Virtual Family-Centered Rounds to Improve Health and Quality of Life Outcomes for Neonates and their Caregivers

PROJECT SUMMARY / ABSTRACT The project objective is to improve neonatal and family health and quality of life outcomes by optimizing family- centered rounds (FCR) for parents or guardians (“parents” hereafter). This award provides the necessary support to conduct a virtual FCR trial to (1) determine efficacy of the virtual FCR intervention and (2)

understand the factors affecting the implementation and impact of the intervention. Our research team has expertise encompassing telehealth implementation and evaluation, clinical trials, stakeholder engagement, mixed methods, neonatology, and advanced statistical analyses. The focus of this project is the study of FCR in the neonatal intensive care unit (NICU). FCR is recognized as a

best practice for hospitalized children. Benefits of FCR include fewer harmful errors, improved family experience, reduced parental anxiety, and shortened hospital stays. However, FCR is infrequently conducted in the NICU, because it is only possible when parents can be at the bedside during the rounding process.

Importantly, the circumstances that prevent parents form being physically present in the NICU (e.g., financial, work, travel, and childcare constraints) disproportionately hinder underserved families, particularly rural and low-income families. Telehealth use to conduct virtual FCR has potential to mitigate these problems. Telehealth transforms the

rounding paradigm by virtually bringing the parents to the neonate’s bedside, ensuing more opportunities to reconcile misinformation and more collaborative conversations that improve information sharing, shared decision-making, and trust. Although our team has pilot tested virtual FCR, our pilot trial was not powered for

hypothesis testing. Additionally, this proposed trial includes additional health and quality of life outcomes. We pursue three Specific Aims: Evaluate the impact of virtual FCR on parental activation and wellbeing (AIM 1) and neonatal outcomes (AIM 2). Conduct a mixed methods evaluation of the virtual FCR intervention (AIM

3). This project utilizes existing UC Davis telehealth program infrastructure. Outcomes include FCR parent attendance, parent experience, parent activation, parent distress, parent health-related quality of life, breast milk feeding, growth failure, adverse events and errors, and length of stay. By accomplishing these aims, we will advance the delivery of an innovative telehealth solution to improve

the health and quality of life of children and their families. Our telehealth solution is a strategy that allows FCR to actually be family-centered; our intervention acknowledges the barriers parents face to engage in care and provides them with an alternative way to join rounds. Standard FCR does not equitably allow diverse

populations to engage in their child’s care, and virtual FCR has potential to address this inequity. Completion of this proposal will provide essential data that will be used in an R01 application to conduct a multi-site pragmatic virtual FCR trial.