Telemedicine Consultations to Improve Care Quality of Pediatric Hospital-to-Hospital Transfers

项目概要/摘要 该项目的目标是通过使儿科转院更加以家庭为中心， 有效该奖项提供了必要的支持，以（1）培养仪器开发技能， 测试，研究领导和健康信息技术（IT）干预措施，（2）收集初步的 支持R 01应用程序的数据，以测试儿科转移远程医疗咨询的有效性 在一项大型多中心随机试验中。我安排了一个导师团队， 开发和测试、研究领导力、利益相关者参与和健康IT（远程医疗）。 该项目的重点是研究医院间的转移。转移给患者带来安全风险， 也给病人和家庭带来了负担和痛苦。由于信息不足，这些危害大部分是可以预防的 共享，缺乏共同决策，咨询/接收医生的能力有限， 转移分流决定在开始转院之前使用远程医疗提供专家咨询， 缓解这些问题的潜力。远程医疗改变了通信模式， 在转移过程中更以家庭为中心。它允许咨询医生几乎在病人的 床边，随之而来的更多的合作对话，改善信息共享，共同决策， 和信任为了在转移期间有效地改善以家庭为中心的护理，我们需要一种有效的方法来衡量 这种结果在儿科急诊科（艾德）遇到的儿童， 需要调职还需要进行随机试验，以检查远程医疗在儿科转移中的应用。 在这个建议中，我追求两个具体目标：目标1：一个现有文书的修改版本， 评估以家庭为中心的照顾，在新应用的背景下，艾德遇到的儿童需要 转移目的2：测试进行随机试验的可行性和潜在影响， 远程医疗到儿科转诊咨询的标准电话通信。该试点试验利用 现有的UC Davis远程医疗计划基础设施。可行性将使用指定的目标进行测试， 协议遵守、忠诚度和调查响应率。将测试潜在影响，以告知未来的R 01试验 通过探索对分诊适当性结果的干预的反应来设计（例如，潜在 可避免的转移）以及患者和家庭结果（例如，危难）。 通过实现这些目标，我将验证一个工具，以衡量以家庭为中心的照顾，其他 研究人员和卫生系统可以使用。远程医疗正在成为一种广泛使用的技术， 越来越多地出现在急诊科，因此通过测试远程医疗干预，该项目 大规模吸收的潜力。这项研究将改变儿科转移的沟通模式 并有助于改善分诊的适当性以及患者和家庭的结果。这个奖项将帮助我实现 我的长期目标是：利用先进技术提高儿科护理过渡的质量。

PROJECT SUMMARY / ABSTRACT The project objective is to improve care quality by making pediatric transfers more family-centered and effective. This award provides the necessary support to (1) develop skills in instrument development and testing, research leadership, and health information technology (IT) interventions and (2) gather preliminary data to support an R01 application to test the effectiveness of telemedicine consultations for pediatric transfers in a large multi-center randomized trial. I arranged a mentorship team with expertise encompassing instrument development and testing, research leadership, stakeholder engagement, and health IT (telemedicine). The focus of this project is the study of hospital-to-hospital transfers. Transfers pose safety risks to patients as well as burdens and distress to patients and families. Much of this harm is preventable, due to poor information sharing, lack of shared decision-making, and limited ability of the consulting/receiving physician to make transfer triage decisions. The use of telemedicine to provide expert consultation prior to initiating a transfer has potential to mitigate these problems. Telemedicine transforms the communication paradigm to make care during transfers more family-centered. It permits the consulting physician to virtually be at the patient’s bedside, ensuing more collaborative conversations that improve information sharing, shared decision-making, and trust. To effectively improve family-centered care during transfers, we need a validated method to measure this outcome in the context of pediatric emergency department (ED) encounters with children who are thought to need a transfer. Randomized trials are also needed to examine telemedicine use for pediatric transfers. In this proposal, I pursue two Specific Aims: AIM 1: Validate a modified version of an existing instrument that assesses family-centeredness of care in the newly applied context of ED encounters for children in need of transfer. AIM 2: Test the feasibility and potential impact of conducting a randomized trial comparing telemedicine to standard telephone communication for pediatric transfer consultations. This pilot trial utilizes existing UC Davis telemedicine program infrastructure. Feasibility will be tested using specified objectives for protocol adherence, fidelity, and survey response rates. Potential impact will be tested to inform future R01 trial design by exploring responsiveness to the intervention for triage appropriateness outcomes (e.g., potentially avoidable transfers) and patient and family outcomes (e.g., distress). By accomplishing these aims, I will validate an instrument to measure family-centeredness of care that other researchers and health systems can use. Telemedicine is becoming a widely available technology that is increasingly present in emergency departments, so by testing a telemedicine intervention, this project has potential for large-scale uptake. This research will change the communication paradigm for pediatric transfers and help to improve triage appropriateness and patient and family outcomes. This award will help me achieve my long-term goal: to leverage advanced technology to improve the quality of pediatric transitions of care.