Provision of Definitive Care for Children in Rural Hospitals

项目总结/摘要 该提案描述了一个为期五年的研究培训计划，将准备博士。 她的长期目标是成为一名独立的医生，科学家，致力于支持提供高， 为农村地区住院儿童提供优质、公平的护理。超过1200万儿童生活在农村， 在美国，几乎一半的农村县没有提供明确的普通儿科 住院治疗，农村地区儿童的健康状况较差，获得儿科治疗的机会有限。 卫生保健基础设施和资源相对于城市地区的儿童。解决儿童获得教育机会不平等的问题 在资源稀缺和基础设施有限的情况下，农村地区的儿童需要改变卫生政策 和创新举措。McDaniel博士的项目目标是建立系统级（例如，供应商，医院， 在农村医院提供儿科护理的促进者， 为农村社区儿童提供公平的住院治疗 在本提案的第一个目标中，使用差异中的差异方法，麦克丹尼尔博士将确定 如果在州一级为关键访问提供基于成本的补偿之间存在关联， 医院，一个联邦指定，以促进保留服务的农村社区，和 儿科服务的维持（1a）。然后，她将研究农村医院和系统的特点， 与损失、收益或持续提供全科儿科住院服务相关的医院 2010年至2018年美国（1b）。总之，这些将确定这些将确定医院，县，和国家一级 与农村县持续提供普通儿科住院服务相关的特征 时间在第二个目标中，采用与来自七个农村合作伙伴的主要利益攸关方达成共识的方法， McDaniel博士将开发一个干预包，以支持提供普通儿科 住院治疗该捆绑包将建立初步的定性数据，确定农村医院的战略， 支持护理和目标1中确定的背景因素。在第三个目标中，麦克丹尼尔博士将引导一个飞行员 在三家农村医院试行已制定的干预措施。她将评估4个主要 实施结果：可接受性、可行性、适当性和采用。这将创建一个 未来多地点干预措施的框架， 持续提供高质量的普通儿科住院护理。 麦克丹尼尔博士的研究将得到一群杰出的导师的支持，他们具有患者方面的专业知识， 以结果为中心的研究，农村医疗差距，定性和混合方法，计量经济学。 她的导师致力于确保这个项目的成功和她作为一个独立的发展 临床研究者通过实现本提案的目标，McDaniel博士将具备必要的技能， 致力于改善农村地区住院儿童的护理和减少差异的研究生涯。

Project Summary/Abstract This proposal describes a five-year research training program that will prepare Dr. McDaniel to achieve her long-term goal of becoming an independent physician-scientist dedicated to supporting the delivery of high- quality, equitable care to children hospitalized in rural settings. With more than 12 million children living in rural communities in the United States and with almost half of rural counties not providing definitive general pediatric inpatient care, children in rural areas experience both poorer health status and limited access to pediatric healthcare infrastructure and resources relative to children from urban areas. Addressing inequity in access for children in rural areas in the setting of scarce resources and limited infrastructure requires health policy change and innovative initiatives. Dr. McDaniel’s project goal is to establish system-level (e.g., provider, hospital, community) facilitators for the provision of pediatric care in rural hospitals that may improve access to and delivery of equitable inpatient care for children in rural communities In the first aim of this proposal, using a difference-in-differences approach, Dr. McDaniel will determine if there is an association between the state-level provision of cost-based reimbursement for critical access hospitals, a federal designation to promote the retention of services within rural communities, and the maintenance of pediatric services (1a). Then she will examine the hospital and system characteristics of rural hospitals associated with loss, gain, or sustained provision of general pediatric inpatient services across the US from 2010 to 2018 (1b). Together, these will identify these will identify hospital, county, and state-level characteristics associated with sustained provision of general pediatric inpatient services in rural counties over time. In the second aim, using a consensus methodology with key stakeholders from seven partnering rural hospitals, Dr. McDaniel will develop an intervention-bundle to support the provision of general pediatric inpatient care. The bundle will build off preliminary qualitative data identifying rural hospital strategies to support care and the contextual factors identified in Aim 1. In the third aim, Dr. McDaniel will conduct a pilot implementation trial at three rural hospitals of the developed intervention bundle. She will assess 4 primary implementation outcomes: acceptability, feasibility, appropriateness, and adoption. These will create a framework for future multi-site interventions evaluating the effectiveness of interventions to promote the sustained provision of high-quality general pediatric inpatient care. Dr. McDaniel’s research will be supported by an outstanding group of mentors with expertise in patient- centered outcomes research, rural healthcare disparities, qualitative and mixed-methods, and econometrics. Her mentors are dedicated to ensuring the success of this project and her development as an independent clinical investigator. By accomplishing the aims of this proposal, Dr. McDaniel will have the necessary skills for a research career dedicated to improving care and reducing disparities for children hospitalized in rural areas.