The Family Bridge Program to Address Communication and Navigation-Related Inequities for Minority Children and Families: A Randomized Controlled Trial

项目摘要 在美国，儿科医疗保健不公平现象仍然持续存在且普遍存在。次优 患者与提供者之间的沟通在创造和维持不同的结果方面起着重要作用;这是 家庭的技能和资源与复杂性所带来的需求之间的不匹配， 卫生系统（如健康素养和系统导航）。几乎没有干预措施可以解决 与住院环境中的通信和系统导航相关的不公平;鉴于已建立的联系 在这些不平等和不同的临床结果之间，需要这种干预。为了弥补这一差距， 研究小组与父母/照顾者、工作人员和提供者合作，开发并试点测试了一种新的 一个为不同人群改善导航能力、通信和医院到家庭过渡的计划 家庭桥梁方案（FBP）。 FBP结合了有效患者导航和沟通指导干预的原则 变成一个简短而有针对性的住院计划它是专为广大人口的低收入儿童， 颜色，不是疾病特异性的，不限于英语熟练的家庭，并且比 传统的导航，使更多的家庭提供支持。FBP由一名 受过训练的外行导航员，包括：（1）医院定位;（2）未满足的社会需求筛查（例如，粮食不安全）; (3)父母沟通和文化偏好评估，转达给医疗团队;（4）沟通 辅导父母;（5）情感支持;（6）护理协调和后勤援助;以及（7） 出院后2天电话联系。根据家长的需求和兴趣灵活地提供计划内容。 在试点测试中，该计划是可行的，家长和供应商可以接受， 改进的家长报告系统导航能力。目前的R 01提出了一种双中心随机 在728个低收入家庭的有色人种儿童中进行了FBP有效性的对照试验（RCT）。入组 家庭将按1：1（按研究中心分层）随机分配至FBP或常规护理加书面资源组。具体 该研究的目的是（1）使用严格和可复制的过程，社会， 技术分析，这也将为今后的调整提供实施指南;（2）测试效果 父母报告的系统导航能力、医院到家庭过渡的质量、诊断 低收入家庭的理解，观察到的沟通质量，感知压力和重访 （3）检查父母报告的障碍和需求的变化是否介导了计划的效果; （4）确定在哪些父母中，家庭支持计划更有效。拟议的RCT将使用 严格的设计，以测试一个可行的，创新的方案，以解决一个关键的国家问题。如果有效， 家庭桥梁计划将提供一个可扩展的模式，以改善医疗保健的经验和成果 为低收入家庭的有色人种儿童，包括那些与LEP。

Project Summary Pediatric healthcare inequities in the United States (US) remain persistent and pervasive. Suboptimal patient-provider communication plays an important role in creating and maintaining disparate outcomes; this is compounded by mismatches between a family’s skills and resources and demands imposed by the complexity of the health system (such as health literacy and system navigation). Few interventions exist to address inequities related to communication and system navigation in the inpatient setting; given t he established links between these inequities and disparate clinical outcomes, such interventions are needed. To address this gap, the study team collaborated with parents/caregivers, staff, and providers to develop and pilot-test a novel program to improve navigation ability, communication, and hospital-to-home transition for a diverse population of children and their families, The Family Bridge Program (FBP). The FBP combines principles of effective patient navigation and communication coaching interventions into a brief and targeted inpatient program. It is designed for a broad population of low-income children of color, is not disease-specific, is not limited to English-proficient families, and is less time-intensive than traditional navigation, to enable provision of support to more families. The FBP, delivered in-person by a trained lay navigator, includes: (1) hospital orientation; (2) unmet social needs screening (e.g., food insecurity); (3) parent communication and cultural preference assessment, relayed to the medical team; (4) communication coaching for parents; (5) emotional support; (6) assistance with care coordination and logistics; and (7) a phone call 2 days post-discharge. Program elements are flexibly delivered based on parent need and interest. In pilot testing, the program was feasible to deliver, acceptable to parents and providers, and significantly improved parent-reported system navigation ability. The current R01 proposes a two-site randomized controlled trial (RCT) of the effectiveness of FBP among 728 families of low-income children of color. Enrolled families will be randomized 1:1 (stratified by site) to FBP or usual care plus written resources. The specific aims of the study are to (1) Adapt the FBP to a new site using a rigorous and replicable process, Socio- Technical Analysis, which will also result in an implementation guide for future adaptations; (2) Test the effect of the FBP on parent-reported system navigation ability, quality of hospital-to-home transition, diagnosis comprehension, observed communication quality, perceived stress and revisits for families of low-income children of color; (3) Examine whether changes in parent-reported barriers and needs mediate program effects; and (4) Identify subgroups of parents among whom the FBP is more effective. The proposed RCT will use a rigorous design to test a feasible, innovative program to address a critical national problem. If effective, the Family Bridge Program would provide a scalable model for improving health care experiences and outcomes for families of low-income children of color, including those with LEP.