Candidate: Carolyn Foster, MD, MSHS is a pediatrician and junior clinical investigator focused on improving the evidence-based for the care of children with chronic lung disease (CLD) of prematurity who require invasive home mechanical ventilation (HMV). Dr. Foster?s long-term career goal is to become an independent physician-investigator who works in cross-disciplinary teams to design and evaluate evidence-based health care delivery interventions for children with medical technology dependence who require in-home services. Research Context/Objective: Children with CLD of prematurity are a growing, costly group of patients with high health care resource use and significant family caregiver burden. No empirically based parameters exist to guide how this population is discontinued from invasive HMV, leading to lack of appropriate, timely discontinuation of HMV. Therefore, the objective of this award is for Dr. Foster to learn how to assess the multifaceted factors that contribute to HMV duration, and to pilot test the integration of these factors into clinical management of children with CLD of prematurity, to safely shorten duration of HMV use.
Specific Aims : 1) Determine which patient level factors are associated with HMV duration; 2) Determine which family caregiver and health service factors are associated with weaning of HMV support; 3) Develop and pilot the feasibility, acceptability, and usability of integrating patient, family, and health service data elements into a clinical management dashboard design to optimize HMV use in children with CLD of prematurity. Research Plan: Dr. Foster will retrospectively analyze existing patients? clinical data to evaluate the association of patient medical factors (e.g., ventilator settings, oxygen use, weight, end-tidal CO2,) with HMV duration (Aim 1); prospectively collect patient reported outcome (PRO) measures (i.e., validated surveys) to elucidate which caregiver and system factors are associated with weaning of HMV support among current HMV patients (Aim 2); and use a stakeholder-engaged Learning Health System approach to develop and pilot the feasibility, acceptability, and usability (implementation) of a clinical HMV dashboard (Aim 3). Career Development Plan/Environment: Through a combination of local and national didactic activities, experiential learning, workshops, seminars, and professional activities, Dr. Foster will acquire expertise in evaluating longitudinal health outcomes and health care utilization; patient-reported outcome (PRO) health measurement science; and intervention design and pilot testing. Dr. Foster will strengthen her professional skills needed for an independent physician-investigator career through close mentorship by an experienced, complementary team of NIH-funded team mentors, advisors, and collaborators. Northwestern University and Lurie Children?s Hospital will provide outstanding research infrastructures to enable a successful award and are strongly committed to Dr. Foster?s transition to research independence.
Some children who are born very early develop severe, long-term lung problems that make them need a breathing machine to live at home and there are no studies that explain why some children need to use a breathing machine longer than others. This research will provide new understanding about why a given child may, in the context of their family and the care they receive, use a breathing machine longer, have to go the emergency room more often, and be hospitalized more often than another child. This research will also test whether providing more complete information to a child?s team of doctors, nurses, and respiratory therapists about the factors that affect how long children use breathing machines at home, can safely decrease the time a child uses a breathing machine while also avoiding hospitalization.
