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，儿科医疗保健的不平等现象仍然持续和普遍存在。次优 患者与提供者的沟通在创造和维护不同的结果方面发挥着重要作用；这是 一个家庭的技能和资源之间的不匹配与复杂性强加的要求之间的不匹配使情况更加复杂 卫生系统(如卫生知识普及和系统导航)。几乎没有什么干预措施可以解决 住院环境中与通信和系统导航相关的不平等；鉴于已建立的联系 在这些不平等和不同的临床结果之间，需要这样的干预。为了解决这一差距， 研究小组与父母/照顾者、工作人员和提供者合作，开发并试行了一种 为多样化人群改善导航能力、通信和医院到家庭过渡的计划 关于儿童及其家庭的家庭桥梁计划(FBP)。 FBP结合了有效的患者导航和沟通指导干预的原则 变成了一个简短而有针对性的住院计划。它是为广大的低收入儿童设计的。 颜色，不特定于疾病，并不局限于精通英语的家庭，而且比 传统导航，为更多家庭提供支持。FBP，由一名 训练有素的业馀导航员，包括：(1)医院定位；(2)未满足的社会需求筛查(例如，粮食无保障)； (3)家长沟通和文化偏好评估，传达给医疗队；(4)沟通 对父母的指导；(5)情感支持；(6)护理协调和后勤方面的援助；以及(7) 出院后2天打电话。课程内容可根据家长的需要和兴趣灵活提供。 在试点测试中，该计划是可行的，父母和提供者可以接受，并且显著 改进了家长报告的系统导航能力。目前的R01提出了一种两点随机 在728个低收入有色人种儿童家庭中进行FBP效果的对照试验。已注册 家庭将按1：1(按地点分层)随机分配到FBP或常规护理加书面资源。具体的 这项研究的目的是(1)使用严格和可复制的过程，使FBP适应新的地点，社会- 技术分析，这也将产生未来适应的实施指南；(2)测试效果 FBP对家长报告系统导航能力、医院到家庭过渡质量、诊断 低收入家庭的理解、观察到的沟通质量、感受到的压力和再访 (3)考察父母报告的障碍和需要的变化是否对程序效果起到中介作用； 以及(4)确定FBP在其中更有效的父母亚群。拟议的RCT将使用 严格的设计，以测试一个可行的，创新的计划，以解决一个关键的国家问题。如果有效， 家庭桥梁计划将为改善医疗保健体验和结果提供一个可扩展的模式 适用于低收入有色人种儿童的家庭，包括患有LEP的家庭。

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.