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

用于优化结果并减少 ED 出院后差异的可记录卡：RECORD-ED 试点研究

基本信息

批准号：
10056976
负责人：
Katherine Casey Lion
金额：
$ 24.57万
依托单位：
SEATTLE CHILDREN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-08-11 至 2022-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10056976
关键词：
Accident and Emergency department Acute Address Adherence Anxiety Asthma Caregivers Caring Child Child Health Child health care Clinical Communication Comprehension Day Surgery Diagnosis Education Effectiveness Electronic Mail English Language Enrollment Ensure Family Future Goals Health Healthcare Healthcare Systems Home environment Hospitals Human Resources Instruction Intention Intervention Interview Joints Language Limited English Proficiency Linguistics Low income Measures Medical Modeling Nurses Outcome Paper Parents Pattern Pediatric Hospitals Pharmaceutical Preparations Pharmacists Pilot Projects Primary Health Care Protocols documentation Provider Quality of life Randomized Randomized Controlled Trials Reporting Research Research Personnel Risk Site Source Standardization Surveys System Telephone Testing Time Uncertainty Visit Vulnerable Populations acute care adverse outcome arm asthma exacerbation base disparity reduction economic evaluation evidence base experience follow-up health care disparity health care service utilization health literacy improved improved outcome innovation intervention cost literacy medication compliance participant retention patient home care primary outcome reading ability satisfaction skills tool treatment as usual trial design usability user-friendly

项目摘要

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.

项目总结