Development of a Healthcare Navigation Intervention

 描述(由申请者提供)：这个为期4年的奖项支持医学硕士Katherine Yun的职业发展和指导研究经验，Katherine Yun是一名临床医生兼科学家，专注于难民和移民家庭的儿童，包括有特殊医疗需求的儿童(SHCN)的健康差距和获得照顾的机会。通过K23奖项，云博士将获得定性研究和研究伦理方面的高级培训，她将扩大自己的技能，包括健康测量和基于社区的干预措施的开发。这项培训将作为今后大规模干预措施的基础，以促进难民和移民家庭中儿童的健康。Yun博士建议与费城的不丹难民社区开展一项全面的研究项目，以便在未来对移民群体进行比较研究。这项拟议的研究将从经验上定义、衡量和开发一种干预措施，以促进医疗导航，即父母为实现获得儿科医疗保健所使用的技能和策略。目标1利用新移民调查和全国儿童健康调查来确定与已实现的获得照料有关的父母特征，以便为目标2制定一个有目的的抽样计划。目标2使用多种定性方法，以不丹难民社区的父母为主要信息来源，建立一个医疗保健导航的概念框架。AIM 3使用概念框架建立和评估一种工具，以衡量医疗导航能力，并确定支持领域，以提高个人使用医疗服务的能力。目标4使用混合方法来适应、试点和评估单臂社区卫生工作者干预，以促进对这些技能的掌握。在目标2中创建的概念框架将被用于调整干预方案，关于可行性、可接受性和效果大小的数据将被用于改进干预并为未来的对照试验提供动力。这项工作有可能影响每年以难民身份进入美国的30,000名儿童；它也对120万公共保险的移民家庭中患有SHCN并继续报告难以获得必要护理的美国儿童具有重要意义。Yun博士是初级研究员和儿科学助理教授，接受过医疗服务研究方面的培训，在美国难民和移民儿童的医疗保健方面拥有丰富的经验，并与费城不丹社区建立了现有的合作伙伴关系。她组建了一个多学科的导师和顾问团队，由医学硕士大卫·鲁宾(MSCE)(主要导师)、弗朗西斯·巴格(France Barg)、医学博士(共同导师)[以及马萨诸塞州利拉·库伊克尔(Leela Kuikel)(社区共同导师)]领导。她的职业发展计划将包括课程工作；[一项由NIH支持的为期一年的混合方法研究培训计划；]定向阅读；以及在医学人类学、生物统计学、心理测量学和公共卫生学科的方法论方面的指导实践经验。普通儿科、儿科和费城儿童医院都致力于她的成功和事业的发展。

 DESCRIPTION (provided by applicant): This 4-year award supports career development and mentored research experience for Katherine Yun, MD MHS, a clinician-scientist focusing on health disparities and access to care for children in refugee and immigrant families, including children with special healthcare needs (SHCN). Through the K23 award, Dr. Yun will gain advanced training in qualitative research and research ethics, and she will expand her skills to include health measurement and the development of community-based interventions. This training will serve as the basis for future, large-scale interventions to promote the health of children in refugee and immigrant families. Dr. Yun proposes a comprehensive research program with the Bhutanese refugee community in Philadelphia that will allow for future comparative work across immigrant populations. The proposed research will empirically define, measure, and develop an intervention to promote healthcare navigation, meaning the skills and strategies used by parents to realize access to pediatric healthcare. Aim 1 uses the New Immigrant Survey and National Survey of Children's Health to identify parental characteristics associated with realized access to care in order to develop a purposive sampling plan for Aim 2. Aim 2 uses multiple qualitative methods to build a conceptual framework for healthcare navigation, using parents in the Bhutanese refugee community as key informants. Aim 3 uses the conceptual framework to build and evaluate an instrument to measure healthcare navigation competency and to identify areas for support to improve individuals' ability to use health services. Aim 4 uses mixed methods to adapt, pilot, and evaluate a single-arm community health worker intervention to promote mastery of these skills. The conceptual framework created in Aim 2 will be used to adapt the intervention protocol, and data on feasibility, acceptability, and effect sizes will be used to refine the intervention and power a future controlled trial. This work has the potential to impact the 30,000 children who enter the US as refugees each year; it also has significance for the 1.2 million publicly-insured, US children in immigrant families who have SHCN and continue to report difficulties obtaining necessary care. Dr. Yun is a junior investigator and Assistant Professor of Pediatrics with training in health services research, extensive experience with healthcare for refugee and immigrant children in the US, and existing partnerships with Philadelphia's Bhutanese community. She has assembled a multidisciplinary team of mentors and advisors led by David Rubin, MD MSCE (primary mentor), Frances Barg, PhD MEd (co-mentor), [and Leela Kuikel, MA (community co-mentor)]. Her career development program will include coursework; [a 1-year, NIH- supported mixed methods research training program;] directed reading; and mentored practical experience in methodologies from the disciplines of medical anthropology, biostatistics, psychometrics, and public health. The Division of General Pediatrics, the Department of Pediatrics, and the Children's Hospital of Philadelphia are committed to her success and the advancement of her career.