Predictors of Days at Home for Children with Mechanical Ventilator Assistance

项目总结/摘要 本申请的研究部分建议使用混合方法来确定 侵入性家居儿童在家天数与住院天数增加的预测因素 美国各地的机械呼吸机（HMV）援助。这些病人，有着复杂的遗传， 肺，心脏和神经肌肉疾病，有长期住院的非医疗 原因，并有助于整体儿科医疗保健支出的高百分比。目标1 建议利用定性方法来了解父母和家庭护理的观点， 环境、资源和儿童特征导致快速出院和更少的再入院。 目标2将利用国家医疗补助要求，以确定哪些患者，家庭和社区医疗保健 因素，特别是家庭护理的可用性，预测积极的结果，包括较短的索引医院， 气管切开术放置后的停留时间，再入院的可能性较低，在家的天数增加。目标3 我将描述一个试点队列的儿童与HMV援助生活在社区，功能水平 在运动、认知和交流领域。 此应用程序的教育组件提供定性、医疗补助 成本效益分析。这些技能对于索博特卡博士过渡到 医疗复杂性儿童问题独立卫生服务研究专家， 神经发育障碍为此，拟议的研究项目的重点是 确定支持HMV儿童的策略：医学上最脆弱的，神经发育上 脆弱的，最消耗资源的儿科患者。索博特卡博士的专长是 神经发育将使她能够评估这一群体中的能力和残疾。 所描述的课程将通过扩大她的能力来补充和实现她的长期目标。 在四个教育领域的能力：1）定性研究方法; 2）医疗补助索赔分析; 3） 先进的流行病学和生物统计学; 4）公共政策。后者将为今后的提案提供参考 考虑到她的研究结果在更大的医疗保健框架内的政策影响。 博士索博特卡将得到芝加哥大学研究人员和资源的支持， 教育和分析支持，包括医疗补助数据分析小组，公共部门 健康科学和生物统计学实验室。她将由一个具有不同专业知识的团队指导： 导师Michael E. Msall和共同导师Monica E. Peek，Dr. Lucy A. Bilaver和博士。 杰·G贝瑞索博特卡博士还得到了内容和方法学合作者基特博士的支持。 n. Simpson，Dr. Quinn，Dr. Agrawal和Rob J. Graham博士。K23 NICHD 职业发展奖将支持索博特卡博士向独立过渡。

Project Summary/Abstract The research component of this application proposes using a mixed-methods approach to determine the predictors of increased days at home versus days hospitalized for children with invasive home mechanical ventilator (HMV) assistance throughout the US. These patients, with complex genetic, pulmonary, cardiac, and neuromuscular disorders, have prolonged hospital stays for non-medical reasons and contribute to high percentages of overall pediatric healthcare expenditures. Aim 1 of this proposal utilizes qualitative methodology to understand parental and home nursing perspectives on which circumstances, resources, and child characteristics lead to expeditious discharge and fewer readmissions. Aim 2 will utilize national Medicaid claims to determine which patient, family, and community healthcare factors, particularly home nursing availability, predict positive outcomes including a shorter index hospital stay after tracheostomy placement, a lower likelihood of readmissions and increased days at home. Aim 3 will describe, for a pilot cohort of children with HMV assistance living in the community, functional levels within motoric, cognitive, and communicative domains. The educational component of this application provides advanced training in qualitative, Medicaid claims, and cost-effectiveness analysis. Those skills are essential for Dr. Sobotka to transition into an independent health services research expert on children with medical complexity and neurodevelopmental disabilities. Toward that end, the proposed research project is focused on determining strategies to support children with HMV: the most medically fragile, neurodevelopmentally vulnerable, and highest resource-consuming pediatric patients. Dr. Sobotka’s expertise in neurodevelopment will enable her to assess abilities and disabilities within this cohort. The coursework described will complement and enable her long-term goals by expanding her capabilities in four educational areas: 1) Qualitative research methods; 2) Medicaid Claims analysis; 3) Advanced Epidemiology and Biostatistics; 4) Public Policy. The latter will inform future proposals considering the policy implications of her research findings within the larger healthcare framework. Dr. Sobotka will be supported by investigators and resources at the University of Chicago to provide educational and analytic support, including the Medicaid Data Analysis group, the Department of Public Health Sciences, and the Biostatistics Laboratory. She will be mentored by a team with diverse expertise: primary mentor, Dr. Michael E. Msall, and co-mentors, Dr. Monica E. Peek, Dr. Lucy A. Bilaver, and Dr. Jay G. Berry. Dr. Sobotka is additionally supported by content and methodologic collaborators, Dr. Kit N. Simpson, Dr. Michael T. Quinn, Dr. Rishi K. Agrawal, and Dr. Rob J. Graham. The K23 NICHD career development award will support Dr. Sobotka’s transition to independence.