Digital Health Pathway for Children With Medical Complexity Requiring Tracheostomy

Официальное название

Adoption and Enhancement of a Care Pathway for Children With Medical Complexity: an Implementation Evaluation Project for Tracheostomy in Pediatrics

Обзор

The DECIDE-T project is developing a standardized clinical pathway specifically for pediatric patients who require tracheostomy with or without long-term ventilation (tracheostomy/LTV). These patients represent a small portion of Alberta's population but account for over 50% of pediatric patients hospitalized for more than 180 days. The pathway will include a hospital-to-home directive that incorporates digital health solutions to provide support to families, caregivers, and healthcare professionals. Digital supports will include a Connect Care pathway, resources for informed decision-making, educational modules, high-fidelity simulations for family and caregiver education, an online parental resource center, and access to peer support within the hospital and community, as well as a post-discharge telehealth program. The goal of the DECIDE-T project is to reduce hospital stays and associated costs for children requiring tracheostomy/LTV, as well as to decrease mental distress and burnout experienced by their caregivers and families.

Подробное описание

BACKGROUND: Medical advances have resulted in more children surviving critical illness and then living with medical complexity. Children discharged after critical illness with a tracheostomy-a surgical opening created through the neck to form an artificial airway that can be used for mechanical ventilation-are an example of this medically complex, technologically-dependent patient population. In Alberta, care for these children is centralized at the Stollery and Alberta Children's Hospitals. Fewer than 40 tracheostomized patients/year account for \>50% of pediatric patients hospitalized for over 180 days and average $484.660/patient/year-more than 30% of Alberta's annual pediatric acute care budget. These tertiary centers, however, lack a provincial standardized tracheostomy care pathway and, based on current guidelines, have substantial variations in practice, program inefficiencies, and barriers to care. This causes: 1) compromised health and disease burden for patients; 2) inconsistent and poorly informed decision-making; 3) increased stay in intensive care and hospital; 4) systemic inequities for certain subpopulations; and 5) substantial burdens for families-caregivers and healthcare providers (HCPs), causing burnout and long-lasting mental health complications. These factors result in a high cost for the health system and potential detriment to the care of other pediatric patients.

DIGITAL SOLUTION: Investigators propose the adaptation, implementation, and assessment of a provincial Digital hEalth Pathway for ChIldren with MeDical ComplExity requiring Tracheostomy/LTV (DECIDE-T). The DECIDE-T model will comprise a hospital-to-home journey, education and peer support digital solutions and a telemedicine follow-up program to support families-caregivers and HCPs looking after tracheostomized children.

PRIMARY OBJECTIVE: Reduce hospital stay and costs by 40%; SECONDARY OBJECTIVE: decrease families-caregivers mental stress and HCPs moral distress using validated measures.

APPROACHES: The key components of DECIDE-T will be defined using evidence-based guidelines and consultation with families-caregivers, HCPs, and other stakeholders. Scientific methods will be used to evaluate outcomes after implementation of DECIDE-T.

Вмешательства

• Процедура Digital health pathway for children with medical complexity requiring tracheostomy (DECIDE-T)
  The intervention involves developing a standardized clinical pathway for these children requiring tracheostomy. The pathway comprises of a hospital to home directive, incorporating digital health solutions to support family, caregivers, and healthcare professionals. These digital supports include but are not limited to a Connect Care pathway, resources to aid families to make informed choices during the clinical decision-making process, education modules and high-fidelity simulations to enhance

Первичные конечные точки

• Hospital length of stay [Срок оценки: 12 months]
• ICU length of stay [Срок оценки: 12 months]
• ICU readmission [Срок оценки: 12 months]
• Mortality [Срок оценки: 12 months]
• Decannulation [Срок оценки: 12 months]
• Duration of tracheostomy [Срок оценки: 12 months]
• Tracheostomy adverse events [Срок оценки: 12 months]
• Hospital cost [Срок оценки: 12 months]
• Hospital readmission [Срок оценки: 12 months]
• Net-monetary benefit of DECIDE-T [Срок оценки: 12 months]

Вторичные конечные точки (1)

• Caregivers mental stress [Срок оценки: 12 months]

Критерии участия

Критерии включения

• Age < 18 years
• First tracheostomy placement

Критерии исключения

\-

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Нерандомизированное

Модель

Одна группа

Маскирование

Открытое

Основная цель

Лечение

Центры проведения

Канада · 2 центра

• Alberta Children&#39;s Hospital — Calgary
• Stollery Children&#39;s Hospital — Edmonton

Публикации

• Ofosu D, Qureshi N, Kammerer E, Lecona L, Thomson-Kai P, Nitschke S, Gibson K, Schellenberg C, Wilkes S, Duke D, Schaab K, Davis J, Bonn N, Mahon K, Deus A, Doran T, Wiens S, Platt JM, Garros D, Jamal SM, Majaesic C, Soril L, Kam K, Walton J, Round J, Zimmermann GL, Mack C, Stickland MK, van Manen M, Castro Codesal ML. The DECIDE-T protocol: adoption and enhancement of a care pathway for children PMID 42532566

Идентификаторы

NCT: NCT06375369 · Pro00127121

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

Открыть это исследование на ClinicalTrials.gov ↗