Virtual Family-Centered Rounds to Improve Health and Quality of Life Outcomes for Neonates and their Caregivers

以家庭为中心的虚拟查房，以改善新生儿及其护理人员的健康和生活质量

• 批准号: 10588748
• 负责人: Jennifer Rosenthal
• 金额: $ 21.94万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-22 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10588748
• 关键词: Address; Adult; Adverse event; Affect; Anxiety; Award; Caregivers; Caring; Child; Child Care; Child Health; Childhood; Clinical Trials; Control Groups; Critical Illness; Data; Data Collection; Diabetes Mellitus; Dimensions; Distress; Effectiveness; Evaluation; Face; Failure; Family; Family Study; Family health status; Growth; Health; Health Insurance Portability and Accountability Act; Hospitalized Child; Hospitals; Human Milk; Hybrids; Hypertension; Infant; Infrastructure; Intelligence; Intervention; Interview; Length of Stay; Life; Low income; Measures; Mental Depression; Methods; Misinformation; Neonatal; Neonatal Intensive Care Units; Neonatology; Newborn Infant; Nurses; Obesity; Outcome; Outcome Measure; Parents; Patients; Personal Satisfaction; Persons; Phase; Physicians; Population Heterogeneity; Process; Provider; Quality of life; Randomized; Randomized Controlled Trials; Reach Effectiveness Adoption Implementation and Maintenance; Reporting; Research; Risk; Rural; SF-36; Sample Size; Secure; Sepsis; Site; Speed; Statistical Data Interpretation; Surveys; Technology; Testing; Time; Translations; Travel; Trust; Work; arm; biomedical referral center; care delivery; cognitive development; design; efficacy evaluation; efficacy trial; experience; feeding; group intervention; health related quality of life; improved; innovation; lower income families; multi-site trial; multidisciplinary; neonatal health; neonatal outcome; neonate; pilot test; pilot trial; population based; post-traumatic stress; prevent; primary outcome; programs; psychologic; randomized trial; shared decision making; standard of care; telehealth; treatment arm; trial comparing; virtual; virtual assessment

PROJECT SUMMARY / ABSTRACT The project objective is to improve neonatal and family health and quality of life outcomes by optimizing family- centered rounds (FCR) for parents or guardians (“parents” hereafter). This award provides the necessary support to conduct a virtual FCR trial to (1) determine efficacy of the virtual FCR intervention and (2) understand the factors affecting the implementation and impact of the intervention. Our research team has expertise encompassing telehealth implementation and evaluation, clinical trials, stakeholder engagement, mixed methods, neonatology, and advanced statistical analyses. The focus of this project is the study of FCR in the neonatal intensive care unit (NICU). FCR is recognized as a best practice for hospitalized children. Benefits of FCR include fewer harmful errors, improved family experience, reduced parental anxiety, and shortened hospital stays. However, FCR is infrequently conducted in the NICU, because it is only possible when parents can be at the bedside during the rounding process. Importantly, the circumstances that prevent parents form being physically present in the NICU (e.g., financial, work, travel, and childcare constraints) disproportionately hinder underserved families, particularly rural and low-income families. Telehealth use to conduct virtual FCR has potential to mitigate these problems. Telehealth transforms the rounding paradigm by virtually bringing the parents to the neonate’s bedside, ensuing more opportunities to reconcile misinformation and more collaborative conversations that improve information sharing, shared decision-making, and trust. Although our team has pilot tested virtual FCR, our pilot trial was not powered for hypothesis testing. Additionally, this proposed trial includes additional health and quality of life outcomes. We pursue three Specific Aims: Evaluate the impact of virtual FCR on parental activation and wellbeing (AIM 1) and neonatal outcomes (AIM 2). Conduct a mixed methods evaluation of the virtual FCR intervention (AIM 3). This project utilizes existing UC Davis telehealth program infrastructure. Outcomes include FCR parent attendance, parent experience, parent activation, parent distress, parent health-related quality of life, breast milk feeding, growth failure, adverse events and errors, and length of stay. By accomplishing these aims, we will advance the delivery of an innovative telehealth solution to improve the health and quality of life of children and their families. Our telehealth solution is a strategy that allows FCR to actually be family-centered; our intervention acknowledges the barriers parents face to engage in care and provides them with an alternative way to join rounds. Standard FCR does not equitably allow diverse populations to engage in their child’s care, and virtual FCR has potential to address this inequity. Completion of this proposal will provide essential data that will be used in an R01 application to conduct a multi-site pragmatic virtual FCR trial.

项目概要/摘要 该项目的目标是通过优化家庭来改善新生儿和家庭的健康以及生活质量。 针对父母或监护人（以下简称“父母”）的集中查房 (FCR)。该奖项提供了必要的 支持进行虚拟 FCR 试验，以 (1) 确定虚拟 FCR 干预的功效，以及 (2) 了解影响干预措施实施和影响的因素。我们的研究团队有 专业知识涵盖远程医疗实施和评估、临床试验、利益相关者参与、 混合方法、新生儿学和高级统计分析。 该项目的重点是新生儿重症监护病房 (NICU) 中的 FCR 研究。 FCR 被认为是 住院儿童的最佳实践。 FCR 的好处包括减少有害错误、改善家庭状况 经验，减少父母的焦虑，并缩短住院时间。然而，FCR 很少进行 在 NICU 中，因为只有在查房过程中父母可以在床边时才有可能。 重要的是，妨碍父母亲自入住 NICU 的情况（例如经济、 工作、旅行和儿童保育方面的限制）极大地阻碍了服务不足的家庭，特别是农村和 低收入家庭。 使用远程医疗进行虚拟 FCR 有可能缓解这些问题。远程医疗改变了 通过虚拟地将父母带到新生儿的床边，从而获得更多机会 协调错误信息和更多协作对话，以改善信息共享、共享 决策和信任。尽管我们的团队已经对虚拟 FCR 进行了试点测试，但我们的试点试验并未提供支持 假设检验。此外，这项拟议的试验还包括额外的健康和生活质量结果。 我们追求三个具体目标： 评估虚拟 FCR 对父母激活和福祉的影响（AIM 1) 和新生儿结局 (AIM 2)。对虚拟 FCR 干预（AIM 3）。该项目利用现有的加州大学戴维斯分校远程医疗项目基础设施。结果包括 FCR 母体 出勤率、家长体验、家长积极性、家长困扰、家长健康相关生活质量、乳房 牛奶喂养、生长障碍、不良事件和错误以及住院时间。 通过实现这些目标，我们将推进创新远程医疗解决方案的交付，以改善 儿童及其家人的健康和生活质量。我们的远程医疗解决方案是一种允许 FCR实际上以家庭为中心；我们的干预措施承认父母在参与护理方面面临的障碍 并为他们提供另一种参加回合的方式。标准 FCR 并不能公平地允许多样化 虚拟 FCR 有可能解决这种不平等问题。完成 该提案将提供将在 R01 应用程序中使用的基本数据，以进行多站点实用 虚拟 FCR 试验。