HOMeVent4Kids: Home-based Optimization of Mechanical Ventilation for Children

项目总结/摘要 候选人：卡罗琳福斯特，医学博士，MSHS是一名儿科医生和初级临床研究人员，专注于改善 以证据为基础的早产儿慢性肺疾病（CLD）儿童的护理， 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 在跨学科团队中工作的医生调查员，以设计和评估基于证据的健康 为需要家庭服务的依赖医疗技术的儿童提供护理干预。 研究背景/目的：患有早产儿CLD的儿童是一个不断增长的，昂贵的患者群体， 保健资源使用率高和家庭照顾者负担重。不存在基于经验的参数 指导这一人群如何停止侵入性HMV，导致缺乏适当的，及时的 停止HMV。因此，这个奖项的目的是为博士福斯特学习如何评估 多方面的因素，有助于HMV的持续时间，并试点测试这些因素的整合到临床 早产儿CLD儿童的管理，以安全地缩短HMV的使用时间。 具体目的：1）确定哪些患者水平因素与HMV持续时间相关; 2）确定哪些 家庭照顾者和卫生服务因素与HMV支持的脱机有关; 3）开发和试点 将患者、家庭和卫生服务数据元素整合到一个 临床管理仪表板设计，以优化早产儿CLD儿童中HMV的使用。 研究计划：福斯特博士将回顾性分析现有患者的临床数据，以评估 患者医疗因素的关联（例如，呼吸机设置、氧气使用、体重、潮气末CO2）和HMV 持续时间（目标1）;前瞻性收集患者报告结局（PRO）指标（即，经验证的调查）， 阐明目前HMV支持中，哪些照顾者和系统因素与HMV支持的脱机相关 HMV患者（目标2）;并使用一个由患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（实现）（目标3）。 职业发展计划/环境：通过地方和国家教学活动的结合， 体验式学习，研讨会，研讨会和专业活动，福斯特博士将获得专业知识， 评价纵向健康结局和卫生保健利用;患者报告结局（PRO）健康 测量科学;干预设计和试点测试。福斯特博士将加强她的专业能力 通过由经验丰富， NIH资助的团队导师，顾问和合作者的补充团队。西北大学和 Lurie儿童医院将提供出色的研究基础设施，以确保成功获奖， 坚定地致力于福斯特博士向独立研究的过渡。

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.