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儿童健康福祉:一项随机对照试验方案,采用机会性、整体性和以家庭为中心的方法,改善新西兰奥特亚罗瓦住院儿童及其家庭的结局。

Harti Hauora Tamariki: randomised controlled trial protocol for an opportunistic, holistic and family centred approach to improving outcomes for hospitalised children and their families in Aotearoa, New Zealand.

作者信息

Scott Nina, Atatoa Carr Polly E, Jones Amy R, Sandiford Peter, Masters-Awatere Bridgette, Clark Helen

机构信息

Matauranga Māori, Rangahau Hauora Māori, Te Aka Whai Ora, Hamilton, New Zealand.

Te Whatu Ora Waikato, Hamilton, New Zealand.

出版信息

Front Pediatr. 2024 Feb 22;12:1359214. doi: 10.3389/fped.2024.1359214. eCollection 2024.

Abstract

BACKGROUND

Health and wellbeing inequities between the Indigenous Māori and non-Māori populations in Aotearoa, New Zealand continue to be unresolved. Within this context, and of particular concern, hospitalisations for diseases of poverty are increasing for tamariki Māori (Māori children). To provide hospitalised tamariki Māori, and their whānau (families) comprehensive support, a wellbeing needs assessment; the Harti Hauora Tamariki Tool (The Harti tool) was developed. The purpose of this study is to determine how effective the Harti tool is at identifying wellbeing needs, ensuring the documentation of needs, enabling access to services and improving wellbeing outcomes for tamariki and their whānau.

METHODS

The study uses a Kaupapa Māori methodology with qualitative and quantitative methods. Qualitative methods include in-depth interviews with whānau. This paper presents an overview of a randomised, two parallel, controlled, single blinded, superiority trial for quantitative evaluation of the Harti programme, and hospital satisfaction with care survey. Participants will be Māori and non-Māori tamariki/children aged 0-4 years admitted acutely to the paediatric medical wards at Waikato Hospital, Hamilton, Aotearoa New Zealand. They will be randomised electronically into the intervention or usual care group. The intervention group will receive usual care in addition to the Harti programme, which includes a 24-section health needs assessment delivered by trained Māori navigators to whānau during the time they are in hospital. The primary endpoint is the relative risk of an acute hospital readmission in the 30 days following discharge for the intervention group patients compared with control group patients. Secondary outcomes include access and utilisation of preventative health services including: oral health care, general practice enrolment, immunisation, healthy home initiatives, smoking cessation and the Well Child Tamariki Ora universal health checks available free of charge for children in Aotearoa New Zealand.

DISCUSSION

Randomised controlled trials are a gold standard for measuring efficacy of complex multifaceted interventions and the results will provide high quality evidence for implementing the intervention nationwide. We expect that this study will provide valuable evidence for health services and policy makers who are considering how to improve the configuration of paediatric hospital services.

TRIAL REGISTRATION

The study is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), registration number: ACTRN12618001079235.

摘要

背景

在新西兰奥特亚罗瓦,毛利原住民与非毛利人群之间的健康与福祉不平等问题仍未得到解决。在此背景下,尤其令人担忧的是,毛利儿童因贫困相关疾病住院的情况日益增多。为了向住院的毛利儿童及其家庭提供全面支持,开展了一项福祉需求评估,并开发了“哈蒂儿童健康工具”(简称“哈蒂工具”)。本研究的目的是确定哈蒂工具在识别福祉需求、确保需求记录、促进获得服务以及改善儿童及其家庭的福祉结果方面的效果如何。

方法

本研究采用毛利研究方法,结合定性和定量方法。定性方法包括对家庭进行深入访谈。本文概述了一项随机、双平行、对照、单盲、优效性试验,用于对哈蒂项目进行定量评估,以及医院护理满意度调查。参与者将是新西兰奥特亚罗瓦汉密尔顿怀卡托医院儿科病房急性收治的0至4岁毛利和非毛利儿童。他们将通过电子方式随机分为干预组或常规护理组。干预组除接受常规护理外,还将接受哈蒂项目,该项目包括由经过培训的毛利导航员在患儿住院期间向其家庭提供的24部分健康需求评估。主要终点是干预组患者出院后30天内急性再入院的相对风险与对照组患者相比。次要结局包括预防性健康服务的获得和利用,包括:口腔保健、全科医生注册、免疫接种、健康家庭倡议、戒烟以及新西兰奥特亚罗瓦为儿童免费提供的“健康儿童奥拉”通用健康检查。

讨论

随机对照试验是衡量复杂多方面干预措施效果的金标准,其结果将为在全国范围内实施该干预措施提供高质量证据。我们预计本研究将为正在考虑如何改善儿科医院服务配置的卫生服务机构和政策制定者提供有价值的证据。

试验注册

本研究已在澳大利亚新西兰临床试验注册中心(ANZCTR)注册,注册号:ACTRN12618001079235。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ef38/10917950/6d9282d4a5e4/fped-12-1359214-g001.jpg

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