Targeted Inpatient Navigation to Improve Care for Minority Children and Families

描述（由申请人提供）：美国医疗保健质量的改善并没有平等地惠及低收入和少数民族儿童，他们在临床环境和疾病方面的医疗保健经历和结果比其他儿童更差。由非专业卫生工作者帮助患者在系统中导航的“患者导航”项目已显示出改善特定患者群体护理质量的希望，但由于成本和特定疾病的内容而没有得到广泛实施。一个成本更低、适用范围更广的项目将有可能改善更多低收入少数族裔儿童的教育质量和结果。K23候选人Casey Lion，医学博士，公共卫生硕士，长期目标是通过开发和评估面向系统的、家庭参与的干预措施，提高服务不足儿童的卫生保健质量、经验和结果，这些干预措施可能对广泛的人群产生影响。这一目标与美国卫生与公众服务部“健康人2020”总体目标一致，即实现卫生公平，消除差距，改善所有群体的健康。为了实现她的目标，Lion博士将进行教学和体验式培训，以提高四个方面的知识和技能：(1)患者导航；(2)参与者参与的项目开发和研究；(3)行为干预；(4)传播与实施科学。Lion博士组建了一个在医疗质量研究、差异、患者导航、经济评估和参与者参与研究方面具有专业知识的指导团队，以确保完成拟议的研究和培训，并成功过渡到独立。根据她的培训目标，利恩博士提出了三个连续的创新项目。这些项目将有助于为低收入、少数民族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的家庭技能、知识和态度，并在诊断中普遍存在。具体目的是：(1)确定家庭技能的相对重要性；

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.