Targeted Inpatient Navigation to Improve Care for Minority Children and Families

描述(申请人提供)：美国医疗保健质量的改善并没有同样惠及低收入和少数族裔儿童，他们仍然比其他儿童更有可能在临床环境和疾病范围内有更差的医疗保健经历和结果。患者导航器计划，其中非专业卫生工作者帮助患者导航系统，显示出在特定患者群体中提高护理质量的希望，但由于成本和疾病特定内容的原因，尚未广泛实施。一个成本更低、适用范围更广的计划将有可能改善更多低收入少数族裔儿童的质量和结果。K23候选人Casey Lion，医学博士，公共卫生硕士，其长期目标是通过开发和评估可能对人群产生广泛影响的面向系统的、家庭参与的干预措施，改善服务不足儿童的医疗质量、体验和结果。这一目标与美国卫生与公众服务部2020年健康人群总体目标一致，即实现健康公平，消除差异，改善所有群体的健康。为了实现她的目标，Lion博士将进行授课和体验式培训，以提高四个领域的知识和技能：(1)患者导航；(2)参与者参与的项目开发和研究；(3)行为干预；以及(4)传播和实施科学。Lion博士组建了一支导师团队，在医疗质量研究、差异、患者导航、经济评估和参与者参与的研究方面拥有专业知识，以确保完成拟议的研究和培训，并成功过渡到独立。莱恩博士提出了三个以她的培训目标为基础的连续创新项目。这些项目将有助于为低收入、少数族裔儿童家庭制定和试点评估住院导航计划，目标是最有可能改善结果并在诊断中普遍存在的家庭技能、知识和态度。具体目标是：(1)确定家庭技能的相对重要性， (2)与主要利益相关方合作，制定有针对性的住院患者导航(TNAV)计划，重点关注目标1中确定的中介因素；(3)针对低收入、少数族裔住院儿童家庭，初步测试TNAV计划的可行性、可接受性、成本和潜在影响。结果将包括与健康相关的生活质量、住院疼痛控制、住院时间、医院婴儿床和30天的再入院。这一建议的新颖之处在于，它将患者导航扩展到更具包容性的人群；将导航调整为更简短、成本更低的干预措施，以便于传播；在考虑低收入、少数族裔住院儿童方面， 很少有干预措施被证明能改善结果的群体。

DESCRIPTION (provided by applicant): Improvements in the quality of US health care have not equally benefitted low income and minority children, who remain more likely than other children to have worse health care experiences and outcomes across the spectrum of clinical settings and diseases. Patient navigator programs, in which lay health workers help patients navigate the system, have shown promise for improving quality of care among specific patient populations, but are not widely implemented due to cost and disease-specific content. A less costly, more broadly applicable program would have the potential to improve quality and outcomes for a larger population of low income minority children. The long-term objective of the K23 candidate, Casey Lion, MD, MPH, is to improve health care quality, experiences and outcomes for underserved children by developing and evaluating systems-oriented, family- engaged interventions with potential for broad population impact. This goal is consistent with the US Department of Health and Human Services Healthy People 2020 overarching goal to achieve health equity, eliminate disparities, and improve health for all groups. To achieve her objective, Dr. Lion will undertake didactic and experiential training to improve knowledge and skills in four areas: (1) patient navigation; (2) participant-engaged program development and research; (3) behavioral interventions; and (4) dissemination and implementation science. Dr. Lion has assembled a mentorship team with expertise in health care quality research, disparities, patient navigation, economic evaluation, and participant-engaged research, to ensure completion of the proposed research and training and successful transition to independence. Dr. Lion proposes three sequential, innovative projects that build upon her training goals. These projects will contribute to the development and pilot evaluation of an inpatient navigation program for families of low income, minority children, targeted to the family skills, knowledge and attitudes that are most likely to improve outcomes and are common across diagnoses. The specific aims are: (1) to determine the relative importance of family skills, attitudes and behaviors that navigation might target as mediators of the relationship between demographic characteristics and outcomes for hospitalized children; (2) to collaborate with key stakeholders to develop a targeted inpatient navigation (TNav) program, focused on the mediators identified in Aim 1; and (3) to pilot test the feasibility, acceptability, cost and potenial impact of the TNav program for families of low income, minority hospitalized children. Outcomes will include health-related quality of life, in- hospital pain control, length of stay, hospital cots, and 30-day readmissions. This proposal is novel in its expansion of patient navigation to a more inclusive population; in its adaptation of navigation into a briefer, less costly intervention to facilitate dissemination; and in its consideration of low income, minority hospitalized children, a group for which few interventions have been shown to improve outcomes.