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

项目摘要/摘要 该项目的目标是通过使儿科转运更加以家庭为中心和 有效。该奖项提供必要的支持，以(1)发展仪器开发技能和 测试、研究领导力和卫生信息技术(IT)干预，以及(2)收集初步 支持R01应用程序的数据，以测试儿科转院远程医疗会诊的有效性 在一项大型多中心随机试验中。我安排了一个由乐器专家组成的指导团队 开发和测试、研究领导、利益相关者参与和健康信息技术(远程医疗)。 本项目的重点是医院间转院的研究。转账对患者构成安全风险，因为 以及给病人和家属带来的负担和痛苦。由于信息匮乏，这种伤害大部分是可以预防的。 共享，缺乏共享的决策，咨询/接待医生做出决定的能力有限 转移分诊决定。在启动转移之前使用远程医疗提供专家会诊 有可能缓解这些问题。远程医疗改变了通信模式，使护理 在转移过程中，更多的是以家庭为中心。它允许咨询医生虚拟地在病人的 在床边，随之而来的是更多的协作对话，以改善信息共享、共享决策、 和信任。为了有效地改善转移期间以家庭为中心的护理，我们需要一种经过验证的方法来衡量 这一结果是在儿科急诊科(ED)遇到被认为是 需要转院。还需要随机试验来检查远程医疗在儿科转移中的使用。 在这项提案中，我追求两个具体目标：目标1：确认现有文书的修改版本 评估以家庭为中心的关怀在新应用的ED遇到有需要的儿童的背景下的情况 调职。目标2：测试进行随机试验比较的可行性和潜在影响 用于儿科转院会诊的远程医疗到标准电话通信。这项试点试验利用 加州大学戴维斯分校现有的远程医疗计划基础设施。将使用指定的目标来测试可行性 协议遵从性、保真度和调查回复率。将测试潜在影响，以便为未来的R01试验提供信息 通过探索对分类适当性结果的干预的响应性来设计(例如，潜在地 可避免的转移)以及患者和家属的结局(例如，痛苦)。 通过实现这些目标，我将验证一种工具，以衡量以家庭为中心的照顾他人 研究人员和卫生系统可以使用。远程医疗正在成为一项广泛可用的技术， 越来越多的人出现在急诊科，所以通过测试远程医疗干预，这个项目已经 有大规模吸收的潜力。这项研究将改变儿科转院的沟通模式 并有助于改善分诊的适当性以及患者和家庭的结局。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过渡护理的质量。

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.