Newborn Screening for Critical Congenital Heart Disease in U.S.: Assessment of implementation obstacles and application of cost-effectiveness to gauge if action needed for improved implementation

这项拟议的研究重点是使用Pulse对新生儿进行危重先天性心脏病(CCHD)筛查 血氧测定仪，2011年被添加到建议的统一筛查小组(RUSP)。经常面临挑战 面对在患者环境中实施新的医疗筛查，尽管在 研究。筛查的实施水平低会极大地降低未确诊婴儿的预后 CCHD可能导致更高的死亡率和发病率，包括发育问题。无CCHD的婴儿 还会受到低执行率的影响，因为不正确的筛查程序可能会导致误报 结果，导致家庭面临焦虑和不必要的交通和进一步检查的费用。 目前，超过99%的美国新生儿出生在单独强制进行CCHD筛查的州 在过去的3年里，许多州的执行水平很低或未知。 在这项研究的第一个目标中，将评估当前CCHD筛查实施中的障碍和促进者 通过：(1)观察当地医院的CCHD筛查做法；(2)全国范围内一对一 对托儿所护理管理人员的访谈；(3)全国托儿所护士调查。一个系统的 对多级执行情况的评估将以执行综合框架为指导 研究(CFIR)，作为一种组织结构。结果将有助于量身定制干预措施以改善 实施。为了评估未来的实施水平，护士调查将在两个月内进行 时间点(第三年和第五年)。对于我们的第二个目标，我们将使用成本效益分析(CEA)。使用 CEA，将计算本年度和未来几年的成本效益差额。结果将 确定扩散(一种技术随着时间的推移自然采用)是否足以达到所需的水平 如果需要投资来实现预期的具有成本效益的干预措施水平，则需要进行投资。 父母K01是我实现成为独立人士的职业目标的重要机制 卫生服务研究方面的调查员。支持将使我能够将我的研究敏锐性扩展到我的主要 实施科学的着力点，从定性和定量两方面入手。到目前为止，我的 重点和实践一直是临床和量化的。K01为我提供了我从未有过的技能培训 或发展的机会，包括定性研究、访谈方法、调查设计和 管理和成本效益分析。我在洛杉矶担任助理教授一职 生物医学研究所，港湾-加州大学洛杉矶分校医学中心，可访问加州大学洛杉矶分校的许多资源 韦斯特伍德、查尔斯·R·德鲁大学和兰德大学。此外，我得到了一个令人难以置信的团队的支持 这些加州大学洛杉矶分校的优秀导师。实施科学和成本研究- 当我通过R01机制寻求资金时，有效性分析将推动我未来的职业方向。

This proposed study focuses on newborn screening for Critical Congenital Heart Disease (CCHD) using Pulse Oximetry, which was added to the recommended uniform screening panel (RUSP) in 2011. Challenges often face implementation of new medical screenings into the patient environment, in spite of proven effectiveness in research. Low implementation levels of screening can greatly diminish outcomes for infants, as undiagnosed CCHD can lead to greater mortality and morbidities, including developmental problems. Infants without CCHD will also be affected by low implementation because incorrect screening procedures can lead to false positive results, causing families to face anxiety and unnecessary costs for transport and further examination. Currently, over 99% of U.S. newborns are born in states that have individually mandated CCHD screening in the last 3 years, yet implementation levels in many states are low or unknown. In the study’s first aim, barriers and facilitators in the current CCHD screening implementation will be assessed through: (1) observation of CCHD screening practices at hospitals in the local area, (2) nationwide one-on-one interviews among nurse managers in nursery units, and (3) nationwide surveys of nursery nurses. A systematic assessment of multilevel implementation will be guided by the Consolidated Framework for Implementation Research (CFIR), serving as an organizational construct. Results will help tailor interventions to improve implementation. In order to estimate future implementation levels, the nurses’ survey will be conducted at two time points (years three and five). For our second aim, we will use cost-effectiveness analysis (CEA). With CEA, the difference in cost-effectiveness between current and future years will be calculated. Results will determine whether diffusion (natural adoption of a technique over time) is enough to bring about desired levels of implementation, or if investment is needed to accomplish desired levels of cost-effective interventions. The Parent K01 is an important mechanism for reaching my career goal to become an independent investigator in health services research. Support will allow me to extend my research acumen into my primary focus of implementation science, from both a qualitative and quantitative approach. Up until this point, my focus and practice has been clinical and quantitative. K01 provides me with training in skills I have not had time or the opportunity to develop, including qualitative research interview methodologies, survey design and administration, and cost-effectiveness analysis. I hold an Assistant Professor position at Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, with access to many resources at UCLA Westwood, Charles R. Drew University, and RAND. Moreover, I have the support of an incredible team of outstanding mentors from these UCLA-associated institutions. Research in implementation science and cost- effectiveness analysis will drive my future career direction when I seek funding through an R01 mechanism.