Home Oxygen Use for Infants with Bronchopulmonary Dysplasia: Balancing Infant, Family, and Health System Outcomes

项目总结/摘要 该提案的目标是提供一条独立的途径，作为一名临床研究者在医疗保健 利用和健康相关的生活质量（HRQL）评估，应用于婴儿的结果研究， 支气管肺发育不良（BPD）。患有BPD的婴儿有延长NICU住院时间、再次入院的高风险， 和发育迟缓。家庭氧气通常用于促进早日出院，但 美国医院在使用这种疗法方面存在很大差异。我最近的研究表明， 使用更频繁的家庭氧气的中心比中心的婴儿平均NICU停留时间短1.2周 根据病情的严重程度，减少家庭吸氧的频率。在如何回家的知识方面存在着差距 氧气影响NICU出院后的婴儿结局，以及它如何影响他们的家庭。我想开发 评估NICU出院后医疗保健利用和HRQL的独特利基，以生成基于证据的 NICU出院指南，优化婴儿健康结果，最大限度地减少家庭负担。我会 我开始通过参与职业发展计划来实现这些目标，该计划在逻辑上扩展了我之前的培训 在传染病学和流行病学。我将培养前瞻性研究领导能力、卫生服务成果 测量，以及发展和HRQL评估。本职业发展计划将遵循以下原则： 经验丰富的导师和科学咨询委员会在威斯康星州医学院的专业知识， 儿科医疗利用，慢性病儿童的HRQL，BPD临床结局研究， 先进的定量分析，发展评估和新生儿生物伦理学。这种指导和 职业发展计划与调查NICU后BPD婴儿结局的研究相结合 放电，重点是家庭氧气使用后的差异。第一个目的是确定是否家 BPD婴儿的氧气使用与NICU出院后一年内再入院率的增加有关， 匹配疾病严重程度和人口统计学风险因素。这将通过次要分析进行评估， 数据来自儿童医院新生儿数据库，这是一个由25家四级儿童医院组成的多中心队列 通过儿科健康信息系统获得出院后再入院数据的NICU。的 第二个目标是前瞻性地比较BPD婴儿出院后的婴儿和父母的结局。 威斯康星州儿童医院NICU从NICU出院到2年的有和没有家庭氧气 年龄这项前瞻性研究将测量NICU后婴儿医疗保健利用率和父母HRQL随时间的变化 出院，并研究这些因素和2年结果之间的关系。结果将提供 结果比较BPD婴儿出院时有和没有家庭氧疗，并评估如何 特定的NICU治疗会随着时间的推移影响父母的HRQL。这可以用于做出基于证据的决策 新生儿重症监护室出院计划在此期间获得的成果和专业知识将用于测试 实施家庭氧气使用一致指南的多中心干预的影响。

PROJECT SUMMARY/ABSTRACT The goal of this proposal is to provide a pathway to independence as a clinical investigator in healthcare utilization and health-related quality of life (HRQL) assessment, applied to outcomes research for infants with bronchopulmonary dysplasia (BPD). Infants with BPD are at high risk for prolonged NICU stays, readmissions, and developmental delay. Home oxygen is used commonly to facilitate earlier hospital discharge, but there is wide variation across U.S. hospitals in use of this therapy. My recent study showed that infants with BPD in centers using more frequent home oxygen had a 1.2-week shorter average NICU stay than infants in centers using less frequent home oxygen, adjusted for illness severity. There is a gap in knowledge of how home oxygen impacts infant outcomes after NICU discharge, and how it affects their families. I would like to develop a unique niche assessing healthcare utilization and HRQL after NICU discharge, to generate evidence-based NICU discharge guidelines that optimize infant health outcomes with minimal undue burden on families. I will begin to achieve these goals by engaging in a career development plan that logically extends my prior training in neonatology and epidemiology. I will build skills in prospective study leadership, health services outcomes measurement, and developmental and HRQL assessment. This career development plan will be guided by experienced mentors and a scientific advisory committee at the Medical College of Wisconsin with expertise in pediatric healthcare utilization, HRQL for children with chronic illness, BPD clinical outcomes research, advanced quantitative analysis, developmental assessment, and neonatal bioethics. This mentorship and career development plan are integrated with research investigating outcomes of infants with BPD after NICU discharge, focusing on differences following home oxygen use. The first aim seeks to determine whether home oxygen use for infants with BPD is associated with increased readmissions in the year after NICU discharge, matched on illness severity and demographic risk factors. This will be assessed via a secondary analysis of data from the Children’s Hospitals Neonatal Database, a multi-center cohort of 25 Level IV children’s hospital NICUs with linked post-discharge readmission data available via the Pediatric Health Information System. The second aim will prospectively compare infant and parent outcomes for infants with BPD discharged from the Children’s Hospital of Wisconsin NICU with and without home oxygen from NICU discharge through 2 years of age. The prospective study will measure infant healthcare utilization and parent HRQL over time after NICU discharge, and study the relationship between those factors and 2-year outcomes. Results will provide outcome comparisons for infants with BPD discharged with and without home oxygen therapy, and assess how a specific NICU therapy affects parent HRQL over time. This can be used in making evidence-based decisions about NICU discharge planning. Results and expertise acquired during this award will be used to test the impact of a multi-center intervention implementing consistent guidelines for home oxygen use.