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(LEP)有限的家庭经历了多种交流--以及 接受高质量、安全和有效的医疗护理的理解相关障碍 都病了。教育程度低和识字率低也是造成理解和执行困难的原因之一。 出院指示。几乎没有基于系统的干预措施来提高出院指导的理解 而现存的大多数依赖于阅读能力、健康素养和英语语言技能的某种组合， 限制了他们接触到了解不足和不良后果风险最大的家庭的能力。 纸制、可录音的贺卡提供了一种技术含量低、价格便宜、随手可得的贺卡 解决基于理解的差异的方法。卡可以与多个护理者共享， 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 这项研究的目的是确定记录教育干预的可行性、可接受性和潜在效果， 它包括通常的护理，再加上一张卡片，上面有父母首选的录音说明 护理语言(英语或西班牙语)。录制的说明是与家长合作开发的 和临床人员，以确保信息是有用的，并在文化和语言上量身定做。我们的目标是 提高父母对出院指示的理解、回忆和执行，因为家庭从 从急诊科(ED)的护理到在家中管理儿童的医疗护理。《公约》的具体目标 研究的目的是：1)测试记录教育干预的可行性、可接受性和潜在的有效性 改善低收入哮喘儿童及其父母的父母、儿童和使用结果， 使用和不使用LEP；以及2)描述家长和提供者使用Record-Ed干预的体验， 以告知未来的实施情况。为了实现这些目标，调查人员提出了一种随机试点 对照试验，招募100名从西雅图儿童医院出院的哮喘儿童家庭 艾德医院。将在两天、一周和三天内联系家庭完成电话或电子邮件调查 艾德出院后几个月。干预的可行性和可接受性将是主要结果，因为 建议用于试点研究。潜在的有效性将通过评估临床上重要的 在指导回忆、服药依从性、家庭护理舒适度、生活质量、初级护理方面的差异 一项意向治疗的随访、哮喘控制和指定研究组之间3个月的再利用 分析。将对提供者和护士进行干预可接受性和感知效果的调查。 家长和护士将接受采访，以了解使用基于卡片的说明的经验。学习 结果将通知多站点R01提案，以严格确定Record-Ed干预的效果 关于父母理解、遵守出院指示以及儿童哮喘控制和保健 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.