Telemedicine Integrated into Pediatric Primary Care & Child Outcomes

远程医疗融入儿科初级保健

基本信息

批准号：
10705131
负责人：
Alexander Gabriel Fiks
金额：
$ 66.69万
依托单位：
CHILDREN'S HOSP OF PHILADELPHIA
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-15 至 2027-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10705131
关键词：
Academy Acute Address Adoption American Antibiotics Asthma Attention deficit hyperactivity disorder COVID-19 pandemic Caring Case Study Characteristics Child Child Care Child Health Childhood Chronic Chronic Care Clinic Clinical Communities Community Health Competence Data Electronic Health Record Engineering Equity Family Practice Future Goals Health Health Personnel Health Promotion Health system Immunization Interruption Interview Knowledge Lead Medical Methods Modeling Neighborhood Health Center Outcome Outcome Study Patients Pediatric Research Pediatrics Persons Physicians Policies Population Preventive Preventive care Primary Care Principal Investigator Process Provider Publications Quality of Care Reporting Research Respiratory Tract Infections Sampling Social Distance Structure Subgroup System Technology Telemedicine Time Series Analysis Variant Visit acute care adolescent health comparative design experience health care delivery health equity improved member patient population patient safety pediatrician pre-pandemic primary care patient primary care practice primary care visit programs sociodemographics

项目摘要

During the summer of 2021, 80% of pediatricians reported using live audio-video telemedicine in the prior month, up from 16% of pediatricians with telemedicine experience just four years before. Supported by favorable federal and state policies begun to support physical distancing during the Coronavirus Disease 2019 (COVID-19) pandemic, the child health workforce now actively uses telemedicine to care for children, but lacks evidence to guide best practices for telemedicine use in pediatric primary care. Our research team previously found gaps in the quality of care delivered by commercial direct-to-consumer telemedicine for the most common acute pediatric concerns (acute respiratory tract infections). We also demonstrated improvement in management of common chronic conditions (e.g., asthma, attention-deficit/hyperactivity disorder) using telemedicine in research settings. However, the child health community lacks data regarding the use of telemedicine in evolving “real-world” primary care practices, including how telemedicine visits compare to in- person visits for the same conditions and how telemedicine use impacts longitudinal outcomes and equity for primary care patients. Additionally, we lack understanding of the structures and processes that support primary care practices in using telemedicine in ways that optimally enhance child health and health equity. The overarching goal of this proposal is to identify actionable strategies for promoting the use of telemedicine within primary care in ways that improve child health and health equity, using data from primary care practices from 2018-25. In Aim 1, we will compare visit-level quality of primary care visits for children delivered through telemedicine vs. in-person using electronic health record data from over 1,000 practices including independent practices, health system-affiliated practices, and community health centers. In Aim 2, we will compare child health outcomes for children receiving care in primary care practices with higher vs. lower telemedicine use through comparative interrupted time series analysis of metrics related to preventive, acute, and chronic care. In both of these aims, we will examine the impact of telemedicine on health equity by assessing variation in the effect of telemedicine by child and clinic characteristics. Finally, in Aim 3, we will identify the practice structures and processes that promote or impede use of telemedicine in primary care in ways that improve child health through a qualitative multiple-case study. Through this rigorous mixed-methods approach informed by the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model and a Structural Competency framework, we will identify visit-level and child-level impact of telemedicine integration within primary care for children as well as processes supporting health-promoting use of telemedicine. As a result, this examination of telemedicine across preventive, acute, and chronic care activities overall, for subpopulations, and within exemplar practices will provide critical knowledge to inform research, practice, and policy to optimize ongoing use of telemedicine within primary care to promote child health and health equity.

在2021年夏季，有80％的儿科医生在先前的现场音频视频远程医疗报告一个月，只有四年前的16％的儿科医生患有远程医疗经验。支持有利的联邦和州政策开始支持2019年冠状病毒疾病期间的身体距离（Covid-19）流行病，儿童健康员工现在积极使用远程医疗来照顾儿童，但缺乏指导小儿初级保健中远程医疗使用的最佳实践的证据。我们的研究团队以前在商业直接面向消费者远程医疗提供的医疗质量方面发现了差距常见的急性小儿问题（急性呼吸道感染）。我们还证明了使用常见慢性病（例如哮喘，注意力缺陷/多动障碍）的管理研究环境中的远程医疗。但是，儿童健康社区缺乏有关使用的数据远程医疗在不断发展的“现实世界”初级保健实践中，包括远程医疗的访问与In- 人访问相同条件以及远程医疗的使用如何影响纵向结果和公平性初级保健患者。此外，我们对支持主要的结构和过程缺乏了解使用远程医疗以最佳增强儿童健康和健康公平的方式使用远程医疗。这该提案的总体目标是确定可行的策略来促进远程医疗的使用在初级保健中，使用初级保健实践的数据，以改善儿童健康和健康公平的方式从2018-25开始。在AIM 1中，我们将比较分娩的儿童的初级保健访问质量使用来自1,000多种惯例的电子健康记录数据，包括独立的远程医疗与面对面实践，卫生系统附属实践和社区卫生中心。在AIM 2中，我们将比较孩子与远程医疗使用较高的初级保健实践中接受护理的儿童的健康成果通过比较中断的时间序列分析与预防，急性和慢性护理有关的指标。在这两个目标中，我们将通过评估远程医疗对健康平等的影响来评估远程医疗对卫生公平的影响儿童和诊所特征对远程医疗的影响。最后，在AIM 3中，我们将确定实践结构以及促进或阻碍在初级保健中使用或阻碍使用远程医疗的过程，以改善儿童健康通过定性多案例研究。通过这种严格的混合方法方法患者安全的系统工程计划（SEIPS）2.0模型和结构能力框架，我们将确定远程医疗整合在初级保健中对儿童的访问级和儿童级别的影响以及支持促进健康远程医疗的过程。结果，对远程医疗跨预防，急性和慢性护理活动总体，用于亚群以及内部示例实践将提供批判知识，以告知研究，实践和政策以优化正在进行的在初级保健中使用远程医疗以促进儿童健康和健康公平。