素与 HMV 支持的断绝相关； 3）开发和试点 将患者、家庭和健康服务数据元素整合到一个数据中的可行性、可接受性和可用性 临床管理仪表板设计可优化早产儿 CLD 儿童的 HMV 使用。 研究计划：Foster博士将回顾性分析现有患者的临床数据，以评估 患者医疗因素（例如呼吸机设置、氧气使用、体重、呼气末二氧化碳）与 HMV 的关联 持续时间（目标 1）；前瞻性地收集患者报告的结果（PRO）测量（即经过验证的调查） 阐明哪些护理人员和系统因素与目前 HMV 支持的断绝相关 HMV 患者（目标 2）；并使用利益相关者参与的学习健康系统方法来开发和试点 临床 HMV 仪表板的可行性、可接受性和可用性（实施）（目标 3）。 职业发展计划/环境：通过结合地方和国家的教学活动， 体验式学习、讲习班、研讨会和专业活动，福斯特博士将获得以下方面的专业知识 评估纵向健康结果和医疗保健利用；患者报告结果 (PRO) 健康状况 测量科学；以及干预设计和试点测试。福斯特博士将加强她的专业 通过经验丰富的、 由 NIH 资助的团队导师、顾问和合作者组成的互补团队。西北大学和 卢里儿童医院将提供出色的研究基础设施，以确保获奖和成功 坚定地致力于福斯特博士向独立研究的过渡。

项目成果

Parental self-efficacy managing a child's medications and treatments: adaptation of a PROMIS measure.

• DOI: 10.1186/s41687-023-00549-z
• 发表时间: 2023-02-03
• 期刊: Journal of patient-reported outcomes
• 影响因子: 2.7

Paying Family Medical Caregivers for Children's Home Healthcare in Colorado: A Working Medicaid Model.

向家庭医疗护理人员支付科罗拉多州儿童家庭医疗保健费用：有效的医疗补助模式。

• DOI: 10.1016/j.jpeds.2022.12.043
• 发表时间: 2023
• 期刊: The Journal of pediatrics
• 作者: Foster,CarolynC;Kwon,Soyang;Blakely,Christy;Carter,Kristin;Sobotka,SarahA;Goodman,DeniseM;Agrawal,Rishi;Brittan,Mark
• 通讯作者: Brittan,Mark

Employing Family Caregivers: An Innovative Health Care Model.

• DOI: 10.1542/peds.2021-054273
• 发表时间: 2022-06-01
• 期刊: PEDIATRICS
• 影响因子: 8
• 作者: Carter, Kristin;Blakely, Christy;Zuk, Jeannie;Brittan, Mark;Foster, Carolyn
• 通讯作者: Foster, Carolyn

Children With Medical Complexity and Mental and Behavioral Disorders in the Emergency Department.

急诊科患有医疗复杂性以及精神和行为障碍的儿童。

• DOI: 10.1542/hpeds.2022-006835
• 发表时间: 2023
• 期刊: Hospital pediatrics
• 作者: Ramgopal,Sriram;Goodman,DeniseM;Kan,Kristin;Smith,Tracie;Foster,CarolynC
• 通讯作者: Foster,CarolynC

Family and Provider Experiences With Longitudinal Care Coordination for Infants With Medical Complexity.

家庭和提供者对医疗复杂性婴儿进行纵向护理协调的经验。

• DOI: 10.1097/anc.0000000000000998
• 发表时间: 2023
• 期刊: Advances in neonatal care : official journal of the National Association of Neonatal Nurses
• 作者: Dallas,Abbey;Ryan,Alexandra;Mestan,Karen;Helner,Khrystyna;Foster,Carolyn
• 通讯作者: Foster,Carolyn