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Telemedicine Consultations to Improve Care Quality of Pediatric Hospital-to-Hospital Transfers

远程医疗咨询可提高儿科医院间转院的护理质量

基本信息

批准号：
10620722
负责人：
Jennifer Rosenthal
金额：
$ 16.3万
依托单位：
UNIVERSITY OF CALIFORNIA AT DAVIS
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-06-01 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10620722
关键词：
Accident and Emergency department Address Adherence Assessment tool Award Caregivers Caring Child Childhood Clinical Trials Code Communication Communication Methods Communities Community Hospitals Consultations Critical Illness Data Decision Making Device or Instrument Development Devices Diagnosis Distress Eligibility Determination Emergency Department patient Emergency department visit Face Family Family Caregiver Family Physicians Future Goals Health Insurance Portability and Accountability Act Health system Hospitalization Hospitals Infrastructure Institution Intensive Care Units Interdisciplinary Study Intervention Leadership Life Literature Measures Medical Mentors Mentorship Methods National Institute of Child Health and Human Development Nurses Outcome Outcome Measure Parents Patients Pediatric Hospitals Perception Personal Satisfaction Physicians Procedures Protocols documentation Qualitative Methods Quality of Care Research Research Personnel Resources Risk Risk Factors Safety Severity of illness Specific qualifier value Stress Structure Surveys Technology Telemedicine Telephone Testing Time Trauma patient Triage Trust Visit Work acute stress career development cognitive interview design distrust effectiveness testing experience family burden feasibility testing health information technology hospital readmission improved instrument multidisciplinary operation patient safety pediatric emergency pediatric trauma pilot test pilot trial programs psychological trauma randomized trial remote assessment response shared decision making skills stress reduction trial comparing trial design uptake usability virtual

项目摘要

PROJECT SUMMARY / ABSTRACT The project objective is to improve care quality by making pediatric transfers more family-centered and effective. This award provides the necessary support to (1) develop skills in instrument development and testing, research leadership, and health information technology (IT) interventions and (2) gather preliminary data to support an R01 application to test the effectiveness of telemedicine consultations for pediatric transfers in a large multi-center randomized trial. I arranged a mentorship team with expertise encompassing instrument development and testing, research leadership, stakeholder engagement, and health IT (telemedicine). The focus of this project is the study of hospital-to-hospital transfers. Transfers pose safety risks to patients as well as burdens and distress to patients and families. Much of this harm is preventable, due to poor information sharing, lack of shared decision-making, and limited ability of the consulting/receiving physician to make transfer triage decisions. The use of telemedicine to provide expert consultation prior to initiating a transfer has potential to mitigate these problems. Telemedicine transforms the communication paradigm to make care during transfers more family-centered. It permits the consulting physician to virtually be at the patient’s bedside, ensuing more collaborative conversations that improve information sharing, shared decision-making, and trust. To effectively improve family-centered care during transfers, we need a validated method to measure this outcome in the context of pediatric emergency department (ED) encounters with children who are thought to need a transfer. Randomized trials are also needed to examine telemedicine use for pediatric transfers. In this proposal, I pursue two Specific Aims: AIM 1: Validate a modified version of an existing instrument that assesses family-centeredness of care in the newly applied context of ED encounters for children in need of transfer. AIM 2: Test the feasibility and potential impact of conducting a randomized trial comparing telemedicine to standard telephone communication for pediatric transfer consultations. This pilot trial utilizes existing UC Davis telemedicine program infrastructure. Feasibility will be tested using specified objectives for protocol adherence, fidelity, and survey response rates. Potential impact will be tested to inform future R01 trial design by exploring responsiveness to the intervention for triage appropriateness outcomes (e.g., potentially avoidable transfers) and patient and family outcomes (e.g., distress). By accomplishing these aims, I will validate an instrument to measure family-centeredness of care that other researchers and health systems can use. Telemedicine is becoming a widely available technology that is increasingly present in emergency departments, so by testing a telemedicine intervention, this project has potential for large-scale uptake. This research will change the communication paradigm for pediatric transfers and help to improve triage appropriateness and patient and family outcomes. This award will help me achieve my long-term goal: to leverage advanced technology to improve the quality of pediatric transitions of care.

项目概要/摘要该项目的目标是通过使儿科转移更加以家庭为中心和有效的。该奖项为 (1) 培养仪器开发技能和测试、研究领导力和健康信息技术 (IT) 干预措施，以及 (2) 收集初步信息支持 R01 应用程序的数据，以测试儿科转移远程医疗咨询的有效性在一项大型多中心随机试验中。我安排了一支拥有仪器专业知识的指导团队开发和测试、研究领导力、利益相关者参与以及健康 IT（远程医疗）。该项目的重点是医院间转移的研究。转运给患者带来安全风险也给患者和家属带来了负担和痛苦。由于信息匮乏，大部分伤害是可以预防的共享、缺乏共同决策以及咨询/接收医生的能力有限转移分类决定。在开始转移之前使用远程医疗提供专家咨询已经缓解这些问题的潜力。远程医疗改变了通信范式以提供护理在转移过程中更加以家庭为中心。它允许咨询医生几乎在患者身边床边，进行更多的协作对话，改善信息共享、共同决策，和信任。为了有效改善转移期间以家庭为中心的护理，我们需要一种经过验证的方法来衡量这一结果是在儿科急诊科 (ED) 遇到的儿童被认为是需要转机。还需要进行随机试验来检验远程医疗在儿科转移中的应用。在本提案中，我追求两个具体目标：目标 1：验证现有工具的修改版本，评估在急诊科新应用背景下对需要帮助的儿童的护理以家庭为中心的情况转移。目标 2：测试进行随机试验比较的可行性和潜在影响远程医疗到儿科转诊咨询的标准电话通信。该试点试验利用现有的加州大学戴维斯分校远程医疗项目基础设施。将使用指定目标来测试可行性协议遵守率、忠诚度和调查响应率。将测试潜在影响，为未来的 R01 试验提供信息通过探索对分类适当性结果干预的反应来设计（例如，潜在的可避免的转移）以及患者和家庭的结果（例如痛苦）。通过实现这些目标，我将验证一种工具来衡量其他护理以家庭为中心的程度研究人员和卫生系统可以使用。远程医疗正在成为一种广泛应用的技术越来越多地出现在急诊科，因此通过测试远程医疗干预，该项目已经大规模采用的潜力。这项研究将改变儿科转运的沟通模式并有助于改善分诊的适当性以及患者和家庭的结果。这个奖项将帮助我实现我的长期目标：利用先进技术提高儿科过渡护理的质量。

项目成果

期刊论文数量（17）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Virtual Family-Centered Rounds in the Neonatal Intensive Care Unit: A Randomized Controlled Pilot Trial.

DOI：
10.1016/j.acap.2021.03.007
发表时间：
2021-09
期刊：
Academic pediatrics
影响因子：
3.1
作者：
Rosenthal JL;Sauers-Ford HS;Williams J;Ranu J;Tancredi DJ;Hoffman KR
通讯作者：
Hoffman KR

Parent and Physician Qualitative Perspectives on Reasons for Pediatric Hospital Readmissions.

DOI：
10.1542/hpeds.2020-004499
发表时间：
2021-10
期刊：
Hospital pediatrics
影响因子：
0
作者：
Hamline MY;Sauers-Ford H;Kair LR;Vadlaputi P;Rosenthal JL
通讯作者：
Rosenthal JL

Understanding of Lactational Amenorrhea As a Contraceptive Method Among U.S. Pregnant Women.

美国孕妇对哺乳期闭经作为避孕方法的了解。

DOI：
10.1089/bfm.2023.0105
发表时间：
2023
期刊：
Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine
影响因子：
0
作者：
Hoyt-Austin,Adrienne;Chen,MelissaJ;Iwuagwu,Caidon;Brown,SusanD;Fix,Margaret;Kair,LauraR;Schwarz,EleanorB
通讯作者：
Schwarz,EleanorB

Exploring Telehealth to Improve Discharge Outcomes in Children.

探索远程医疗以改善儿童的出院结果。