Recordable Cards for Optimizing Outcomes and Reducing Disparities after ED Discharge: The RECORD-ED Pilot Study

项目摘要 低收入和/或英语水平有限（LEP）的家庭经历了多种沟通， 与理解相关的障碍，以获得高质量，安全，有效的医疗保健时，他们的孩子 生病了教育程度有限和识字率低也是原因之一，导致难以理解和执行 出院指示很少有基于系统的干预措施可以提高出院指导的理解 大多数存在依赖于阅读能力、健康素养和英语语言技能的某种组合， 限制了他们接触最有可能缺乏理解和产生不利后果的家庭的能力。 纸质的、可录制音频的贺卡提供了一种低技术含量、廉价且容易获得的 解决基于理解的差异的方法。卡片可以与多个护理人员共享， 包括那些出院时不在场的人，并可以留在生病的孩子身边，以便快速参考。总目标 本研究的目的是确定RECORD-ED干预的可行性、可接受性和潜在影响， 它包括通常的护理，并辅以一张卡片，上面有父母喜欢的录音说明。 护理语言（英语或西班牙语）。记录的指令是与父母合作开发的 和临床人员，以确保信息是有用的，文化和语言定制。目标是 提高父母的理解，回忆和执行出院指示，因为家庭从 从急诊科（艾德）的护理到管理儿童的家庭医疗护理。的具体目标 研究的目的是：1）测试记录干预的可行性、可接受性和潜在有效性， 改善低收入哮喘儿童及其父母的父母、儿童和利用结果， 有和没有LEP;和2）描述父母和提供者对RECORD-ED干预的经验， 为今后的实施提供信息。为了实现这些目标，研究人员提出了一个试点随机 对照试验，招募100个从西雅图儿童医院出院回家的哮喘儿童家庭。 医院急诊室。家庭将联系完成电话或电子邮件调查两天，一周，三 艾德出院后3个月。干预的可行性和可接受性将是主要结果， 建议进行试点研究。将通过评估临床重要的 在指令回忆、药物依从性、家庭护理舒适度、生活质量、初级保健方面的差异 随访、哮喘控制和3个月重复使用，在意向治疗中 分析.提供者和护士将接受调查，对干预的可接受性和感知效果。 父母和护士将接受采访，以了解使用基于卡片的指示的经验。研究 研究结果将为多地点R 01方案提供信息，以严格确定RECORD-ED干预的效果 对父母理解、遵守出院指示以及儿童哮喘控制和医疗保健的影响 利用率

Project Summary Families with low income and/or limited English proficiency (LEP) experience multiple communication- and comprehension-related barriers to receiving high quality, safe, and effective medical care when their children are ill. Limited education and low literacy also contribute, leading to difficulties understanding and implementing discharge instructions. Few system-based interventions exist to improve discharge instruction comprehension and most that exist rely on some combination of reading ability, health literacy, and English language skills, limiting their ability to reach the families most at risk for poor understanding and adverse outcomes. Paper-based, audio-recordable greeting cards offer a low-tech, inexpensive, and readily available approach to addressing comprehension-based disparities. Cards can be shared with multiple caregivers, including those not present at discharge, and can remain with the ill child for quick reference. The overall goal of this study is to determine the feasibility, acceptability, and potential effect of the RECORD-ED intervention, which consists of usual care augmented by a card with audio-recorded instructions in the parent's preferred language for care (English or Spanish). The recorded instructions were developed collaboratively with parents and clinical personnel, to ensure the information is useful and culturally and linguistically tailored. The goal is to improve parent comprehension, recall, and implementation of discharge instructions, as families transition from care in the emergency department (ED) to managing the child's medical care at home. The specific aims of the study are to: 1) test the feasibility, acceptability, and potential effectiveness of the RECORD-ED intervention for improving parent, child, and utilization outcomes among low-income children with asthma and their parents, with and without LEP; and 2) characterize parent and provider experience with the RECORD-ED intervention, to inform future implementation. To accomplish these aims, the investigators propose a pilot randomized controlled trial, enrolling 100 families of children with asthma being discharged home from Seattle Children's Hospital ED. Families will be contacted to complete telephone or email surveys two days, one week, and three months after ED discharge. Intervention feasibility and acceptability will be primary outcomes, as recommended for pilot studies. Potential effectiveness will be determined by assessing for clinically important differences in instruction recall, medication adherence, comfort with home care, quality of life, primary care follow-up, asthma control, and 3-month re-utilization between assigned study arms, in an intention-to-treat analysis. Providers and nurses will be surveyed regarding intervention acceptability and perceived effect. Parents and nurses will be interviewed to understand experiences using the card-based instructions. Study results will inform a multi-site R01 proposal to rigorously determine the effect of the RECORD-ED intervention on parent comprehension, adherence to discharge instructions, and child asthma control and healthcare utilization.