Promoting Safe Transitions from Hospital to Home for Children with Medical Complexity: A Health Literacy-Informed and Family-Centered Approach

促进患有医疗复杂性的儿童从医院到家庭的安全过渡：一种以健康素养为基础、以家庭为中心的方法

• 批准号: 10610853
• 负责人: Alexander Glick
• 金额: $ 16.85万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10610853
• 关键词: Academy; Accident and Emergency department; Acute; Address; Adherence; Adult; Adverse drug event; Adverse event; Affect; Antibiotics; Appointment; Asthma; Back; Caregivers; Caring; Cellulitis; Child; Childhood; Chronic; Clinic; Communication; Complex; Comprehension; Congenital Abnormality; Counseling; Data; Dependence; Development; Diagnosis; Discharge Plannings; Education; Educational process of instructing; Electronic Health Record; Elements; Environment; Epilepsy; Equipment; Equity; Evaluation; Expenditure; Family; Family dynamics; Financial Hardship; Goals; Health; Home; Hospitalization; Hospitals; Household and Family; Individual; Infection; Inpatients; Instruction; Intervention; Interview; Joints; Knowledge; Language; Lead; Life Expectancy; Link; Liquid substance; Malignant Neoplasms; Medical; Medication Errors; Medicine; Mentors; Mentorship; Modeling; Morbidity - disease rate; Outcome; Outpatients; Parents; Patients; Pediatric Hospitals; Pharmaceutical Preparations; Physicians; Pneumonia; Process; Provider; Qualitative Methods; Qualitative Research; Randomized, Controlled Trials; Recommendation; Regimen; Research; Research Methodology; Research Personnel; Risk; Route; Sampling; Self Management; Shunt Device; Social support; Stress; Structure; Symptoms; System; Technology; Testing; Time; Training; Treatment Efficacy; United States Agency for Healthcare Research and Quality; Visit; Work; Writing; Yin; design; digital; effectiveness study; efficacy testing; evidence base; experience; family management; future implementation; health literacy; high risk; hospital readmission; implementation science; implementation study; improved; literacy; medical schools; medication administration; multidisciplinary; multiple chronic conditions; patient oriented; pediatrician; provider-level barriers; readmission rates; respiratory; side effect; skills; stakeholder perspectives; tool; tool development; usability; user centered design

PROJECT SUMMARY/ABSTRACT Children with medical complexity (CMC), or those with multiple chronic conditions, progressive conditions, or technology dependence, are at high risk for post-hospitalization morbidity. Despite representing 1% of children in the US, CMC account for 1/3 of pediatric hospital expenditures; 30-day readmission rates are ~20%. Research on post-discharge morbidity (e.g., adverse drug events, infections, unanticipated visits) has focused on adults. Few studies have assessed strategies to reduce post-discharge morbidity in CMC. Such strategies must account for 1) factors distinct to children (e.g., liquid medications, recognizing symptoms in children who cannot express what is wrong) and 2) specific needs of CMC (e.g., medical equipment, knowing which of many providers to contact, managing multiple chronic medications, complex family/household dynamics). Inadequate provider- parent communication and low parent health literacy contribute to poor comprehension of and adherence to discharge instructions, increasing risk for post-discharge morbidity. Despite recommendations from multiple national organizations for evidence-based, health literacy-informed interventions to improve communication processes, to date, a health literacy-informed approach to address post-hospitalization morbidity for CMC has not been used while also incorporating principals of family dynamics. The primary objective of this application is to support Dr. Glick’s goal of becoming an independent investigator with the aim of improving 1) parent comprehension of/adherence to discharge instructions and 2) post-discharge outcomes for CMC. This goal will be achieved through training from an expert multidisciplinary mentorship team and formal coursework. He will gain advanced skills in 1) qualitative/mixed method research, 2) family dynamics, 3) user-centered design, and 4) implementation science/design and evaluation of complex interventions. Dr. Glick will accomplish his goals at NYU School of Medicine through the following 3 aims: In Aim 1, Dr. Glick will use qualitative methods to examine barriers/facilitators for a) parents in comprehension of/adherence to discharge instructions and b) pediatricians in providing optimal discharge education for CMC. In Aim 2, Dr. Glick will use Aim 1 findings, multiple rounds of usability testing, multi-disciplinary workgroups, a national sample of discharge instructions for CMC, and an existing tool designed to improve parent adherence to discharge instructions for common pediatric diagnoses to inform the design of his new tool for CMC. In Aim 3, Dr. Glick will utilize a randomized controlled trial to examine this tool’s efficacy in improving parent comprehension of and adherence to discharge instructions and reducing post-hospitalization morbidity for CMC. Successful completion of this project will lead to an R01 application to test the efficacy of the intervention, now linked to the electronic health record, in improving parent comprehension of/adherence to discharge plans and reducing post-hospitalization morbidity for CMC.

项目摘要/摘要 有医疗复杂性(CMC)的儿童，或有多种慢性病、进展性疾病或 对技术的依赖，是住院后发病率的高危人群。尽管代表了1%的儿童 在美国，CMC占儿科医院支出的三分之一；30天再住院率约为20%。研究 关于出院后发病率(例如，药物不良事件、感染、意外就诊)的报告侧重于成年人。 很少有研究评估降低CMC出院后发病率的策略。这样的战略必须考虑到 对于儿童独特的因素(例如，液体药物，识别不能表达的儿童的症状 错误之处)和2)CMC的特定需求(例如，医疗设备，知道许多供应商中的哪一个 接触、管理多种慢性药物、复杂的家庭/家庭动态)。供应商不足- 父母沟通和较低的父母健康素养导致对父母健康的理解和遵守程度较低 出院指示，增加了出院后发病的风险。尽管来自多个国家的 国家循证、健康知识知情干预组织，以改善沟通 到目前为止，解决CMC住院后发病率的健康素养知情方法已经 没有被使用，同时也纳入了家庭动态的原则。 这个应用程序的主要目标是支持Glick博士成为一名独立调查员的目标 目的是提高父母对出院指示的理解/遵守，以及2)出院后 CMC的结果。这一目标将通过专家多学科指导团队的培训来实现 和正式的课程作业。他将在1)定性/混合方法研究，2)家庭动力学， 3)以用户为中心的设计；4)复杂干预措施的实施科学/设计和评估。Dr。 格利克将通过以下三个目标实现他在纽约大学医学院的目标： 在目标1中，格利克博士将使用定性的方法来检查a)父母在理解方面的障碍/促进者 B)儿科医生为CMC提供最佳的出院教育。 在Aim 2中，Glick博士将使用Aim 1的发现、多轮可用性测试、多学科工作组、 CMC的全国出院指令样本，以及旨在提高家长遵从性的现有工具 执行常见儿科诊断的说明，为CMC的新工具设计提供信息。 在目标3中，格利克博士将利用一项随机对照试验来检验这一工具在改善父母方面的有效性 理解和遵守出院指导，减少CMC住院后发病率。 这个项目的成功完成将导致R01应用程序来测试干预的效果，现在 与电子健康记录相联系，提高家长对出院计划的理解/遵守，以及 减少CMC患者住院后的发病率。