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使低收入和少数民族儿童同样受益，他们仍然比其他儿童更有可能在临床环境和疾病范围内获得更差的医疗保健体验和结果。患者导航程序，其中非专业卫生工作者帮助患者导航系统，已显示出改善特定患者人群护理质量的前景，但由于成本和疾病特异性内容而没有广泛实施。一个成本更低、适用范围更广的方案将有可能为更多的低收入少数民族儿童提高质量和成果。 K23候选人凯西狮子，医学博士，公共卫生硕士的长期目标是通过开发和评估系统导向的，家庭参与的干预措施，提高医疗保健质量，经验和结果，为服务不足的儿童，具有广泛的人口影响的潜力。这一目标与美国卫生与公众服务部2020年健康人总体目标一致，即实现健康公平，消除差距，改善所有群体的健康状况。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;（4）传播和实施科学。Lion组建了一个具有医疗保健质量研究，差异，患者导航，经济评估和参与者参与研究方面专业知识的导师团队，以确保完成拟议的研究和培训并成功过渡到独立。 Lion博士根据她的培训目标提出了三个连续的创新项目。这些项目将有助于为低收入家庭和少数民族儿童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常见的家庭技能，知识和态度。具体目标是：（1）确定家庭技能的相对重要性， 导航可能作为住院儿童人口统计学特征和结局之间关系的中介的态度和行为;（2）与关键利益相关者合作，制定有针对性的住院导航（TNav）计划，重点关注目标1中确定的中介;（3）对低收入家庭、少数民族住院儿童实施TNav项目的可行性、可接受性、成本和潜在影响进行初步测试。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，住院婴儿床和30天再入院。这一建议是新颖的，因为它将患者导航扩展到更具包容性的人群;它将导航调整为更简短，成本更低的干预措施，以促进传播;并且考虑到低收入，少数民族住院儿童， 很少有干预措施被证明可以改善结果。

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.