Telemedicine to Reduce Disparities in the Identification and Treatment of Neonatal Encephalopathy

远程医疗可减少新生儿脑病的识别和治疗方面的差异

• 批准号: 10090071
• 负责人: Alexa Kanwit Craig
• 金额: $ 50.81万
• 依托单位: MAINEHEALTH
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-02-10 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10090071
• 关键词: Absence Epilepsy; Address; Birth; Brain; Brain Injuries; Caring; Centers of Research Excellence; Cessation of life; Childhood; Clinical; Clinical Research; Clinical Trials; Collaborations; Community Hospitals; Consent; Consult; Consultations; Critical Care; Critical Illness; Data; Disadvantaged; Discipline of obstetrics; Edema; Electroencephalogram; Eligibility Determination; Future; Goals; Hospital Mortality; Hospitals; Hour; Individual; Informed Consent; Interview; Legal patent; Life; Limb structure; Location; Magnetic Resonance Imaging; Maine; Mentorship; Movement; Muscle Tonus; Neonatal; Neonatology; Neurologic; Neurologist; New England; Newborn Infant; Outcome; Parents; Patient Selection; Pediatric Neurology; Pediatrics; Pilot Projects; Predictive Value; Primary Care Physician; Process; Qualitative Methods; Reflex action; Research; Research Personnel; Resuscitation; Risk; Rural; Rural Community; Secure; Seizures; Services; Standardization; Telemedicine; Therapeutic; Time; Trauma; acute care; adverse outcome; base; care outcomes; disparity reduction; effectiveness testing; excitotoxicity; experience; health care availability; health care disparity; implementation science; improved; member; mental state; metabolic rate; natural hypothermia; neonatal encephalopathy; neonate; neuroinflammation; prevent; programs; rural area; rural disparities; rural healthcare; standard of care; sucking; teleconsultation; tertiary care

Abstract Newborns with neonatal encephalopathy delivered in community hospitals in rural Maine experience critical delays in resuscitation and initiation of therapeutic hypothermia (TH), a standard-of-care neuroprotective therapy. A rapid assessment of neonatal encephalopathy is required to determine eligibility for TH, because TH is only performed in two tertiary care centers in Maine. More than half of the neonates born annually are disadvantaged due to the lack of immediately available expertise in the community hospital and the need to be transported within the first 6 hours of life for assessment and care. There is a critical need to test effectiveness of strategies, such as telemedicine, to provide immediate expert consultation in neonatal critical care in rural community hospital settings. Our long-term goal is to use implementation science to improve survival and neurodevelopmental outcomes for neonates born in rural states. Our objective is to develop our telemedicine consultative network to improve both timeliness and patient selection for TH, and thus improve short-term outcomes and decrease rural healthcare disparities. In Aim 1, telemedicine consults will be used in eight community hospitals in Maine to determine if the time to initiation of TH can be decreased through the use of telemedicine. In Aim 2, telemedicine consults will be used in three tertiary care centers to develop evidence for the threshold at which neonates can be safely excluded from hypothermia treatment. In Aim 3, we will investigate the parent experience of participating in telemedicine consults, and specifically in giving consent for neonatal critical care research through the telemedicine interface. We aim to understand the parent experience in the context of the trauma associated with a newborn being critically ill at birth. Upon completion of this study, we anticipate that the telemedicine network in New England will include three tertiary care centers in two states and 8 or more community hospitals. This collaboration of tertiary care centers and community hospitals will be poised to welcome new members into the network, which will have the capacity to plan and execute clinical trials addressing topics that will further refine the delivery of timely TH care to neonates who meet criteria. Through implementation science, the proposed project and future projects will insure that neonates born in rural community hospitals have access to the same care available in a tertiary care center. This project is led by Dr. Alexa Craig, a junior investigator and neonatal/pediatric neurologist with a research program to address healthcare outcome disparities for neonates born in rural areas. She recently completed a KL2 project and pilot studies to establish feasibility for the current studies. Her strong mentorship team will bring expertise in clinical pediatrics (M. Ottolini) and pediatric neurology clinical research (G. Holmes), and Dr. Craig will utilize this COBRE to advance her research partnerships and program across northern New England.

摘要 缅因州农村社区医院分娩的新生儿脑病患者的经验至关重要 延迟复苏和开始治疗性低温（TH），一种标准的神经保护治疗， 疗法需要对新生儿脑病进行快速评估以确定TH的合格性，因为TH 只在缅因州的两个三级护理中心进行。每年出生的新生儿中有一半以上是 由于社区医院缺乏立即可用的专业知识， 在出生后6小时内运送进行评估和护理。迫切需要测试有效性 远程医疗等战略，为农村新生儿重症监护提供即时专家咨询 社区医院设置。我们的长期目标是利用实施科学来提高生存率， 农村出生的新生儿的神经发育结果。我们的目标是发展远程医疗 咨询网络，以改善TH的及时性和患者选择，从而改善短期 减少农村医疗差距。在目标1中，将在八个国家使用远程医疗咨询， 缅因州的社区医院，以确定是否可以通过使用 远程医疗在目标2中，远程医疗咨询将在三个三级护理中心使用，以开发证据， 新生儿可以安全地从低温治疗中排除的阈值。在目标3中，我们 调查父母参与远程医疗咨询的经验，特别是在同意 通过远程医疗接口进行新生儿重症监护研究。我们的目标是了解父母的经历 在与新生儿在出生时患有危重病相关的创伤的背景下。完成本研究后， 我们预计，新英格兰的远程医疗网络将包括两个州的三个三级医疗中心 8个或更多的社区医院。三级医疗中心和社区医院的合作将是 准备欢迎新成员加入网络，该网络将有能力规划和执行临床 试验的主题将进一步完善提供及时TH护理的新生儿谁符合标准。 通过实施科学，拟议的项目和未来的项目将确保出生在 农村社区医院可获得与三级保健中心相同的保健服务。 该项目由Alexa克雷格博士领导，他是一名初级研究员和新生儿/儿科神经学家， 解决农村地区出生新生儿保健结果差异的研究方案。她最近 完成了KL 2项目和试点研究，以确定目前研究的可行性。她强大的指导能力 团队将带来临床儿科学的专业知识（M。Adolini）和儿科神经病学临床研究（G。 Holmes），而克雷格博士将利用这一COBRE推进她的研究伙伴关系和计划， 北方新英格兰。