DESCRIPTION (provided by applicant): This proposal describes a five-year research training program that will allow Dr. Desai to achieve her long-term goal of becoming an independent physician-scientist dedicated to improving access to comprehensive, coordinated health services for vulnerable children. Dr. Desai's project goal is to improve the quality of care coordination for children with medical complexity (CMC). She will achieve this goal by examining the design and implementation requirements of web-based care plans to meet the care coordination needs of CMC families. She will use a participatory design approach by engaging stakeholders in an iterative design process to build a web-based care plan to help CMC families coordinate their child's care. This proposal builds upon her clinical training in pediatric hospital medicine and her previous quality improvement research related to pediatric hospital-to-home transitions. Dr. Desai's research will be supported by an outstanding group of mentors with expertise in quality improvement research, comparative effectiveness research, health informatics and user-centered design. Her mentors are dedicated to ensuring the success of this project and her career development as an independent clinical investigator. The first aim of this proposal involves a large observational study to examine factors that impact use of existing care plans among CMC families. Through development and administration of a survey, Dr. Desai will identify design and implementation features of existing care plans that are associated with extent of care plan use among CMC caregivers. Her second aim will consist of an iterative process of design workshops and rapid prototyping where caregivers, providers and health information technology experts will actively participate in the development of a new web-based care plan prototype. Workshop participants will also create an implementation strategy for the web-based care plan. The third aim will determine caregiver use and perceptions of care coordination quality of the web-based care plan prototype in comparison to a standard paper-based care plan. This proof-of-concept study will inform the development of a multicenter, pragmatic comparative effectiveness trial of web-based versus paper-based care plans for improving health outcomes in CMC populations. By accomplishing the aims in this proposal, Dr. Desai will address critical gaps in our understanding of how to leverage health information technology to meet the care coordination needs of CMC families. By engaging patients and families in her research, she will design interventions that are consistent with their values, preferences and goals. Ultimately, this proposal will allow Dr. Desai to build a larger research program to investigate system-oriented, patient-centered solutions to improve access to comprehensive, coordinated health services for vulnerable children.
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