Development of a Healthcare Navigation Intervention

 描述（由申请人提供）：这个为期4年的奖项支持职业发展和指导研究经验的凯瑟琳云，医学博士MHS，临床科学家专注于健康差距和获得照顾难民和移民家庭的儿童，包括儿童有特殊医疗保健需求（SHCN）。通过K23奖，Yun博士将获得定性研究和研究伦理方面的高级培训，她将扩展自己的技能，包括健康测量和社区干预措施的发展。这一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儿童的健康。云博士提出了一个全面的研究计划与不丹难民社区在费城，将允许未来的比较工作，在移民人口。拟议的研究将根据经验定义，测量和开发一种干预措施，以促进医疗导航，这意味着父母使用的技能和策略，以实现获得儿科医疗保健。目标1使用新移民调查和全国儿童健康调查，以确定与实现获得保健相关的父母特征，以便为目标2制定有目的的抽样计划。目标2使用多种定性方法，建立一个概念框架，医疗导航，使用父母在不丹难民社区的关键信息。目标3使用的概念框架，建立和评估一个工具来衡量医疗导航能力，并确定支持领域，以提高个人的能力，使用卫生服务。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，以促进掌握这些技能。目标2中创建的概念框架将用于调整干预方案，可行性、可接受性和效应量的数据将用于完善干预措施，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;它对120万有公共保险的移民家庭中的美国儿童也具有重要意义，这些儿童患有SHCN并继续报告难以获得必要的护理。Yun博士是一名初级研究员和儿科助理教授，接受过卫生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，并与费城的不丹社区建立了现有的合作关系。她组建了一个多学科的导师和顾问团队，由大卫鲁宾，医学博士（主要导师），弗朗西斯巴格，医学博士（共同导师），[和Leela Kuikel，MA（社区共同导师）]领导。她的职业发展计划将包括课程; [一个为期1年的，美国国立卫生研究院支持的混合方法研究培训计划;]指导阅读;并指导实践经验的方法，从医学人类学，生物统计学，心理测量学和公共卫生学科。普通儿科，儿科系和费城儿童医院致力于她的成功和她的职业生涯的进步。

 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.