The goal of this K23 award is to provide the training and research experience necessary for me to become a leading researcher in the development of technology-based resources that improve the quality of care for pediatric surgical patients and their families. Because burn patients and their caregivers often live long distances from regional burn centers, access to expert burn care is limited, resulting in a negative effect on adherence to treatment and a higher risk of wound complication. Based on clinical experience in our outpatient burn clinic, I designed and piloted TOBI, a smartphone app aimed at enabling burn experts to direct burn wound care while the patient and caregiver are home through text messaging and video-conferencing. As a dual board-certified General and Thoracic Pediatric Surgeon at the Medical University of South Carolina (MUSC), I have a broad-based experience in clinical practice ranging from routine outpatient procedures to complex congenital problems in infancy, with a special interest in pediatric burn injury. My clinical experience treating pediatric burn injury and interest in patient-centered outcome research led to this K23 proposal. I propose to receive additional training in the following areas: 1) mHealth training and evaluation; 2) qualitative data collection and analysis; 3) biostatistics and clinical trial design; 4) remote healthcare monitoring implementation; 5) grant writing and project management skills; and 6) ethics and the responsible conduct of research within these domains. My mentorship team includes senior level investigators with active federally- funded research projects, extensive experience mentoring early-career investigators, and expertise in the following areas: iterative design, development, and evaluation of technology-based MH interventions (Ruggiero), qualitative research methods (Barroso), clinical trial design and evaluation (Mueller), and implementation of mHealth platforms in surgical disease (Evans). First, I propose to refine TOBI using qualitative research directed at stakeholder feedback. Second, I will perform a feasibility RCT conducted with 64 patient/caregiver dyads recruited from our outpatient burn clinic and randomly assigned to TOBI vs standard face-to-face burn care. Primary outcomes (wound healing, complications, and infection) will be assessed over the course of burn treatment. Last, strategies for implementation will be assessed via qualitative methods with stakeholders from other pediatric burn centers who will trial TOBI during the grant period. This will inform the next phase of this research, which will be a large-scale hybrid effectiveness-implementation trial of TOBI (NIH R01). This research complements my training and career trajectory, and will, ultimately, provide valuable data toward understanding how mHealth can improve access to healthcare for vulnerable populations.
Although approximately 120,000 children sustain a severe burn injury every year, access to high-quality burn services has significantly decreased over the past three decades. The majority of families of burn injured children travel long distances to receive burn care from regional burn centers, creating a burden on families and impairing clinical outcomes. This study will refine and preliminarily test a novel, scalable, sustainable smartphone intervention designed to allow burn experts to direct treatment for burn-injured children and their families in the home.
