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Seppänen AV, Draper ES, Petrou S, Barros H, Aubert AM, Andronis L, Kim SW, Maier RF, Pedersen P, Gadzinowski J, Lebeer J, Ådén U, Toome L, van Heijst A, Cuttini M, Zeitlin J. High Healthcare Use at Age 5 Years in a European Cohort of Children Born Very Preterm. J Pediatr 2022; 243:69-77.e9. [PMID: 34921871 DOI: 10.1016/j.jpeds.2021.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/21/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To describe parent-reported healthcare service use at age 5 years in children born very preterm and investigate whether perinatal and social factors and the use of very preterm follow-up services are associated with high service use. STUDY DESIGN We used data from an area-based cohort of births at <32 weeks of gestation from 11 European countries, collected from birth records and parental questionnaires at 5 years of age. Using the published literature, we defined high use of outpatient/inpatient care (≥4 sick visits to general practitioners, pediatricians, or nurses, ≥3 emergency room visits, or ≥1 overnight hospitalization) and specialist care (≥2 different specialists or ≥3 visits). We also categorized countries as having either a high or a low rate of children using very preterm follow-up services at age 5 years. RESULTS Overall, 43% of children had high outpatient/inpatient care use and 48% had high specialist care use during the previous year. Perinatal factors were associated with high outpatient/inpatient and specialist care use, with a more significant association with specialist services. Associations with intermediate parental educational level and unemployment were stronger for outpatient/inpatient services. Living in a country with higher rates of very preterm follow-up service use was associated with lower use of outpatient/inpatient services. CONCLUSIONS Children born very preterm had high healthcare service use at age 5 years, with different patterns for outpatient/inpatient and specialist care by perinatal and social factors. Longer follow-up of children born very preterm may improve care coordination and help avoid undesirable health service use.
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Affiliation(s)
- Anna-Veera Seppänen
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, Center of Research in Epidemiology and Statistics, Université de Paris, INSERM, INRAE, Paris, France.
| | - Elizabeth S Draper
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Henrique Barros
- Epidemiology Research Unit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Adrien M Aubert
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, Center of Research in Epidemiology and Statistics, Université de Paris, INSERM, INRAE, Paris, France
| | - Lazaros Andronis
- Division of Clinical Trials, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Sung Wook Kim
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rolf F Maier
- Department of Neonatology, Children's Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
| | | | - Janusz Gadzinowski
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jo Lebeer
- Department of Family Medicine & Population Health, Disability Studies, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Ulrika Ådén
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Liis Toome
- Department of Neonatal and Infant Medicine, Tallinn Children's Hospital, Tallinn, Estonia; Department of Pediatrics, University of Tartu, Tartu, Estonia
| | - Arno van Heijst
- Department of Neonatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Jennifer Zeitlin
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, Center of Research in Epidemiology and Statistics, Université de Paris, INSERM, INRAE, Paris, France
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52
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Noritz G, Shah S, Glader L. Estimating fracture risk in children and adults with disabilities: An iniquitous use of race. Dev Med Child Neurol 2022; 64:523. [PMID: 35089608 DOI: 10.1111/dmcn.15170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Garey Noritz
- Nationwide Children's Hospital - Complex Care, Columbus, Ohio, USA
| | - Summit Shah
- Nationwide Children's Hospital - Radiology, Columbus, Ohio, USA
| | - Laurie Glader
- Nationwide Children's Hospital - Complex Care, Columbus, Ohio, USA
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53
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Driansky A, Pilapil M, Mastrogiannis A. Updating the healthcare maintenance visit for children with medical complexity: applying lessons learned from the coronavirus disease 2019 pandemic. Curr Opin Pediatr 2022; 34:248-254. [PMID: 35125381 PMCID: PMC8900886 DOI: 10.1097/mop.0000000000001116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Coronavirus disease 2019 (COVID-19) has exposed the vulnerabilities of children with medical complexity (CMC). This article uniquely describes how pediatric providers in various clinical settings can adapt routine healthcare maintenance visits to meet the needs of CMC in the era of COVID-19. We also discuss unique visit components important to address when providing primary care to CMC, including caregiver support, disaster preparedness, long-term care planning, and telemedicine. RECENT FINDINGS Although some children may be less severely affected by COVID-19 than adults, current literature suggests that CMC may be at higher risk for severe disease. In addition, the COVID-19 pandemic has highlighted the value in consistent, primary care for CMC. Children, especially those with medical complexity, are at risk for interruptions in care, delayed vaccinations, increasing caregiver burden, and barriers to in-person care. SUMMARY This article summarizes the components of the healthcare maintenance visit for CMC, providing salient recommendations on how pediatric providers can adapt their approach to the primary care of CMC in the era of COVID-19.
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Affiliation(s)
- Allison Driansky
- Steven and Alexandra Cohen Children's Medical Center, Pediatrics, New Hyde Park, New York, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
| | - Mariecel Pilapil
- Steven and Alexandra Cohen Children's Medical Center, Pediatrics, New Hyde Park, New York, Division of General Pediatrics, Division of General Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead
| | - Ariana Mastrogiannis
- Steven and Alexandra Cohen Children's Medical Center, Pediatrics, New Hyde Park, New York, USA
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54
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Curfman A, Hackell JM, Herendeen NE, Alexander J, Marcin JP, Moskowitz WB, Bodnar CEF, Simon HK, McSwain SD. Telehealth: Opportunities to Improve Access, Quality, and Cost in Pediatric Care. Pediatrics 2022; 149:184902. [PMID: 35224638 DOI: 10.1542/peds.2021-056035] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The use of telehealth technology to connect with patients has expanded significantly over the past several years, particularly in response to the global coronavirus disease 2019 pandemic. This technical report describes the present state of telehealth and its current and potential applications. Telehealth has the potential to transform the way care is delivered to pediatric patients, expanding access to pediatric care across geographic distances, leveraging the pediatric workforce for care delivery, and improving disparities in access to care. However, implementation will require significant efforts to address the digital divide to ensure that telehealth does not inadvertently exacerbate inequities in care. The medical home model will continue to evolve to use telehealth to provide high-quality care for children, particularly for children and youth with special health care needs, in accordance with current and evolving quality standards. Research and metric development are critical for the development of evidence-based best practices and policies in these new models of care. Finally, as pediatric care transitions from traditional fee-for-service payment to alternative payment methods, telehealth offers unique opportunities to establish value-based population health models that are financed in a sustainable manner.
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Affiliation(s)
- Alison Curfman
- Department of Pediatrics, Mercy Clinic, St Louis, Missouri.,Rubicon Founders
| | - Jesse M Hackell
- Department of Pediatrics, New York Medical College and Boston Children's Health Physicians, Pomona, New York
| | - Neil E Herendeen
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, New York
| | - Joshua Alexander
- Departments of Physical Medicine and Rehabilitation and Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - James P Marcin
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of California Davis and University of California Davis Children's Hospital, Sacramento, California
| | - William B Moskowitz
- Division of Pediatric Cardiology, Department of Pediatrics, Children's of Mississippi and University of Mississippi Medical Center, Jackson, Mississippi
| | - Chelsea E F Bodnar
- Robert Wood Johnson Foundation Clinical Scholars Program, University of Montana, Missoula, Montana
| | - Harold K Simon
- Departments of Pediatrics and Emergency Medicine, School of Medicine, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - S David McSwain
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
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55
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Chhibber R, Shrivastava R, Tandale M. Addressing consequences of school closure on oral health care of children during COVID-19. Front Pediatr 2022; 10:725977. [PMID: 35935378 PMCID: PMC9354613 DOI: 10.3389/fped.2022.725977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Radhika Chhibber
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC, Canada
| | | | - Madhura Tandale
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC, Canada
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56
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Nageswaran S, Ellis MB, Beveridge MS. Communication Challenges Faced by Spanish-Speaking Caregivers of Children with Medical Complexity: a Qualitative Study. J Racial Ethn Health Disparities 2022; 9:2218-2226. [PMID: 34595676 PMCID: PMC8483426 DOI: 10.1007/s40615-021-01161-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Communication between caregivers and healthcare providers is important in the delivery of high-quality healthcare for children with medical complexity (CMC). Hispanic children face many challenges in access to healthcare services. Our objective was to describe the communication challenges faced by Spanish-speaking parents with limited English proficiency (SSP-LEP). METHODS This was a qualitative study of 70 children of Spanish-speaking caregivers, enrolled in a complex care program of a tertiary care children's hospital in North Carolina. Secondary source data were abstracted logs of care coordination tasks maintained by the program's two bilingual care coordinators for a median observation period of 45 months, and complemented by data from care coordinator interviews. Data were entered and coded in ATLAS.ti. Using thematic content analysis and an iterative process, we identified recurrent themes related to communication challenges of Spanish-speaking caregivers. RESULTS Median age of children was 5 years; 51% were girls; 97% had Medicaid; and 3% were uninsured. Seven children died during the observation period. Three major themes were identified as follows: (1) caregivers faced many communication challenges primarily because of language barrier. (2) Multiple factors at caregiver, provider, and system levels, in addition to language barrier, contributed to communication challenges. (3) Communication challenges had serious consequences for CMC. These consequences were lessened by bilingual coordinators. CONCLUSION SSP-LEP face unique communication challenges resulting in negative impact on the healthcare of their CMC. Bilingual coordinators can help improve communication between SSP-LEP and their healthcare providers. Interventions to address communication challenges of Spanish-speaking caregivers are warranted.
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Affiliation(s)
- Savithri Nageswaran
- Department of Pediatrics, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA.
| | | | - Mark S Beveridge
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
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57
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Yu J, Perrin JM, Hagerman T, Houtrow AJ. Underinsurance Among Children in the United States. Pediatrics 2022; 149:183780. [PMID: 34866156 PMCID: PMC9647940 DOI: 10.1542/peds.2021-050353] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES We describe the change in the percentage of children lacking continuous and adequate health insurance (underinsurance) from 2016 to 2019. We also examine the relationships between child health complexity and insurance type with underinsurance. METHODS Secondary analysis of US children in the National Survey of Children's Health combined 2016-2019 dataset who had continuous and adequate health insurance. We calculated differences in point estimates, with 95% confidence intervals (CIs), to describe changes in our outcomes over the study period. We used multivariable logistic regression adjusted for sociodemographic characteristics and examined relationships between child health complexity and insurance type with underinsurance. RESULTS From 2016 to 2019, the proportion of US children experiencing underinsurance rose from 30.6% to 34.0% (+3.4%; 95% CI, +1.9% to +4.9%), an additional 2.4 million children. This trend was driven by rising insurance inadequacy (24.8% to 27.9% [+3.1%; 95% CI, +1.7% to +4.5%]), which was mainly experienced as unreasonable out-of-pocket medical expenses. Although the estimate of children lacking continuous insurance coverage rose from 8.1% to 8.7% (+0.6%), it was not significant at the 95% CI (-0.5% to +1.7%). We observed significant growth in underinsurance among White and multiracial children, children living in households with income ≥200% of the federal poverty limit, and those with private health insurance. Increased child health complexity and private insurance were significantly associated with experiencing underinsurance (adjusted odds ratio, 1.9 and 3.5, respectively). CONCLUSIONS Underinsurance is increasing among US children because of rising inadequacy. Reforms to the child health insurance system are necessary to curb this problem.
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Affiliation(s)
- Justin Yu
- Departments of Pediatrics,Address correspondence to Justin Yu, MD, MS, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Faculty Pavilion, Suite 3110, 4401 Penn Ave, Pittsburgh, PA, 15224. E-mail:
| | - James M. Perrin
- Department of Pediatrics, Harvard Medical School and MassGeneral Hospital for Children, Boston, Massachusetts
| | - Thomas Hagerman
- Department of Emergency Medicine, Henry Ford Health System, Detroit, Michigan
| | - Amy J. Houtrow
- Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh and University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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Moonpanane K, Kodyee S, Potjanamart C, Purkey E. Adjusting the family's life: A grounded theory of caring for children with special healthcare needs in rural areas, Thailand. PLoS One 2021; 16:e0258664. [PMID: 34695121 PMCID: PMC8544842 DOI: 10.1371/journal.pone.0258664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 10/03/2021] [Indexed: 11/19/2022] Open
Abstract
This study aims to understand the experiences of families of children with special healthcare needs in rural areas in Thailand. Grounded theory (GT) was employed to understand families' experiences when caring for children with special healthcare needs (CSHCN) in rural areas. Forty-three family members from thirty-four families with CSHCN participated in in-depth interviews. Interviews were recorded and transcribed. The constant comparative method was used for data analysis and coding analysis. Adjusting family's life was the emergent theory which included experiencing negative effects, managing in home environment, integrating care into a community health system, and maintaining family normalization. This study describes the process that families undergo in trying to care for CSHCN while managing their lives to maintain a sense of normalcy. This theory provides some intervention opportunities for health care professionals when dealing with the complexities in their homes, communities and other ambulatory settings throughout the disease trajectory, and also indicates the importance of taking into consideration the family's cultural background.
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Affiliation(s)
| | - Salisa Kodyee
- School of Nursing, Mae Fah Luang University, Chiang Rai, Thailand
| | | | - Eva Purkey
- Department of Family Medicine, Faculty of Health Science, Queen’s University, Kingston, Canada
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59
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Mitchell SM. True Resilience: A Look Inside COVID's Effect on Children with Medical Complexity and Their Families. CURRENT PEDIATRICS REPORTS 2021; 9:171-177. [PMID: 34659915 PMCID: PMC8501934 DOI: 10.1007/s40124-021-00254-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 01/10/2023]
Abstract
Purpose of Review Vulnerable children with medical complexity are silent victims of the COVID-19 pandemic, impacted by lack of resources and sick caregivers. In this article, we examine ways in which the pandemic has increased the significant difficulties already experienced by these patients and their families. Increased awareness will lead to improvement in the disparities experienced by this population and improve the ability of healthcare providers to care for them. Recent Findings The number of children living with medical complexity is rapidly increasing. They face unique circumstances which can lead to compromise in care. This population is especially at risk for complications related to COVID, so may have a more prolonged admission with more morbidities. Children of ethnic minorities are also more impacted by severe illness and death. Finally, access to palliative care has been limited, which is a huge part in caring for these children who have life-long medical care needs. Summary Children with medical complexity have unique circumstances and the entirety of the effect of the coronavirus pandemic on this group is unknown. While the medical world has found ways to adapt, these changes can increase disparities for this population. Given the increase in number of children with medical complexity living in the USA, it is important to continue to consider the unique challenges they face in the current pandemic and improve the care delivery for both the child and his or her family.
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Affiliation(s)
- Sarah M Mitchell
- Department of Pediatrics-Hospitalist Based Medicine, LaRabida Children's Hospital, 6501 S. Promotory Dr., Chicago, IL 60653 USA
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60
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Medeiros JPB, Neves ET, Pitombeira MGV, Figueiredo SV, Campos DB, Gomes ILV. Continuity of care for children with special healthcare needs during the COVID-19 pandemic. Rev Bras Enferm 2021; 75:e20210150. [PMID: 34614106 DOI: 10.1590/0034-7167-2021-0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/21/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To describe the continuity of care for children with special healthcare needs during the COVID-19 pandemic through the perception of their caregivers in the Northeast of Brazil. METHODS Qualitative descriptive-exploratory research carried out between June and September 2020, in a municipality in the Northeast of Brazil. Eleven caregivers participated through semi-structured interviews conducted at home. The data were submitted to thematic content analysis. RESULTS The social isolation period and the suspension of health services affected the continuity of care, configuring the category "Implications of the COVID-19 pandemic for the continuity of care". Caregivers expressed fear of children contracting the coronavirus, characterizing the category "Fears and uncertainties of the COVID-19 pandemic in view of the vulnerability of children with special healthcare needs". FINAL CONSIDERATIONS Caregivers' reports revealed problems in the continuity of care for the studied cohort. Therefore, health care practices must be rethought in times of pandemic.
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61
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Keim-Malpass J, Cozad MJ, Svynarenko R, Mack JW, Lindley LC. Medical complexity and concurrent hospice care: A national study of Medicaid children from 2011 to 2013. J SPEC PEDIATR NURS 2021; 26:e12333. [PMID: 33811725 PMCID: PMC8547133 DOI: 10.1111/jspn.12333] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/19/2021] [Accepted: 03/19/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE Pediatric hospice is a comprehensive model of care for medically complex children at end of life. The Affordable Care Act changed regulatory requirements for pediatric Medicaid enrollees to allow for enrollment into hospice services while still receiving life-prolonging therapy. There are gaps in understanding factors associated with pediatric concurrent hospice care use. The objectives were to examine the prevalence of concurrent hospice care overtime and investigated the relationship between medical complexity and concurrent hospice care among Medicaid children. DESIGN AND METHODS We used national Medicaid data and included children less than 21 years with an admission to hospice care. Medical complexity was defined with four criteria (i.e., chronic conditions, functional limitations, high health care use and substantial needs). Using multivariate logistic regression, we evaluated the influence of medical complexity on concurrent hospice care use, while controlling for demographic, hospice, and community characteristics. RESULTS Thirty-four percent of the study sample used concurrent hospice care. Medical complexity was unrelated to concurrent hospice care. However, the four individual criteria were associated. A complex chronic condition was negatively related to concurrent hospice care, whereas technology dependence, multiple complex chronic conditions, and mental/behavioral disorders were positively associated to concurrent care use. PRACTICE IMPLICATIONS These findings suggest that concurrent hospice care may be important for a subset of medically complex children with functional limitations, high health utilization, and substantial needs at end of life.
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Affiliation(s)
- Jessica Keim-Malpass
- Department of Acute and Specialty Care, School of Nursing, University of Virginia, Charlottesville, Virginia, USA
| | - Melanie J Cozad
- Department of Health Services Policy and Management, University of South Carolina, Columbia, South Carolina, USA
| | - Radion Svynarenko
- College of Nursing, University of Tennessee, Knoxville, Tennessee, USA
| | - Jennifer W Mack
- Division of Population Sciences, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Lisa C Lindley
- College of Nursing, University of Tennessee, Knoxville, Tennessee, USA
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62
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Berry JG, Perrin JM, Hoover C, Rodean J, Agrawal RK, Kuhlthau KA. Health Care Insurance Adequacy for Children and Youth With Special Health Care Needs. Pediatrics 2021; 148:peds.2020-039891. [PMID: 34535570 DOI: 10.1542/peds.2020-039891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jay G Berry
- Complex Care, Division of General Pediatrics, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - James M Perrin
- Division of General Academic Pediatrics, MassGeneral Hospital for Children and Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | | | - Rishi K Agrawal
- Ann & Robert H. Lurie Children's Hospital of Chicago, and Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Karen A Kuhlthau
- Division of General Academic Pediatrics, MassGeneral Hospital for Children and Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
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Lax Y, Bathory E, Braganza S. Pediatric primary care and subspecialist providers' comfort, attitudes and practices screening and referring for social determinants of health. BMC Health Serv Res 2021; 21:956. [PMID: 34511119 PMCID: PMC8436516 DOI: 10.1186/s12913-021-06975-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early detection and management of poverty-related disorders is a recommended pediatric practice; however, little is known about variations of practice between pediatric primary care physicians and subspecialists. The objectives of this study were to assess (1) provider perceptions and attitudes toward caring for low-income children in an urban academic medical center, and (2) variations between primary care physicians and subspecialists in social and financial needs screening and referral practices for low-income children. DESIGN/METHODS Primary care providers (pediatric and family medicine) and subspecialists providing direct patient care in an urban academic medical center (response rate = 24 %, n = 85/356) completed a 24-item survey (adapted with permission from the AAP Periodic Survey of Fellows No.90) assessing feasibility and comfort screening and addressing social and financial needs, rates of screening for financial hardship, and referrals to local resources. Chi-square tests were performed. RESULTS Among respondents, 88 % (75/85) reported comfort caring for low-income children, while 28 % (24/85) reported comfort inquiring about social and financial needs and 34 % (29/85) referring to community resources. Primary care providers more commonly than subspecialists screened for childcare (80 % vs. 59 %, p = 0.04), parental: employment (84 % vs. 59 %, p = 0.01), education (40 % vs. 17 %, p = 0.02) and mental health (86 % vs. 46 %, p = 0.0001), and less commonly screened for transportation (47 % vs. 73 %, p = 0.01). Primary care providers more commonly referred for public health insurance (74 % vs. 39 %, p = 0.001), public food assistance (30 % vs. 12 %, p = 0.04), and adult mental health services (65 % vs. 44 %, p < 0.05). CONCLUSIONS In an urban academic institution serving a population with high poverty rates, pediatric providers feel comfortable providing medical care for low-income children but lack comfort screening and addressing SDH. Though most feel it is their job to refer to resources, less than half felt it was feasible to screen for or address financial needs. Pediatric primary care providers report higher rates of screening and referring than subspecialists. Understanding variations in practice and perceptions among primary care providers and subspecialists may aid in creating interventions to increase screening and referral rates.
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Affiliation(s)
- Yonit Lax
- General Pediatrics, Population Health, Maimonides Children’s Hospital, SUNY Downstate Medical Center, 1301 57th Street, NY 11218 Brooklyn, USA
| | - Eleanor Bathory
- Academic General Pediatrics, Social Pediatrics, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, 3544 Jerome Avenue, NY 10467 Bronx, USA
| | - Sandra Braganza
- Academic General Pediatrics, Social Pediatrics, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, 3544 Jerome Avenue, NY 10467 Bronx, USA
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Pierrat V, Marchand-Martin L, Marret S, Arnaud C, Benhammou V, Cambonie G, Debillon T, Dufourg MN, Gire C, Goffinet F, Kaminski M, Lapillonne A, Morgan AS, Rozé JC, Twilhaar S, Charles MA, Ancel PY. Neurodevelopmental outcomes at age 5 among children born preterm: EPIPAGE-2 cohort study. BMJ 2021; 373:n741. [PMID: 33910920 PMCID: PMC8080137 DOI: 10.1136/bmj.n741] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To describe neurodevelopment at age 5 among children born preterm. DESIGN Population based cohort study, EPIPAGE-2. SETTING France, 2011. PARTICIPANTS 4441 children aged 5½ born at 24-26, 27-31, and 32-34 weeks MAIN OUTCOME MEASURES: Severe/moderate neurodevelopmental disabilities, defined as severe/moderate cerebral palsy (Gross Motor Function Classification System (GMFCS) ≥2), or unilateral or bilateral blindness or deafness, or full scale intelligence quotient less than minus two standard deviations (Wechsler Preschool and Primary Scale of Intelligence, 4th edition). Mild neurodevelopmental disabilities, defined as mild cerebral palsy (GMFCS-1), or visual disability ≥3.2/10 and <5/10, or hearing loss <40 dB, or full scale intelligence quotient (minus two to minus one standard deviation) or developmental coordination disorders (Movement Assessment Battery for Children, 2nd edition, total score less than or equal to the fifth centile), or behavioural difficulties (strengths and difficulties questionnaire, total score greater than or equal to the 90th centile), school assistance (mainstream class with support or special school), complex developmental interventions, and parents' concerns about development. The distributions of the scores in contemporary term born children were used as reference. Results are given after multiple imputation as percentages of outcome measures with exact binomial 95% confidence intervals. RESULTS Among 4441 participants, 3083 (69.4%) children were assessed. Rates of severe/moderate neurodevelopmental disabilities were 28% (95% confidence interval 23.4% to 32.2%), 19% (16.8% to 20.7%), and 12% (9.2% to 14.0%) and of mild disabilities were 38.5% (33.7% to 43.4%), 36% (33.4% to 38.1%), and 34% (30.2% to 37.4%) at 24-26, 27-31, and 32-34 weeks, respectively. Assistance at school was used by 27% (22.9% to 31.7%), 14% (12.1% to 15.9%), and 7% (4.4% to 9.0%) of children at 24-26, 27-31, and 32-34 weeks, respectively. About half of the children born at 24-26 weeks (52% (46.4% to 57.3%)) received at least one developmental intervention which decreased to 26% (21.8% to 29.4%) for those born at 32-34 weeks. Behaviour was the concern most commonly reported by parents. Rates of neurodevelopment disabilities increased as gestational age decreased and were higher in families with low socioeconomic status. CONCLUSIONS In this large cohort of children born preterm, rates of severe/moderate neurodevelopmental disabilities remained high in each gestational age group. Proportions of children receiving school assistance or complex developmental interventions might have a significant impact on educational and health organisations. Parental concerns about behaviour warrant attention.
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Affiliation(s)
- Véronique Pierrat
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
- CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France
| | - Laetitia Marchand-Martin
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
| | - Stéphane Marret
- Department of Neonatal Medicine, Intensive Care, and Neuropediatrics, Rouen University Hospital, Rouen, France
- INSERM U1254, Neovascular Team, Perinatal Handicap, Institute of Biomedical Research and Innovation, Normandy University, Rouen, France
| | - Catherine Arnaud
- INSERM U1027, SPHERE Team, France
- Toulouse 3 University Paul-Sabatier, Toulouse, France
- Clinical Epidemiology Unit, University Hospital Toulouse, Toulouse, France
| | - Valérie Benhammou
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
| | - Gilles Cambonie
- Department of Neonatal Medicine, Montpellier University Hospital, Montpellier, France
| | - Thierry Debillon
- Neonatal Intensive Care Unit, Grenoble Alps University Hospital, Grenoble, France
- UMR 5525 Techniques pour l'Evaluation et la Modélisation des Actions de la Santé, Centre National de la Recherche Scientifique, Techniques de l'Ingénierie Médicale et de la Complexité-Informatique, Mathématiques et Applications, Grenoble Alps University, Grenoble, France
| | - Marie-Noëlle Dufourg
- French Institute for Demographic Studies, French Institute for Medical Research and Health, French Blood Agency, ELFE Joint Unit, Paris, France
| | - Catherine Gire
- Department of Neonatology, North Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - François Goffinet
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
- Port-Royal Maternity, Assistance Publique-Hôpitaux de Paris, Centre-University of Paris, Federation Hospitalo-Universitairefor prematurity, Paris, France
| | - Monique Kaminski
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
| | - Alexandre Lapillonne
- Assistance Publique-Hôpitaux de Paris, University Hospital Necker-Enfants Malades, University of Paris, Paris, France
| | - Andrei Scott Morgan
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Jean-Christophe Rozé
- Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
- Clinical Epidemiology, Clinical Investigation Centre CIC004, Nantes University Hospital, Nantes, France
| | - Sabrina Twilhaar
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
| | - Marie-Aline Charles
- Neonatal Intensive Care Unit, Grenoble Alps University Hospital, Grenoble, France
- University of Paris, CRESS, Team Early Life Research on Later Health, UMR 1153, INSERM, INRAE, Villejuif, France
| | - Pierre-Yves Ancel
- University of Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, F-75004 Paris, France
- Clinical Investigation Centre P1419, Assistance Publique-Hôpitaux de Paris, Paris, France
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Gadolin C, Eriksson E, Alexandersson P. Coordination of paediatric oncology care: an explorative Swedish case study. JOURNAL OF INTEGRATED CARE 2021. [DOI: 10.1108/jica-10-2020-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The aim of this paper is to empirically describe and analyze factors deemed to be relevant for the successful provision of coordinated paediatric oncology care by physicians and nurses involved.
Design/methodology/approach
A qualitative case study primarily consisting of interviews.
Findings
The paper's findings indicate that certain factors (i.e. distinct mission, clear treatment protocols and support from external stakeholders) relevant for the provision of coordinated paediatric oncology care have not received sufficient attention in previous research. In addition, emphasis is placed on the necessity of facilitating constructive working relationships and a bottom-up perspective when pursuing improved care coordination.
Originality/value
The factors described and analyzed may act as insights for how paediatric oncology might be improved in terms of care coordination and thus facilitate care integration. In addition, the paper's findings identify factors relevant for further empirical studies in order to delineate their generalizability.
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Rogers J, Reed MP, Blaine K, Manning H. Children with medical complexity: A concept analysis. Nurs Forum 2021; 56:676-683. [PMID: 33625740 DOI: 10.1111/nuf.12559] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 01/01/2021] [Accepted: 01/29/2021] [Indexed: 11/27/2022]
Abstract
AIM The aim of this paper is to conduct a concept analysis on the term, "children with medical complexity." BACKGROUND Children with medical complexity (CMC) describes pediatric patients with chronic, sustained acuity; however, there is a lack of consensus in the literature regarding its exact meaning, characteristics, and implications. DESIGN This analysis relied upon the framework described by Walker and Avant. DATA SOURCE The CINAHL, MEDLINE, and PubMed databases were queried from April 2020 to December 2020 with an initial search of the literature for the keyword, "children with medical complexity" and other associated terms, such as "pediatric medical complexity" and "nursing care of children with medical complexity." REVIEW METHODS This analysis will explore the concept of CMC and its significance, attributes, antecedents, and consequences. RESULTS This investigation revealed that CMC are a growing population of pediatric patients who have one or more complex chronic conditions that affect multiple body systems, experience functional limitations, require extensive care coordination from multiple providers, and are dependent upon life-sustaining medical technology. CONCLUSIONS The findings can serve as a foundation for future work advancing the understanding of the topic of CMC.
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Affiliation(s)
- Jayne Rogers
- Medical Nursing Service, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Mary P Reed
- Medical Nursing Service, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kevin Blaine
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Haylee Manning
- Medical Nursing Service, Boston Children's Hospital, Boston, Massachusetts, USA
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Yu JA, McKernan G, Hagerman T, Schenker Y, Houtrow A. Most Children With Medical Complexity Do Not Receive Care in Well-Functioning Health Care Systems. Hosp Pediatr 2021; 11:183-191. [PMID: 33408158 PMCID: PMC7831373 DOI: 10.1542/hpeds.2020-0182] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To describe the access of children with medical complexity (CMC) to well-functioning health care systems. To examine the relationships between medical complexity status and this outcome and its component indicators. PATIENTS AND METHODS Secondary analysis of children in the National Survey of Children's Health combined 2016-2017 data set who received care in well-functioning health systems. Secondary outcomes included this measure's component indicators. The χ2 analyses were used to examine associations between child and family characteristics and the primary outcome. Adjusted multivariable logistic regression was used to examine relationships between medical complexity status and primary and secondary outcomes. Using these regression models, we examined the interaction between medical complexity status and household income. RESULTS CMC accounted for 1.6% of the weighted sample (n = 1.2 million children). Few CMC (7.6%) received care in a well-functioning health care system. CMC were significantly less likely than children with special health care needs (CSHCN) (odds ratio, 0.3) of meeting criteria for this primary outcome. Attainment rates for secondary outcomes (families feeling like partners in care; receives care within a medical home; received needed health care) were significantly lower among CMC than CSHCN. Family income was significantly associated with likelihood of meeting criteria for primary and secondary outcomes; however, the relationships between medical complexity status and our outcomes did not differ by income level. CONCLUSIONS CMC are less likely than other CSHCN to report receiving care in well-functioning health care systems at all income levels. Further efforts are necessary to better adapt current health care systems to meet the unique needs of CMC.
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Affiliation(s)
- Justin A Yu
- Divisions of Pediatric Hospital Medicine and Palliative and Supportive Care,
- Departments of Pediatrics and
| | - Gina McKernan
- Physical Medicine and Rehabilitation
- Department of Physical Medicine and Rehabilitation, Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Health Care System, Pittsburgh, Pennsylvania
| | - Thomas Hagerman
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - Yael Schenker
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, and
| | - Amy Houtrow
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine and Rehabilitation
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Yu JA, McKernan G, Hagerman T, Schenker Y, Houtrow A. Identifying Children With Medical Complexity From the National Survey of Children's Health Combined 2016-17 Data Set. Hosp Pediatr 2021; 11:192-197. [PMID: 33414223 DOI: 10.1542/hpeds.2020-0180] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To develop a method of identifying children with medical complexity (CMC) from the National Survey of Children's Health (NSCH) 2016-2017 combined data set, to compare this approach to existing CMC identification strategies, and to describe sociodemographic characteristics of our CMC sample. METHODS Using survey items pertinent to the medical complexity domains in the style by Cohen et al (chronic health conditions, health service needs, health care use, and functional limitations), we created a schema to categorize children as CMC by applying a 95th percentile cutoff for survey item positivity. We applied existing CMC identification techniques to the NSCH. We used 2-proportion z tests to compare the classification output of our CMC identification method to those of existing approaches. We used χ2 analyses to examine relationships between child and family characteristics, comparing CMC with children with special health care needs (CSHCN) and children with no special health care needs. RESULTS Among the 71 811 children in the sample, 1.5% were classified as CMC by our method, representing almost 1.2 million children (weighted) in the United States in 2016-2017. CSHCN and children with no special health care needs represented 17.2% (weighted n = 12.6 million) and 81.2% (weighted n = 59.6 million) of the sample, respectively. Our approach classified a significantly smaller number of CSHCN as CMC than existing CMC identification methods, which classified 3.9% to 13.2% of the 2016-2017 NSCH sample as more complex (P < .001). CMC status was significantly associated with male sex, minority race or ethnicity, and experiencing socioeconomic adversity (all P < .001). CONCLUSIONS This method enables standardized identification of CMC from NSCH data sets, thus allowing for an examination of CMC health outcomes, pertinent to pediatric hospitalist medicine, contained in the survey.
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Affiliation(s)
- Justin A Yu
- Divisions of Pediatric Hospital Medicine and Palliative Care Medicine, .,Departments of Pediatrics and
| | - Gina McKernan
- Physical Medicine and Rehabilitation.,Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Health Care System, Pittsburgh, Pennsylvania
| | - Thomas Hagerman
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Yael Schenker
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine and
| | - Amy Houtrow
- Division of Pediatric Rehabilitation Medicine.,Physical Medicine and Rehabilitation
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Parente V, Parnell L, Childers J, Spears T, Jarrett V, Ming D. Point-of-Care Complexity Screening Algorithm to Identify Children With Medical Complexity. Hosp Pediatr 2020; 11:44-51. [PMID: 33298458 DOI: 10.1542/hpeds.2020-0066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES For pediatric complex care programs to target enhanced care coordination services to the highest-risk patients, it is critical to accurately identify children with medical complexity (CMC); however, no gold standard definition exists. The aim of this study is to describe a point-of-care screening algorithm to identify CMC with high health care use, a group that may benefit the most from improved care coordination. METHODS From July 1, 2015, to June 30, 2016 (fiscal year 2016 [FY16]), a medical complexity screening algorithm was implemented by a pediatric complex care program at a single tertiary care center for hospitalized patients at the time of admission. Using the screening algorithm, we categorized inpatients into 1 of 3 groups: CMC, children with special health care needs (CSHCN), or previously healthy (PH) children. Inpatient resource use for FY16 and FY17 encounters was extracted for children screened in FY16. RESULTS We categorized 2187 inpatients in FY16 into the 3 complexity groups (CMC = 77; CSHCN = 1437; PH children = 673). CMC had more complex chronic conditions (median = 6; interquartile range [IQR] 4-11) than CSHCN (median = 1; IQR 0-2) and PH children (median = 0; IQR 0-0). CMC had greater per-patient and per-encounter hospital use than CSHCN and PH children. CMC and children with ≥4 complex chronic conditions had comparable levels of resource use. CONCLUSIONS By implementation of a point-of-care screening algorithm, we identified CMC with high health care use. By using this algorithm, it was feasible to identify hospitalized CMC that could benefit from care coordination by a pediatric complex care program.
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Affiliation(s)
| | | | - Julie Childers
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and
| | - Tracy Spears
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - David Ming
- Departments of Pediatrics and.,Medicine, School of Medicine, Duke University, Durham, North Carolina
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Lang JE, Tang M, Zhao C, Hurst J, Wu A, Goldstein BA. Well-Child Care Attendance and Risk of Asthma Exacerbations. Pediatrics 2020; 146:peds.2020-1023. [PMID: 33229468 PMCID: PMC7706112 DOI: 10.1542/peds.2020-1023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Asthma remains a leading cause of hospitalization in US children. Well-child care (WCC) visits are routinely recommended, but how WCC adherence relates to asthma outcomes is poorly described. METHODS We conducted a retrospective longitudinal cohort study using electronic health records among 5 to 17 year old children residing in Durham County with confirmed asthma and receiving primary care within a single health system, to compare the association between asthma exacerbations and previous WCC exposure. Exacerbations included any International Classification of Diseases, Ninth Revision, or International Classification of Diseases, 10th Revision, coded asthma exacerbation encounter with an accompanying systemic glucocorticoid prescription. Exacerbations were grouped by severity: ambulatory encounter only, urgent care, emergency department, hospital encounters <24 hours, and hospital admissions ≥24 hours. In the primary analysis, we assessed time to asthma exacerbation based on the presence or absence of a WCC visit in the preceding year using a time-varying covariate Cox model. RESULTS A total of 5656 children met eligibility criteria and were included in the primary analysis. Patients with the highest WCC visit attendance tended to be younger, had a higher prevalence of private insurance, had greater asthma medication usage, and were less likely to be obese. The presence of a WCC visit in the previous 12 months was associated with a reduced risk of all-cause exacerbations (hazard ratio: 0.90; 95% confidence interval: 0.83-0.98) and severe exacerbations requiring hospital admission (hazard ratio: 0.53; 95% confidence interval: 0.39-0.71). CONCLUSIONS WCC visits were associated with a lower risk of subsequent severe exacerbations, including asthma-related emergency department visits and hospitalizations. Poor WCC visit adherence predicts pediatric asthma morbidity, especially exacerbations requiring hospitalization.
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Affiliation(s)
- Jason E. Lang
- Children’s Health & Discovery Initiative, Departments of Pediatrics and,Duke Clinical Research Institute, Duke University, Durham, North Carolina; and
| | - Monica Tang
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Congwen Zhao
- Children’s Health & Discovery Initiative, Departments of Pediatrics and,Biostatistics and Bioinformatics, School of Medicine and
| | - Jillian Hurst
- Children’s Health & Discovery Initiative, Departments of Pediatrics and
| | - Angie Wu
- Duke Clinical Research Institute, Duke University, Durham, North Carolina; and
| | - Benjamin A. Goldstein
- Children’s Health & Discovery Initiative, Departments of Pediatrics and,Biostatistics and Bioinformatics, School of Medicine and,Duke Clinical Research Institute, Duke University, Durham, North Carolina; and
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Guo S, Liu M, Chong SY, Zendarski N, Molloy C, Quach J, Perlen S, Nguyen MT, O'Connor E, Riggs E, O'Connor M. Health service utilisation and unmet healthcare needs of Australian children from immigrant families: A population-based cohort study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:2331-2342. [PMID: 32573864 DOI: 10.1111/hsc.13054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/08/2020] [Accepted: 05/15/2020] [Indexed: 06/11/2023]
Abstract
Compared with most other Organization for Economic Co-operation and Development (OECD) countries, information about the patterns of health service use for children from immigrant families in Australia is currently limited, and internationally, data on unmet healthcare needs are scarce. This study aims to examine the distribution of health service utilisation and unmet healthcare needs for immigrant children aged 10-11 years in Australia. We drew on data from the Longitudinal Study of Australian Children Birth (B; n = 5,107) and Kindergarten (K; n = 4,983) cohorts. The exposure was family immigration background collected at 0-1 (B-cohort) and 4-5 (K-cohort) years. Outcomes were parent-reported child health service use and unmet healthcare needs (defined as the difference between services needed and services received) at 10-11 years. Logistic regression analyses were used to examine associations between family immigration background and health service use/unmet healthcare needs, adjusting for potential confounders. Results showed that one-third of Australian children (B-cohort: 29.0%; K-cohort: 33.4%) came from immigrant families. There were similar patterns of health service use and unmet healthcare needs between children from English-speaking immigrant and Australian-born families. However, children from non-English-speaking immigrant families used fewer health services, including paediatric, dental, mental health and emergency ward services. There was a disparity between the services used when considering children's health needs, particularly for paediatric specialist services (B-cohort: OR = 2.43, 95% CI 1.11-5.31; K-cohort: OR = 2.72, 95% CI 1.32-5.58). Findings indicate that Australian children from non-English-speaking immigrant families experience more unmet healthcare needs and face more barriers in accessing health services. Further effort is needed to ensure that the healthcare system meets the needs of all families.
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Affiliation(s)
- Shuaijun Guo
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, Australia
| | - Mengjiao Liu
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, Australia
| | - Shiau Yun Chong
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Nardia Zendarski
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, Australia
| | - Carly Molloy
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, Australia
| | - Jon Quach
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- Melbourne Graduate School of Education, The University of Melbourne, Melbourne, Australia
| | - Susan Perlen
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Minh Thien Nguyen
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, Australia
| | - Elodie O'Connor
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Elisha Riggs
- Intergenerational Health Group, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Australia
| | - Meredith O'Connor
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, Australia
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Mai K, Davis RK, Hamilton S, Robertson-James C, Calaman S, Turchi RM. Identifying Caregiver Needs for Children With a Tracheostomy Living at Home. Clin Pediatr (Phila) 2020; 59:1169-1181. [PMID: 32672065 DOI: 10.1177/0009922820941209] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study sought to understand caregiver needs of children with tracheostomies (CWT) living at home and inform development of standardized tracheostomy simulation training curricula. Long-term goals are decreasing hospital readmissions following tracheostomy placement and improving family experiences while implementing a medical home model. We recruited caregivers of CWT and conducted semistructured interviews, subsequently recorded, transcribed, and analyzed for emerging themes using NVivo. Demographic data were collected via quantitative surveys. Twenty-seven caregivers participated. Emerging themes included the following: (1) caregivers felt overwhelmed, sad, frightened when learning need for tracheostomy; (2) training described as adequate, but individualized training desired; (3) families felt prepared to go home, but transition was difficult; (4) home nursing care fraught with difficulty and yet essential for families of CWT. Families of CWT have specific needs related to discharge training, resources, support, and home nursing. Provider understanding of caregiver needs is essential for child well-being, patient-/family-centered care, and may improve health outcomes.
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Affiliation(s)
- Katherine Mai
- Drexel University, Philadelphia, PA, USA.,St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | | | - Sue Hamilton
- St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | | | - Sharon Calaman
- St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Renee M Turchi
- Drexel University, Philadelphia, PA, USA.,St. Christopher's Hospital for Children, Philadelphia, PA, USA
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Coller RJ, Kelly MM, Sklansky DJ, Shadman KA, Ehlenbach ML, Barreda CB, Chung PJ, Zhao Q, Edmonson MB. Ambulatory quality, special health care needs, and emergency department or hospital use for US children. Health Serv Res 2020; 55:671-680. [PMID: 32594526 PMCID: PMC7518884 DOI: 10.1111/1475-6773.13308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE This study examined family-reported ambulatory care quality and its association with emergency department and hospital utilization, and how these relationships differed across levels of medical complexity. DATA SOURCES The 2006-2013 Medical Expenditure Panel Survey (MEPS). STUDY DESIGN Secondary analysis of MEPS data. Variables fitting the National Quality Measures Clearinghouse clinical quality measures domain framework were selected. Exploratory factor analysis grouped ambulatory quality into 12 access, experience, or process measures. Weighted negative binomial regression stratified by health status identified associations between ambulatory quality and ED visits or hospitalizations. DATA COLLECTION 41,497 children ≤18 years were included. The 5-item special health care needs (SHCN) screener categorized health status as complex, less complex, or no SHCN. PRINCIPAL FINDINGS Weighted SHCN proportions were 1.6 Percent complex, 18.2 Percent less complex, and 80.0 Percent no SHCN. Mean ED visits were 130 and 335 visits/1000 children/year for no/ complex SHCN, respectively. Mean hospitalizations were 20 and 175 hospitalizations/1000 children/year for no/complex SHCN, respectively. ED visits were associated with 8 of 12 quality measures for no/less complex SHCN. For example, usually/always receiving needed care right away was associated with 22 Percent lower ED visit rate (95% CI 0.64-0.96). Hospitalizations were associated with 4 of 12 quality measures for less complex SHCN. In complex SHCN, associations between ambulatory quality and ED/hospital use were weak and inconsistent. CONCLUSIONS Ambulatory quality may best predict ED and hospital use for children with no or less complex SHCN. Whether and how ambulatory care predicts emergency and hospital care in complex SHCN remains an important question.
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Affiliation(s)
- Ryan J. Coller
- Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Michelle M. Kelly
- Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Daniel J. Sklansky
- Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Kristin A. Shadman
- Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Mary L Ehlenbach
- Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Christina B. Barreda
- Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Paul J. Chung
- Departments of Pediatrics and Health Policy & Management, Health Systems ScienceKaiser Permanente School of MedicinePasadenaCaliforniaUSA
| | - Qianqian Zhao
- Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Marshall Bruce Edmonson
- Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
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Berry JG, Harris D, Coller RJ, Chung PJ, Rodean J, Macy M, Linares DE. The Interwoven Nature of Medical and Social Complexity in US Children. JAMA Pediatr 2020; 174:891-893. [PMID: 32338723 PMCID: PMC7186912 DOI: 10.1001/jamapediatrics.2020.0280] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This cross-sectional study uses data from the 2017 National Survey of Children’s Health to assess whether social challenges increase with higher medical condition complexity among US children.
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Affiliation(s)
- Jay G. Berry
- Division of General Pediatrics, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | - Ryan J. Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Paul J. Chung
- Department of Pediatrics, David Geffen School of Medicine at UCLA (University of California at Los Angeles) and Mattel Children’s Hospital, Los Angeles
| | | | - Michelle Macy
- Department of Emergency Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Deborah E. Linares
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
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75
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Coller RJ, Komatz K. Children with Medical Complexity and Neglect: Attention Needed. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2020; 13:293-298. [PMID: 33088386 PMCID: PMC7561630 DOI: 10.1007/s40653-017-0154-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Ryan J. Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 USA
| | - Kelly Komatz
- Department of Pediatrics, University of Florida College of Medicine, Jacksonville, FL USA
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76
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Rasooly IR, Shults J, Guevara JP, Feudtner C. State Variation in Posthospital Home Nursing for Commercially Insured Medically Complex Children. Pediatrics 2020; 146:peds.2019-2465. [PMID: 32641356 PMCID: PMC7397731 DOI: 10.1542/peds.2019-2465] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Home nursing is essential for children with medical complexity (CMC), but provision varies substantially across states. Our objectives were to quantify state-to-state variability in distribution of posthospitalization home nursing to commercially insured CMC and to rank-order states. METHODS Retrospective cohort study of hospitalized commercially insured children with ≥1 complex chronic condition from birth to 18 years of age in the Truven MarketScan database. Cohort eligibility criteria were hospital discharge between January 2013 and November 2016 and at least 30 days of follow-up after discharge. Two primary outcome measures were used: receipt of any home nursing within 30 days of hospital discharge (yes or no) and number of days of posthospitalization home nursing (1-30 days). A composite metric encompassing both receipt and quantity was created by evaluating the 95th percentile of days of home nursing (0-30 days). RESULTS Overall, 9.9% of the sample received home nursing. After we adjusted for patient characteristics, the probability of receiving home nursing varied across states, ranging from 3.4% to 19.2%. Among home nursing recipients, the adjusted median home nursing days across states ranged from 6.6 to 24.5 days. The adjusted 95th percentile of days of home nursing (across the entire of sample, including recipients and nonrecipients of home nursing) ranged from 6.8 to 22.6 days. CONCLUSIONS We observed striking state-to-state variability in receipt of home nursing and mean number of days of posthospitalization home nursing among commercially insured CMC after adjustment for demographic and clinical differences. This suggests opportunities for state-level improvement.
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Affiliation(s)
- Irit R. Rasooly
- Children’s Hospital of Philadelphia,
Philadelphia, Pennsylvania; and,Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pennsylvania
| | - Justine Shults
- Children’s Hospital of Philadelphia,
Philadelphia, Pennsylvania; and,Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pennsylvania
| | - James P. Guevara
- Children’s Hospital of Philadelphia,
Philadelphia, Pennsylvania; and,Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pennsylvania
| | - Chris Feudtner
- Children’s Hospital of Philadelphia,
Philadelphia, Pennsylvania; and,Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pennsylvania
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77
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Conkol KJ, Martinez-Strengel A, Coller RJ, Bergman DA, Whelan EM. Pediatric Hospitalists' Lessons Learned From an Innovation Award to Improve Care for Children With Medical Complexity. Hosp Pediatr 2020; 10:694-701. [PMID: 32651217 DOI: 10.1542/hpeds.2020-0069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Children with medical complexity experience frequent hospitalizations and pose a unique challenge for the pediatric hospitalist and their healthcare team. Pediatric hospitalists are ideally positioned to champion improved care coordination for CMC and to address the areas of need in clinical practice, quality improvement and research. Lessons learned from programs who were Healthcare Innovation Award recipients from Center for Medicare and Medicaid Innovation that were aimed at improving care for this population are presented. We focused on care coordination activities implemented during hospitalization. Through a series of meetings with the participating programs, we identified common themes across awarded programs. Programs described key aspects of care coordination during the hospital stay, beginning on admission (multidisciplinary team goal setting, family partnership and action planning), through hospitalization (integrating outpatient and inpatient care), as well as during and after discharge (linking to community-based systems and supports, expanding the transition concept). Finally, we present actionable steps for inpatient providers seeking to improve care for this patient population at the time of hospitalization.
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Affiliation(s)
| | - Angela Martinez-Strengel
- Department of Internal Medicine, National Clinician Scholars Program, School of Medicine, Yale University, New Haven, Connecticut
| | - Ryan J Coller
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - David A Bergman
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California; and
| | - Ellen-Marie Whelan
- Center for Medicaid and Children's Health Insurance Program Services, Centers for Medicare and Medicaid Services, Baltimore, Maryland
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78
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Telemedicine and Outpatient Subspecialty Visits Among Pediatric Medicaid Beneficiaries. Acad Pediatr 2020; 20:642-651. [PMID: 32278078 PMCID: PMC7194998 DOI: 10.1016/j.acap.2020.03.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Live interactive telemedicine is increasingly covered by state Medicaid programs, but whether telemedicine is improving equity in utilization of subspecialty care is not known. We examined patterns of telemedicine use for outpatient pediatric subspecialty care within the state Medicaid programs. METHODS We identified children ≤17 years old in 2014 Medicaid Analysis eXtract data for 12 states. We identified telemedicine-using and telemedicine-nonusing medical and surgical subspecialists. Among children cared for by telemedicine-using subspecialists, we assessed child and subspecialist characteristics associated with any telemedicine visit using logistic regression with subspecialist-level random effects. Among children cared for by telemedicine-using and nonusing subspecialists, we compared visit rates across child characteristics by assessing negative binomial regression interaction terms. RESULTS Of 12,237,770 pediatric Medicaid beneficiaries, 2,051,690 (16.8%) had ≥1 subspecialist visit. Of 42,695 subspecialists identified, 146 (0.3%) had ≥1 telemedicine claim. Among children receiving care from telemedicine-using subspecialists, likelihood of any telemedicine use was increased for rural children (odds ratio [OR] 10.4, 95% confidence interval [CI] 6.3-17.1 compared to large metropolitan referent group) and those >90 miles from the subspecialist (OR 13.4, 95% CI 10.2-17.7 compared to 0-30 mile referent group). Compared to children receiving care from telemedicine-nonusing subspecialists, matched children receiving care from telemedicine-using subspecialists had larger differences in visit rates by distance to care, county rurality, ZIP code median income, and child race/ethnicity (P < .001 for interaction terms). CONCLUSIONS Children in rural communities and at distance to subspecialists had increased likelihood of telemedicine use. Use overall was low, and results indicated that early telemedicine policies and implementation did not close disparities in subspecialty visit rates by child geographic and sociodemographic characteristics.
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79
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Davis SL, Harmon CM, Baker Urquhart B, Moore B, Sprague R. Women and Infants in the Deep South Receiving Perinatal and Neonatal Palliative and Supportive Care Services. Adv Neonatal Care 2020; 20:216-222. [PMID: 31922972 DOI: 10.1097/anc.0000000000000706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND While women in the Deep South area of the United States have higher rates of maternal and infant mortality, palliative and supportive care programs are lacking. Additionally, few studies have detailed referral triggers that are specific to the mother, infant, or pregnancy for inclusion in perinatal and neonatal palliative and supportive care programs. PURPOSE The purpose of this retrospective, descriptive study was to examine the sociodemographic factors and referral triggers for perinatal-neonatal palliative and supportive care services for women enrolled in a newly developed perinatal-neonatal palliative and supportive care program. METHODS Data were collected from medical records of 135 women enrolled in the program. Triggers for referral to the program were classified as fetal, maternal, or prenatal complications. RESULTS A diverse sample of women were enrolled in the program. Most infants survived to birth and discharge from the hospital. Two-thirds of referrals were related to infant complications and 34% were for multiple complications (fetal, maternal, and/or prenatal). Triggers for referral to the program were not related to sociodemographic characteristics of women. IMPLICATIONS FOR PRACTICE A comprehensive list of triggers that include maternal and prenatal complications, in addition to infant complications, may ensure at-risk women and infants, are enrolled in perinatal-neonatal palliative and supportive care programs early in pregnancy, regardless of sociodemographic factors. IMPLICATIONS FOR RESEARCH Prospective research on the effectiveness of perinatal-neonatal palliative and supportive care programs in diverse populations of women is needed. This includes the examination of family health outcomes and provider perspectives.
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80
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Foster CC, Simon TD, Qu P, Holmes P, Chang JK, Ramos JL, Koutlas A, Rivara FP, Melzer SM, Mangione-Smith R. Social Determinants of Health and Emergency and Hospital Use by Children With Chronic Disease. Hosp Pediatr 2020; 10:471-480. [PMID: 32423995 DOI: 10.1542/hpeds.2019-0248] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate the association between caregiver-reported social determinants of health (SDOH) and emergency department (ED) visits and hospitalizations by children with chronic disease. METHODS This was a nested retrospective cohort study (December 2015 to May 2017) of children (0-18 years) receiving Supplemental Security Income and Medicaid enrolled in a case management program. Caregiver assessments were coded for 4 SDOH: food insecurity, housing insecurity, caregiver health concerns, and safety concerns. Multivariable hurdle Poisson regression was used to assess the association between SDOH with ED and hospital use for 1 year, adjusting for age, sex, and race and ethnicity. ED use was also adjusted for medical complexity. RESULTS A total of 226 children were included. Patients were 9.1 years old (SD: 4.9), 60% male, and 30% Hispanic. At least 1 SDOH was reported by 59% of caregivers, including food insecurity (37%), housing insecurity (23%), caregiver health concerns (18%), and safety concerns (11%). Half of patients had an ED visit (55%) (mean: 1.5 per year [SD: 2.4]), and 20% were hospitalized (mean: 0.4 per year [SD: 1.1]). Previously unaddressed food insecurity was associated with increased ED use in the subsequent year (odds ratio: 3.43 [1.17-10.05]). Among those who had ≥1 ED visit, the annualized ED rate was higher in patients with a previously unaddressed housing insecurity (rate ratio: 1.55 [1.14-2.09]) or a safety concern (rate ratio: 2.04 [1.41-2.96]). CONCLUSIONS Over half of caregivers of children with chronic disease enrolled in a case management program reported an SDOH insecurity or concern. Patients with previously unaddressed food insecurity had higher ED rates but not hospitalization rates.
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Affiliation(s)
- Carolyn C Foster
- Department of Pediatrics, School of Medicine and .,Centers for Child Health, Behavior and Development and
| | - Tamara D Simon
- Department of Pediatrics, School of Medicine and.,Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Pingping Qu
- Centers for Child Health, Behavior and Development and
| | - Paula Holmes
- Seattle Children's Hospital, Seattle, Washington; and
| | - Jason K Chang
- Seattle Children's Hospital, Seattle, Washington; and
| | | | | | - Frederick P Rivara
- Department of Pediatrics, School of Medicine and.,Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington.,Centers for Child Health, Behavior and Development and.,Harborview Injury Prevention and Research Center, Seattle, Washington
| | - Sanford M Melzer
- Department of Pediatrics, School of Medicine and.,Centers for Child Health, Behavior and Development and
| | - Rita Mangione-Smith
- Department of Pediatrics, School of Medicine and.,Centers for Child Health, Behavior and Development and
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81
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Yu JA, Henderson C, Cook S, Ray K. Family Caregivers of Children With Medical Complexity: Health-Related Quality of Life and Experiences of Care Coordination. Acad Pediatr 2020; 20:1116-1123. [PMID: 32599346 PMCID: PMC8063607 DOI: 10.1016/j.acap.2020.06.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To examine the association between care coordination experiences of family caregivers of children with medical complexity (CMC) and caregivers' health-related quality of life (HR-QOL). METHODS From July 2018 to July 2019, family caregivers of CMC completed an electronic survey (n = 136) at the time of initial contact with a regional complex care medical home. Information on caregiver HR-QOL and receipt of care coordination services were assessed using the Center for Disease Control's HR-QOL-14 measure and Family Experiences of Care Coordination questionnaire, respectively. Negative binomial regression, adjusted for caregiver and child characteristics, examined associations between caregiver HR-QOL and caregiver experiences of care coordination. RESULTS In the 30 days prior to initial contact, CMC caregivers reported a median of 3.5 mentally unhealthy days, 2 days felt depressed, 7 days felt anxious, and 16 days with insufficient sleep. Caregivers who had a knowledgeable, supportive care coordinator who advocates for their child reported significantly fewer days mentally unhealthy (incidence rate ratio [IRR], 0.46; 95% confidence interval [CI], 0.22-0.95), depressed (IRR, 0.44; 95% CI, 0.21-0.91), or anxious (IRR, 0.5; 95% CI, 0.29-0.85). Having a shared care plan was associated with significantly fewer days mentally unhealthy (IRR, 0.46; 95% CI, 0.23-0.93) or anxious (IRR, 0.53; 95% CI, 0.31-0.92). Having a written visit summary with appropriate content was associated with fewer days of insufficient sleep (IRR, 0.63; 95% CI, 0.43-0.93). CONCLUSIONS CMC family caregivers report experiencing mentally unhealthy days and negative mental symptom days. The experience of specific care coordination activities was associated with higher caregiver mental HR-QOL.
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Affiliation(s)
- Justin A Yu
- Department of Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh School of Medicine (JA Yu), Pittsburgh, Pa.
| | - Cynterria Henderson
- Department of Pediatrics, University of Pittsburgh School of Medicine (C Henderson, S Cook, and K Ray), Pittsburgh, Pa
| | - Stacey Cook
- Department of Pediatrics, University of Pittsburgh School of Medicine (C Henderson, S Cook, and K Ray), Pittsburgh, Pa
| | - Kristin Ray
- Department of Pediatrics, University of Pittsburgh School of Medicine (C Henderson, S Cook, and K Ray), Pittsburgh, Pa
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82
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D'Aprano A, Gibb S, Riess S, Cooper M, Mountford N, Meehan E. Important components of a programme for children with medical complexity: An Australian perspective. Child Care Health Dev 2020; 46:90-103. [PMID: 31782538 DOI: 10.1111/cch.12721] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 11/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Children with medical complexity (CMC) have high care needs, often unmet by traditional healthcare models. In response to this need, the Complex Care Service (CCS) at The Royal Children's Hospital (RCH), Melbourne was created. Although preliminary parent satisfaction data were available, we lacked knowledge of how the various components of the expanded service were valued and contributed to overall caregiver satisfaction. AIM The aims of this study were to (a) determine what caregivers value most about the CCS and (b) explore caregiver perceptions of care. METHODS All caregivers of children enrolled in the RCH CCS in April 2017 were invited to participate. A purposefully designed survey explored caregiver perceptions of care, including patient quality of care; the extent to which the CCS components added value and satisfaction; and frequency of contact. Participants were also invited to answer open-ended questions and provide general comments. RESULTS Responses were received from 53 families (51%). We found that 24-hr phone advice, coordination of appointments, a key contact, and access to timely information were the most important components of the service. More than 90% of caregivers indicated that they were satisfied with care and that the CCS improved their child's quality of care. Coordination, communication, family-centred care, quality care, and access were emergent themes within comments. CONCLUSION This study provides important information regarding the design and operation of services for CMC throughout Australia and further afield. Our findings highlight the importance of the key contact and family-centred care. This has implications for practice, as maintaining service quality, as the CCS expands and is implemented more widely, is a major sustainability challenge. It is crucial that we have a detailed understanding of what elements are required to support effective care coordination, to achieve successful implementation on a larger scale.
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Affiliation(s)
- Anita D'Aprano
- Department of General Medicine, The Royal Children's Hospital, Melbourne, Melbourne, Victoria, Australia.,Population Health Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Susie Gibb
- Department of General Medicine, The Royal Children's Hospital, Melbourne, Melbourne, Victoria, Australia.,Department of Neurodevelopment & Disability, The Royal Children's Hospital, Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Suzi Riess
- Population Health Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Neurodevelopment & Disability, The Royal Children's Hospital, Melbourne, Melbourne, Victoria, Australia
| | - Monica Cooper
- Department of Neurodevelopment & Disability, The Royal Children's Hospital, Melbourne, Melbourne, Victoria, Australia.,Clinical Sciences Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Nicki Mountford
- Quality and Improvement, The Royal Children's Hospital, Melbourne, Melbourne, Victoria, Australia
| | - Elaine Meehan
- Clinical Sciences Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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83
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Mantler T, Jackson KT, Baer J, White J, Ache B, Shillington K, Ncube N. Changes in Care- A Systematic Scoping Review of Transitions for Children with Medical Complexities. Curr Pediatr Rev 2020; 16:165-175. [PMID: 31854274 PMCID: PMC8193810 DOI: 10.2174/1573396316666191218102734] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/05/2019] [Accepted: 11/26/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Children with medical complexity (CMC) and their parents are affected physically and mentally during transitions in care. Coordinated models of care show promise in improving health outcomes. OBJECTIVE The purpose of this scoping review was to examine research related to CMC and their parents and transitions in care. The aim was 3-fold: (1) to examine the extent, range, and nature of research activity related to the impact of transitions on physical and mental health for CMC and their parents; (2) to summarize and disseminate research findings for key knowledge users; and (3) to identify research gaps in the existing literature to inform future studies. METHODS Twenty-three sources were identified through database searches and five articles met the inclusion criteria of CMC (multi-organ involvement or technology-dependent) (or parents of CMC) transitioning from hospital to alternate levels of care where outcome measures were physical or mental health-related. RESULTS Numerical analysis revealed substantial variation in methodological approaches and outcome measures. Content analysis revealed two themes for parents of CMC during this transition: (1) emotional distress, and (2) high expectations; and three themes for CMC: (1) improved health, (2) changes in emotion, and (3) disrupted relationships. CONCLUSION The findings from this scoping review reveal for parents, transitions in care are fraught with emotional distress and high expectations; and for CMC there are improvements in quality of life and emotional health post- hospital to home transitions when collaborative models of care are available. This review serves as an early attempt to summarize the literature and demonstrate a need for further research.
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Affiliation(s)
- Tara Mantler
- Address correspondence to this author at the School of Health Studies, Faculty of Health Sciences, Western University, London, Canada; Tel: 519-661-2111; E-mail:
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84
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Houtrow A, Harris D, Molinero A, Levin-Decanini T, Robichaud C. Children with disabilities in the United States and the COVID-19 pandemic. J Pediatr Rehabil Med 2020; 13:415-424. [PMID: 33185616 DOI: 10.3233/prm-200769] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Children with disabilities are disproportionately impacted by COVID-19 and the containment response. Their caregivers must now adapt to increased stressors such as lack of access to needed therapies, medical supplies, and nursing care. Prior to COVID-19 these families were already marginalized, and this has only worsened during the pandemic. As a vulnerable population, children with disabilities have not been the focus of much discussion during the pandemic, likely because the disease disproportionately impacts older individuals. Nonetheless, children with disabilities should be a focus of evaluation and intervention to mitigate the negative consequences of COVID-19 and the resulting containment strategies. Their needs should be included in future crisis planning, as well. In order to raise awareness of pediatric rehabilitation professionals, health care administrators, policy makers, and advocates, this manuscript provides a discussion of the following topics: the immediate and ongoing impacts on children with disabilities and their families, the ethical concerns and implications of triage protocols for scarce resources that consider disability in their scoring systems, and optimizing medical care and educational needs in the time of COVID.
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Affiliation(s)
- Amy Houtrow
- Departments of Physical Medicine and Rehabilitation and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Debbi Harris
- Family Voices of Minnesota, Minneapolis, MN, USA
| | | | - Tal Levin-Decanini
- Complex Care Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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85
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Dietzen A, Ide W, Pavone L. Telehealth in pediatric rehabilitation medicine: A survey of clinician reported utilization and experience. J Pediatr Rehabil Med 2020; 13:281-288. [PMID: 33252099 DOI: 10.3233/prm-200762] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Telehealth services have been touted to improve access to specialty pediatric care. COVID-19 accelerated the adoption of telehealth across many medical specialties. The purpose of this study was to examine telehealth utilization and satisfaction among pediatric physiatrists. METHODS Using Google Forms, a voluntary survey was created and administered to pediatric physiatrists. The survey collected information on practice setting, telehealth utilization, provider satisfaction, perceived satisfaction of patients and families, and the anticipated role of telehealth in pediatric rehabilitation going forward. RESULTS Seventy-eight respondents completed the survey. There was a significant reported increase in telehealth utilization since COVID-19 from 14.5% to 97.4%. Eighty-two percent of participants reported feeling comfortable utilizing telehealth, 77% felt confident in the quality of the care provided, and 91% believed patients were satisfied with telehealth visits. Responses indicate that telehealth is expected to play a role in future pediatric physiatry and interest in telehealth continuing medical education is prevalent. Most pediatric physiatrists plan to continue or expand telehealth offerings after COVID-19. CONCLUSION Telehealth adoption has been expedited by COVID-19. Physician interest in and satisfaction with telehealth is high. Patient and family perceptions, outcomes of care, and barriers to implementation limiting program expansion deserve further study.
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Affiliation(s)
- Anton Dietzen
- Marianjoy Rehabilitation Hospital, Northwestern Medicine, Wheaton, IL, USA.,Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William Ide
- Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Larissa Pavone
- Marianjoy Rehabilitation Hospital, Northwestern Medicine, Wheaton, IL, USA
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Lin JL, Clark CL, Halpern-Felsher B, Bennett PN, Assis-Hassid S, Amir O, Castaneda Nunez Y, Cleary NM, Gehrmann S, Grosz BJ, Sanders LM. Parent Perspectives in Shared Decision-Making for Children With Medical Complexity. Acad Pediatr 2020; 20:1101-1108. [PMID: 32540424 PMCID: PMC7655593 DOI: 10.1016/j.acap.2020.06.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 06/05/2020] [Accepted: 06/07/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Shared decision-making (SDM) may improve outcomes for children with medical complexity (CMC). CMC have lower rates of SDM than other children, but little is known about how to improve SDM for CMC. The objective of this study is to describe parent perspectives of SDM for CMC and identify opportunities to improve elements of SDM specific to this vulnerable population. METHODS Interviews with parents of CMC explored SDM preferences and experiences. Eligible parents were ≥18 years old, English- or Spanish-speaking, with a CMC <12 years old. Interviews were recorded, transcribed, and analyzed by independent coders for shared themes using modified grounded theory. Codes were developed using an iterative process, beginning with open-coding of a subset of transcripts followed by discussion with all team members, and distillation into preliminary codes. Subsequent coding reviews were conducted until no new themes emerged and existing themes were fully explored. RESULTS We conducted interviews with 32 parents (27 in English, mean parent age 34 years, standard deviation = 7; mean child age 4 years, standard deviation = 4; 50% with household income <$50,000, 47% with low health literacy) in inpatient and outpatient settings. Three categories of themes emerged: participant, knowledge, and context. Key opportunities to improve SDM included: providing a shared decision timeline, purposefully integrating patient preferences and values, and addressing uncertainty in decisions. CONCLUSION Our results provide insight into parent experiences with SDM for CMC. We identified unique opportunities to improve SDM for CMC that will inform future research and interventions to improve SDM for CMC.
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Affiliation(s)
- Jody L. Lin
- Division of Pediatric Hospital Medicine, Department of Pediatrics; Stanford University School of Medicine, Stanford, CA 94305,Division of Pediatric Hospital Medicine, Department of Pediatrics; University of Utah, Salt Lake City, UT 84113 (Present address)
| | - Catherine L. Clark
- Division of General Pediatrics, Department of Pediatrics; Stanford University School of Medicine, Stanford, CA 94305
| | - Bonnie Halpern-Felsher
- Division of Adolescent Medicine, Department of Pediatrics; Stanford University School of Medicine, Stanford, CA 94305
| | - Paul N. Bennett
- Medical and Clinical Affairs, Satellite Healthcare, San Jose, CA 95128,Deakin University, Geelong, VIC, Australia, 3125
| | - Shiri Assis-Hassid
- Center for Research on Computation and Society, John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138
| | - Ofra Amir
- Technion – Israel Institute of Technology, Haifa, Israel
| | - Yadira Castaneda Nunez
- Division of General Pediatrics, Department of Pediatrics; Stanford University School of Medicine, Stanford, CA 94305
| | - Nancy Miles Cleary
- Division of General Pediatrics, Department of Pediatrics; Stanford University School of Medicine, Stanford, CA 94305
| | - Sebastian Gehrmann
- John A. Paulson School of Engineering and Applied Sciences (Computer Science), Harvard University, Cambridge, MA 02138
| | - Barbara J. Grosz
- John A. Paulson School of Engineering and Applied Sciences (Computer Science), Harvard University, Cambridge, MA 02138
| | - Lee M. Sanders
- Division of General Pediatrics, Department of Pediatrics; Stanford University School of Medicine, Stanford, CA 94305
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Neves ET, Okido ACC, Buboltz FL, Santos RPD, Lima RAGD. Accessibility of children with special health needs to the health care network. Rev Bras Enferm 2019; 72:65-71. [PMID: 31851236 DOI: 10.1590/0034-7167-2017-0899] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 10/22/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To know how children with special health needs access the health care network. METHOD This is a qualitative research of descriptive-exploratory type, developed using semi-structured interviews mediated by the Talking Map design. Participants were 19 family caregivers of these children in two Brazilian municipalities. Data were submitted to inductive thematic analysis. RESULTS Difficulties were mentioned from the diagnosis moment to the specialized follow-up, something represented by the itinerary of the c hild and his/her family in the search for the definition of the medical diagnosis and the access to a specialized professional; a gap between the children's needs and the care offered was observed in primary health care. CONCLUSION The access of children with special health needs is filled with obstacles such as slowness in the process of defining the child's diagnosis and referral to a specialist. Primary health care services were replaced by care in emergency care units.
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88
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Keim-Malpass J, Letzkus LC, Constantoulakis L. Publicly Funded Home and Community-Based Care for Children With Medical Complexity: Protocol for the Analysis of Medicaid Waiver Applications. JMIR Res Protoc 2019; 8:e13062. [PMID: 31344668 PMCID: PMC6686641 DOI: 10.2196/13062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 06/14/2019] [Accepted: 07/05/2019] [Indexed: 11/16/2022] Open
Abstract
Background Children with medical complexity are a group of children with multiple chronic conditions and functional limitations that represent the highest health care utilization and often require a substantial number of home and community-based services (HCBS). In many states, HCBS are offered to target populations through 1915(c) Medicaid waivers. To date, no standard methods or approaches have been established to evaluate or compare 1915(c) waivers across states in the United States for children. Objective The purpose of this analysis was to develop a systematic and reproducible approach to evaluate 1915(c) Medicaid waivers for overall coverage of children with medical complexity. Methods Data elements were extracted from Medicaid 1915(c) approved waiver applications for all included waivers targeting any pediatric age range through October 31, 2018. Normalization criteria were established, and an aggregate overall coverage score was calculated for each waiver. Results Data extraction occurred in two phases: (1) waivers that were considered nonexpired through December 31, 2017, and (2) the final sample that included nonexpired waivers through October 31, 2018. A total of 142 waivers across 45 states in the United States were included in this analysis. We found that the existing adult HCBS taxonomy may not always be applicable for child and family-based service provision. Although there was uniformity in the Medicaid applications, there was high heterogeneity in how waiver eligibility, transition plans, and wait lists were defined. Study analysis was completed in January 2019, and after analyzing each individual waiver, results were aggregated at the level of the state and for each diagnostic subgroup. The published results are forthcoming. Conclusions To our knowledge, this is the first study to systematically evaluate 1915(c) Medicaid waivers targeting children with medical complexity that can be replicated without the threat of missing data. International Registered Report Identifier (IRRID) RR1-10.2196/13062
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Affiliation(s)
| | - Lisa C Letzkus
- University of Virginia School of Nursing, Charlottesville, VA, United States
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Lazow MA, DeBlasio D, Ollberding NJ, Real FJ, Klein MD. Online Simulated Cases Assess Retention of Virtual Neighborhood Tour Curriculum. Matern Child Health J 2019; 23:1159-1166. [PMID: 31267340 DOI: 10.1007/s10995-019-02790-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Learning to identify and address social determinants of health (SDH) is a crucial component of pediatric residency training. A virtual tour of an impoverished neighborhood previously demonstrated efficacy in increasing residents' self-assessed knowledge and competence, but its impact on performance has not yet been reported. Online simulated cases are emerging as feasible assessment tools to measure trainees' skills across various healthcare settings. We developed online simulated cases to evaluate residents' retention of the virtual tour's key SDH-related learning objectives 1 month after completing this curriculum. Methods Three online simulated cases with interpolated open-ended questions were created to assess residents' ability to identify SDH, recommend appropriate resources, and display empathy. Scoring rubrics to objectively evaluate responses were developed and borderline scores were decided by a team of educators. Results 19 residents participated. Mean scores for all cases exceeded pre-established borderline scores (statistically significant in two of the three cases). More than 90% of residents identified relevant SDH in the primary care and emergency department cases. Ninety-five percent of residents recommended appropriate resources in all cases, and 89% displayed empathy. Discussion Residents' performance in online simulated cases demonstrated retention and application of the virtual tour's learning objectives, including recognizing SDH, offering appropriate resources, and displaying empathy, which supports the long-term effectiveness of the virtual tour curriculum to train pediatricians about SDH. Online simulated cases provided a standardized and cost-effective way to measure residents' skills related to curricular uptake, suggesting that this assessment approach may be adapted to evaluate other educational interventions.
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Affiliation(s)
- Margot A Lazow
- Division of Pediatric Hematology/Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.
| | - Dominick DeBlasio
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267, USA
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Nicholas J Ollberding
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Francis J Real
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267, USA
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Melissa D Klein
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267, USA
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
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90
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Breneol S, King ST, Best S, McKibbon S, Curran JA. Respite care for children and youth with complex care needs and their families: a scoping review protocol. ACTA ACUST UNITED AC 2019; 17:1297-1304. [PMID: 31169775 DOI: 10.11124/jbisrir-2017-003998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this scoping review is to identify and characterize interventions, programs or models used to deliver respite care services to children and youth with complex care needs and their families. INTRODUCTION Many children with complex chronic conditions require multifaceted home management plans to address their medical, social and emotional needs. The provision of this care often falls on the parents or primary guardians. Respite care is one strategy to provide families with a break from the demands of caring for a child with complex care needs; however, families commonly face barriers to obtaining respite care services. INCLUSION CRITERIA This scoping review will consider papers that include children and youth (0-25 years of age, in any location, with complex care needs, medical complexity or complex chronic conditions) and their families. Any interventions, programs or models aimed at delivering respite care services to this population will be included. Studies focusing on support provided at the end of life will be excluded. Only studies published in English will be included. No date limits will be set. METHODS A search will be conducted in five databases, as well as multiple sources of unpublished literature. The text words contained in the titles and abstracts of relevant articles and index terms will be used to develop a full search strategy. All potentially relevant papers will be retrieved in full. A pre-defined data extraction tool developed by the reviewers will be used, and extracted data will be presented in tabular form accompanied by a narrative summary.
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Affiliation(s)
- Sydney Breneol
- Strengthening Transitions in Care Lab, IWK Health Centre, Halifax, Canada.,School of Nursing, Dalhousie University, Halifax, Canada.,Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): a Joanna Briggs Institute Centre of Excellence
| | - Sarah T King
- Discharge Planning, IWK Health Centre, Halifax, Canada
| | - Shauna Best
- Inpatient Surgical Care/Child Life Services, IWK Health Centre, Halifax Canada
| | - Shelley McKibbon
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): a Joanna Briggs Institute Centre of Excellence.,WK Kellogg Health Sciences Library, Dalhousie University, Halifax, Canada
| | - Janet A Curran
- Strengthening Transitions in Care Lab, IWK Health Centre, Halifax, Canada.,School of Nursing, Dalhousie University, Halifax, Canada.,Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): a Joanna Briggs Institute Centre of Excellence
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91
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Silveira AD, Neves ET. Cotidiano de cuidado de adolescentes com necessidades especiais de atenção à saúde. ACTA PAUL ENFERM 2019. [DOI: 10.1590/1982-0194201900045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Compreender o cotidiano de cuidado de adolescentes com necessidades especiais de atenção à saúde. Métodos Pesquisa qualitativa, pautada no referencial crítico-libertador Freireano, realizada no ambulatório pediátrico de um hospital de ensino, no segundo semestre de 2016. Realizou-se a análise de prontuários, entrevista semiestruturada e a construção do genograma e ecomapa de 35 adolescentes com algum tipo de demanda de saúde. Após a dupla transcrição, as entrevistas foram submetidas à análise de discurso Pechetiana. Resultados O cotidiano de cuidado desses adolescentes é traduzido por meio da higiene pessoal, aparência física, uso de medicamentos, nutrição e habituais modificados. O discurso dos adolescentes apresentou diferentes níveis emancipatórios: em alguns momentos a partir da adaptação e alienação, pelo costume e necessidade de ter que desenvolver o cuidado por meio de uma reprodução técnica, o que contribui para a opressão; e em outros momentos pela possibilidade de emancipação, a partir da reflexão sobre sua realidade e posicionar-se sobre ela. Conclusão O cotidiano de cuidado do adolescente é permeado pelas possibilidades e habilidades em diferentes níveis emancipatórios. A ausência de dialogicidade, troca de saberes e reflexão podem contribuir para o processo de opressão. A Enfermagem necessita possibilitar a troca de saberes e a reflexão, para que o adolescente transite de uma consciência ingênua para crítica.
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92
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Meehan E, D’Aprano AL, Gibb SM, Mountford NJ, Williams K, Harvey AR, Connell TG, Cohen E. Comprehensive care programmes for children with medical complexity. Hippokratia 2019. [DOI: 10.1002/14651858.cd013329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Elaine Meehan
- Murdoch Children's Research Institute; Neurodisability and Rehabilitation; 50 Flemington Road Melbourne Victoria Australia 3052
| | - Anita L D’Aprano
- The Royal Children's Hospital; General Medicine; Melbourne Australia
| | - Susan M Gibb
- The Royal Children's Hospital; Neurodevelopment and Disability; Melbourne Australia
| | - Nicki J Mountford
- The Royal Children's Hospital; Complex Care Hub; Melbourne Australia
| | - Katrina Williams
- The University of Melbourne; Department of Paediatrics; Melbourne Australia
| | - Adrienne R Harvey
- Murdoch Children's Research Institute; Neurodisability and Rehabilitation; 50 Flemington Road Melbourne Victoria Australia 3052
| | - Tom G Connell
- The Royal Children's Hospital; General Medicine; Melbourne Australia
| | - Eyal Cohen
- University of Toronto; Pediatrics and Health Policy, Management & Evaluation; The Hospital for Sick Children 555 University Avenue Toronto ON Canada M5G 1X8
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93
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Hofacer RD, Panatopoulos A, Vineyard J, Tivis R, Nguyen E, Jingjing N, Lindsay RP. Clinical Care Coordination in Medically Complex Pediatric Cases: Results From the National Survey of Children With Special Health Care Needs. Glob Pediatr Health 2019; 6:2333794X19847911. [PMID: 31106248 PMCID: PMC6506911 DOI: 10.1177/2333794x19847911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/02/2019] [Accepted: 04/05/2019] [Indexed: 12/01/2022] Open
Abstract
This study uses a secondary analysis of the 2009-2010 National Survey of Children
with Special Health Care Needs (NS-CSHCN) to describe care coordination (CC) for
children with medical complexity (CMC). Chi-square test, t
test, and multivariate logistic regression statistical tests are used to
determine the relationships and differences between sources of CC and factors
associated with receiving clinic-based CC for CMC and their family. Among CMC,
66.47% received no CC support and 25.73% received clinic-based CC. In
multivariate models, families reporting dissatisfaction with communication
between health care providers or reporting family-centered care were less likely
to receive clinic-based CC. Families were more likely to receive clinic-based CC
if they had younger children, lower household income, and greater school
absenteeism. Clinic-based CC is associated with improved communication between
health providers but must become more family-centered and minimize student
absenteeism for the CMC population.
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Affiliation(s)
| | | | | | - Rick Tivis
- Idaho State University, Meridian, ID,
USA
| | | | | | - Ryan P. Lindsay
- Idaho State University, Meridian, ID,
USA
- Ryan P. Lindsay, Idaho State University,
Kasiska Division of Health Sciences, 1311 East Central Drive, Meridian, ID
83642, USA.
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94
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Sheftall AH, Chisolm DJ, Alexy ER, Chavez LJ, Mangione-Smith RM, Ferrari RM, Song PH. Satisfaction With Care Coordination for Families of Children With Disabilities. J Pediatr Health Care 2019; 33:255-262. [PMID: 30449647 DOI: 10.1016/j.pedhc.2018.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/03/2018] [Accepted: 08/19/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Children with disabilities have significant health care needs, and receipt of care coordinator services may reduce caregiver burdens. The present study assessed caregivers' experience and satisfaction with care coordination. METHOD Caregivers of Medicaid-enrolled children with disabilities (n = 2,061) completed a survey (online or by telephone) collecting information on the caregivers' experiences and satisfaction with care coordination using the Family Experiences with Coordination of Care questionnaire. RESULTS Eighty percent of caregivers with a care coordinator reported receiving help making specialist appointments, and 71% reported help obtaining community services. Caregivers who reported that the care coordinator helped with specialist appointments or was knowledgeable, supportive, and advocating for children had increased odds of satisfaction (odds ratio = 3.46, 95% confidence interval = [1.01, 11.77] and odds ratio = 1.07, 95% confidence interval = [1.03, 1.11], respectively). DISCUSSION Findings show opportunities for improving care coordination in Medicaid-enrolled children with disabilities and that some specific elements of care coordination may enhance caregiver satisfaction with care.
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95
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Boss RD. Social Disparities and Death Among Children With Complex Chronic Conditions. Pediatrics 2019; 143:peds.2019-0511. [PMID: 30971432 DOI: 10.1542/peds.2019-0511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Renee D Boss
- Division of Neonatology, Department of Pediatrics, School of Medicine and Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland
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96
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Parrish II RH, Casher D, van den Anker J, Benavides S. Creating a Pharmacotherapy Collaborative Practice Network to Manage Medications for Children and Youth: A Population Health Perspective. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E58. [PMID: 30970616 PMCID: PMC6518168 DOI: 10.3390/children6040058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 02/07/2023]
Abstract
Children with special health care needs (CSHCN) use relatively high quantities of healthcare resources and have overall higher morbidity than the general pediatric population. Embedding clinical pharmacists into the Patient-Centered Medical Home (PCMH) to provide comprehensive medication management (CMM) through collaborative practice agreements (CPAs) for children, especially for CSHCN, can improve outcomes, enhance the experience of care for families, and reduce the cost of care. Potential network infrastructures for collaborative practice focused on CSHCN populations, common language and terminology for CMM, and clinical pharmacist workforce estimates are provided. Applying the results from the CMM in Primary Care grant, this paper outlines the following: (1) setting up collaborative practices for CMM between clinical pharmacists and pediatricians (primary care pediatricians and sub-specialties, such as pediatric clinical pharmacology); (2) proposing various models, organizational structures, design requirements, and shared electronic health record (EHR) needs; and (3) outlining consistent documentation of CMM by clinical pharmacists in CSHCN populations.
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Affiliation(s)
- Richard H Parrish II
- Department of Pharmacy Services, St. Christopher's Hospital for Children ⁻ American Academic Health System, 160 East Erie Avenue, Philadelphia, PA 19134, USA.
- School of Pharmacy, Virginia Commonwealth University, Richmond, VA 23298, USA.
| | - Danielle Casher
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA 19134, USA.
| | - Johannes van den Anker
- Universitäts-Kinderspital beider Basel (UKBB), Spitalstrasse 33, CH-4031 Basel, Switzerland.
- Children's National Health System, 111 Michigan Avenue, Washington, DC 20010, USA.
- Erasmus Medical Center-Sophia Children's Hospital, s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
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97
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Silveira AD, Neves ET. The social network of adolescents who need special health care. Rev Bras Enferm 2019; 72:442-449. [DOI: 10.1590/0034-7167-2018-0543] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 09/09/2018] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To describe the social network of adolescents who need special health care. Method: A qualitative, descriptive and exploratory study conducted between 2016 and 2017 in the pediatric outpatient clinic of a teaching hospital in southern Brazil. Thirty-five semi-structured interviews were conducted with adolescents between 12 and 18 years of age, followed by the construction of genograms and ecomaps. After transcription, the enunciations were subjected to Pêcheux’s method of discourse analysis. Results: The institutional network consists of health services, schools and religious entities, as well as adolescents’ families and friends. In the family network, women family members—such as mothers, grandmothers and aunts—have a special role. Final Consideration: The adolescents’ social network is composed of institutional and family circles. In the view of adolescents, the tertiary service is more capable of solving their problems, and for this reason used the most. In order to ensure these adolescents access to and continuity of care, the articulation between health policies and health services is suggested.
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98
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Sobush KT. Principles of Managing Children with Medical Complexity and a New Delivery Model. MISSOURI MEDICINE 2019; 116:134-139. [PMID: 31040500 PMCID: PMC6461320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Children with medical complexity (CMC) have warranted substantial individual provider commitment for pediatric management. New drivers have prompted program creation that focuses even greater care on this small, increasingly influential population. These drivers include enhancing care coordination, aligning value-based reimbursement strategies and managing higher patient acuity in non-hospital environments. This article will review management of CMC and highlight the Complex Medical Care Program at SSM Health Cardinal Glennon Children's Hospital in St. Louis, Missouri.
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Affiliation(s)
- Kurtis T Sobush
- Kurtis T. Sobush, MD, is Associate Professor of Pediatrics in the Department of Pediatric Pulmonary and Sleep Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
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99
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Balistreri KS. Food insufficiency and children with special healthcare needs. Public Health 2019; 167:55-61. [PMID: 30639804 DOI: 10.1016/j.puhe.2018.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/17/2018] [Accepted: 11/20/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the prevalence of food insufficiency, a more severe form of food insecurity, across levels of special healthcare needs among a nationally representative sample of children in the United States. The study also investigates whether medical home access serves as a possible protective mechanism against food hardship. STUDY DESIGN The study involves analysis of nationally representative cross-sectional data. METHODS The data used are the 2016 National Survey of Children's Health, a cross-sectional nationally representative sample of the US children (N = 48,709). Descriptive analyses and logistic regression analysis are used to estimate food insufficiency and its correlates by complexity of children's special healthcare needs. RESULTS Analysis showed that children with more complex special healthcare needs experienced roughly twice the rate of food insufficiency compared with children with no special healthcare needs or children with less complex healthcare needs. Multivariate analysis indicated that children with more complex healthcare needs face an increased risk of food insufficiency net of demographic and economic characteristics. Interaction models revealed that medical home access protects children with medical complexity from food insufficiency. CONCLUSIONS These findings document significantly elevated risk of food insufficiency among families with a child facing more complex special healthcare needs. Interventions in healthcare settings could include referrals to resources already in place to combat hunger such as food bank agencies and other resources that might help at-risk families obtain assistance through programs such as the Supplemental Nutrition Assistance Program and Women, Infants, and Children.
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100
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Okido ACC, Neves ET, Cavicchioli GN, Jantsch LB, Pereira FP, Lima RAG. Factors associated with family risk of children with special health care needs. Rev Esc Enferm USP 2018; 52:e03377. [PMID: 30365673 DOI: 10.1590/s1980-220x2017048703377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/09/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify the factors associated with family risk of children with special health care needs. METHODS Bicentric study, with a cross-sectional design and a quantitative approach, with family caregivers of children with special health care needs. Instruments were applied to obtain a sociodemographic characterization, and identify and classify the family risk. For analysis between variables, Mann-Whitney and Fisher's exact tests were used and the Spearman's correlation coefficient was calculated. RESULTS One hundred and eighteen caregivers participated in the study. The average family risk score was 3.53 (±3.76), with a median of 3.0, and minimum and maximum values of 0 and 16, respectively, with no significant difference between the two studied Brazilian municipalities. In municipality 1, the number of siblings presented a positive correlation with the average family risk score (0.011, p<0.05). Level of education and marital status of the caregiver showed a significant association with the result (0.038 and 0.002, respectively). The social classification variable presented a negative correlation with the outcome in municipalities 1 (0.003, p<0.01) and 2 (0.006, p<0.01). CONCLUSION To classify the family risk and recognize associated factors can be taken as a basis for fair home care to children with special health care needs.
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Affiliation(s)
| | - Eliane Tatsch Neves
- Departamento de Enfermagem, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | | | | | | | - Regina Aparecida Garcia Lima
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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