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: 10558718
• 负责人: Alexa Kanwit Craig
• 金额: $ 38.21万
• 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/10558718
• 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; Edema; Electroencephalography; Eligibility Determination; Exclusion; Future; Genetic Transcription; 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; Standardization; Telemedicine; Therapeutic; Time; Trauma; acute care; adverse outcome; 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; neuroprotection; obstetric services; outcome disparities; 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经历危急 延迟复苏和开始治疗低温(TH)，这是一种标准的神经保护措施 心理治疗。需要对新生儿脑病进行快速评估以确定是否符合TH，因为 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而处于不利地位 在生命的头6个小时内被运送以进行评估和护理。迫切需要测试有效性。 制定战略，如远程医疗，为农村新生儿危重护理提供即时专家会诊 社区医院设置。我们的长期目标是使用实施科学来提高生存和 出生在农村的新生儿的神经发育结果。我们的目标是发展我们的远程医疗 咨询网络，以提高治疗的及时性和患者选择，从而改善短期 取得成果，减少农村医疗保健差距。在目标1中，将在8个月中使用远程医疗会诊 缅因州的社区医院确定是否可以通过使用 远程医疗。在目标2中，远程医疗会诊将在三个三级护理中心使用，以开发证据 新生儿可以安全地排除在低温治疗之外的门槛。在《目标3》中，我们将 调查家长参与远程医疗会诊的经历，特别是在同意 通过远程医疗界面进行新生儿危重护理研究。我们的目标是了解父母的经历 在与新生儿出生时病情危重有关的创伤方面。在完成这项研究后， 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护理中心 以及8家或更多的社区医院。三级护理中心和社区医院的这种合作将是 准备欢迎新成员加入该网络，该网络将有能力规划和执行临床 针对主题的试验将进一步完善向符合标准的新生儿提供及时的TH护理。 通过实施科学，拟议的项目和未来的项目将确保在 农村社区医院可以获得三级护理中心提供的相同护理。 这个项目由Alexa Craig博士领导，他是一名初级研究员，也是新生儿/儿科神经科医生，有 研究计划，以解决出生在农村地区的新生儿的医疗保健结果差异。她最近 完成了KL2项目和初步研究，以确定当前研究的可行性。她强有力的指导 团队将带来儿科临床(M.Ottolini)和儿科神经病学临床研究(G. ，克雷格博士将利用这一Cobre来推动她的研究伙伴关系和项目 新英格兰北部。