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Berkalieva A, Kelly NR, Fisher A, Hohmann SF, Abul-Husn NS, Greally JM, Horowitz CR, Wasserstein MP, Kenny EE, Gelb BD, Ferket BS. Physician and informal care use explained by the Pediatric Quality of Life Inventory (PedsQL) in children with suspected genetic disorders. Qual Life Res 2024; 33:1997-2009. [PMID: 38743313 DOI: 10.1007/s11136-024-03677-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE To examine associations between Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales and PedsQL Infant Scales with formal health care resource utilization (HCRU) and informal caregiver burden. METHODS We studied a pediatric cohort of 837 patients (median age: 8.4 years) with suspected genetic disorders enrolled January 2019 through July 2021 in the NYCKidSeq program for diagnostic sequencing. Using linked ~ nine-month longitudinal survey and physician claims data collected through May 2022, we modeled the association between baseline PedsQL scores and post-baseline HCRU (median follow-up: 21.1 months) and informal care. We also assessed the longitudinal change in PedsQL scores with physician services using linear mixed-effects models. RESULTS Lower PedsQL total and physical health scores were independently associated with increases in 18-month physician services, encounters, and weekly informal care. Comparing low vs. median total scores, increases were 10.6 services (95% CI: 1.0-24.6), 3.3 encounters (95% CI: 0.5-6.8), and $668 (95% CI: $350-965), respectively. For the psychosocial domain, higher scores were associated with decreased informal care. Based on adjusted linear mixed-effects modeling, every additional ten physician services was associated with diminished improvement in longitudinal PedsQL total score trajectories by 1.1 point (95% confidence interval: 0.6-1.6) on average. Similar trends were observed in the physical and psychosocial domains. CONCLUSION PedsQL scores were independently associated with higher utilization of physician services and informal care. Moreover, longitudinal trajectories of PedsQL scores became less favorable with increased physician services. Adding PedsQL survey instruments to conventional measures for improved risk stratification should be evaluated in further research.
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Affiliation(s)
- Asem Berkalieva
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029-6574, USA
| | - Nicole R Kelly
- Division of Pediatric Genetic Medicine, Department of Pediatrics, Children's Hospital at Montefiore/Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ashley Fisher
- Center for Advanced Analytics, Vizient, Chicago, IL, USA
| | | | - Noura S Abul-Husn
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- 23andMe Inc, Sunnyvale, CA, USA
- Division for Genomic Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John M Greally
- Division of Genomics, Department of Genetics, Children's Hospital at Montefiore/Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Carol R Horowitz
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Melissa P Wasserstein
- Division of Pediatric Genetic Medicine, Department of Pediatrics, Children's Hospital at Montefiore/Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Eimear E Kenny
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division for Genomic Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bruce D Gelb
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bart S Ferket
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029-6574, USA.
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Kallio M, Tornivuori A, Miettinen PJ, Kolho KL, Relas H, Culnane E, Loftus H, Sawyer SM, Kosola S. Health-related quality of life and self-reported health status in adolescents with chronic health conditions before transfer of care to adult health care: an international cohort study. BMC Pediatr 2024; 24:163. [PMID: 38459510 PMCID: PMC10921592 DOI: 10.1186/s12887-024-04629-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 02/07/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Heath-related quality of life (HRQoL) is lower in adolescents with chronic health conditions compared to healthy peers. While there is evidence of some differences according to the underlying condition and gender, differences by measure and country are poorly understood. In this study we focus on the differences in HRQoL in adolescents with various chronic medical conditions in the year before transfer of care to adult health services. We also study the associations of two different HRQoL measurements to each other and to self-reported health. METHODS We recruited 538 adolescents from New Children`s Hospital, Helsinki, Finland, and the Royal Children`s Hospital, Melbourne, Australia in 2017-2020. We used two validated HRQoL measurement instruments, Pediatric Quality of Life Inventory (PedsQL) and 16D, and a visual analog scale (VAS) for self-reported health status. RESULTS In total, 512 adolescents (50.4% female, mean age 17.8 [SD 1.2] years), completed the survey measures. Higher HRQoL was reported in males than females in both countries (PedsQL 79.4 vs. 74.1; 16D 0.888 vs. 0.846), and in adolescents from Finland than Australia (80.6 vs. 72.2 and 0.905 vs. 0.825, p < 0.001 for all). Adolescents with diabetes, rheumatological, nephrological conditions and/or organ transplants had higher HRQoL than adolescents with neurological conditions or other disease syndromes (p < 0.001). PedsQL and 16D scores showed a strong correlation to each other (Spearman correlation coefficient r = 0.81). Using the 7-point VAS (1-7), 52% (248 of 479) considered their health status to be good (6-7) and 10% (48 of 479) rated it poor (1-2). Better self-reported health was associated with higher HRQoL. CONCLUSIONS The HRQoL of transition aged adolescents varies between genders, diagnostic groups, and countries of residence. The association between self-reported health and HRQoL suggests that brief assessment using the VAS could identify adolescents who may benefit from in-depth HRQoL evaluation. TRIAL REGISTRATION Trial registration name The Bridge and registration number NCT04631965 ( https://clinicaltrials.gov/ct2/show/NCT04631965 ).
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Affiliation(s)
- Mira Kallio
- Department of Pediatrics, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
- Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Anna Tornivuori
- Department of Nursing Science, University of Turku, Turku, Finland
- Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Päivi J Miettinen
- Department of Pediatrics, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kaija-Leena Kolho
- Department of Pediatrics, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Heikki Relas
- Department of Rheumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Evelyn Culnane
- Transition Support Service, The Royal Children's Hospital, Melbourne, Australia
| | - Hayley Loftus
- Transition Support Service, The Royal Children's Hospital, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Susan M Sawyer
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Silja Kosola
- Department of Pediatrics, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Research, Development and Innovations, Western Uusimaa Wellbeing Services County, Espoo, Finland
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Cousino MK, May LJ, Smyth L, McQueen M, Thompson K, Hunter T, Ventresco C, Fields K, Murray J, Machado DS, Shezad M, Zafar F, Rosenthal DN, Lorts A, Blume ED. Patient and parent-reported outcomes in paediatric ventricular assist device support: a multi-center ACTION learning network feasibility and pilot experience. Cardiol Young 2023; 33:2258-2266. [PMID: 36655506 PMCID: PMC11285008 DOI: 10.1017/s1047951122004048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Patient- and proxy-reported outcomes (PROs) are an important indicator of healthcare quality and can be used to inform treatment. Despite the widescale use of PROs in adult cardiology, they are underutilised in paediatric cardiac care. This study describes a six-center feasibility and pilot experience implementing PROs in the paediatric and young adult ventricular assist device population. METHODS The Advanced Cardiac Therapies Improving Outcomes Network (ACTION) is a collaborative learning network comprised of 55 centres focused on improving clinical outcomes and the patient/family experience for children with heart failure and those supported by ventricular assist devices. The development of ACTION's PRO programme via engagement with patient and parent stakeholders is described. Pilot feasibility, patient/parent and clinician feedback, and initial PRO findings of patients and families receiving paediatric ventricular assist support across six centres are detailed. RESULTS Thirty of the thirty-five eligible patients (85.7%) were enrolled in the PRO programme during the pilot study period. Clinicians and participating patients/parents reported positive experiences with the PRO pilot programme. The most common symptoms reported by patients/parents in the first month post-implant period included limitations in activities, dressing change distress, and post-operative pain. Poor sleep, dressing change distress, sadness, and fatigue were the most common symptoms endorsed >30 days post-implant. Parental sadness and worry were notable throughout the entirety of the post-implant experience. CONCLUSIONS This multi-center ACTION learning network-based PRO programme demonstrated initial success in this six-center pilot study experience and yields important next steps for larger-scale PRO collection, research, and clinical intervention.
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Affiliation(s)
- Melissa K Cousino
- Department of Pediatrics, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Lindsay J May
- Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Lauren Smyth
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Katherine Thompson
- Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Tiffany Hunter
- Department of Pediatrics, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | | | - Katrina Fields
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jenna Murray
- Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Desiree S Machado
- Department of Pediatric Cardiac Critical Care, Congenital Heart Center, University of Florida, Gainesville, FL, USA
| | - Muhammad Shezad
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Farhan Zafar
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Angela Lorts
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Elizabeth D Blume
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
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Gale V, Carlton J. Including Young Children in the Development and Testing of Patient Reported Outcome (PRO) Instruments: A Scoping Review of Children's Involvement and Qualitative Methods. THE PATIENT 2023; 16:425-456. [PMID: 37402059 DOI: 10.1007/s40271-023-00637-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Qualitative research during the development/testing of Patient Reported Outcome Measures (PROMs) is recommended to support content validity. However, it is unclear if and how young children (≤ 7 years) can be involved in this research because of their unique cognitive needs. OBJECTIVES Here we investigate the involvement of children (≤ 7 years) in qualitative research for PROM development/testing. This review aimed to identify (1) which stages of qualitative PROM development children ≤ 7 years had been involved in, (2) which subjective health concepts had been explored within qualitative PROM development with this age group, and (3) which qualitative methods had been reported and how these compared with existing methodological recommendations. METHODS This scoping review systematically searched three electronic databases (searches re-run prior to final analysis on 29 June 2022) with no date restrictions. Included studies had samples of at least 75% aged ≤ 7 years or reported distinct qualitative methods for children ≤ 7 years in primary qualitative research to support concept elicitation or PROM development/testing. Articles not in English and PROMs that did not enable children ≤ 7 years to self-report were excluded. Data on study type, subjective health and qualitative methods were extracted and synthesised descriptively. Methods were compared with recommendations from guidance. RESULTS Of 19 included studies, 15 reported concept elicitation research and 4 reported cognitive interviewing. Most explored quality of life (QoL)/health-related quality of life (HRQoL). Some concept elicitation studies reported that creative/participatory activities had supported children's engagement, but results and reporting detail varied considerably across studies. Cognitive interviewing studies reported less methodological detail and fewer methods adapted for young children compared with concept elicitation studies. They were limited in scope regarding assessments of content validity, mostly focussing on clarity while relevance and comprehensiveness were explored less. DISCUSSION Creative/participatory activities may be beneficial in concept elicitation research with children ≤ 7 years, but future research needs to explore what contributes to the success of young children's involvement and how researchers can adopt flexible methods. Cognitive interviews with young children are limited in frequency, scope and reported methodological detail, potentially impacting PROM content validity for this age group. Without detailed reporting, it is not possible to determine the feasibility and usefulness of children's (≤ 7 years) involvement in qualitative research to support PROM development and assessment.
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Affiliation(s)
- Victoria Gale
- School of Health and Related Research, The University of Sheffield, Sheffield, UK.
| | - Jill Carlton
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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Boyden JY, Bogetz JF, Johnston EE, Thienprayoon R, Williams CSP, McNeil MJ, Patneaude A, Widger KA, Rosenberg AR, Ananth P. Measuring Pediatric Palliative Care Quality: Challenges and Opportunities. J Pain Symptom Manage 2023; 65:e483-e495. [PMID: 36736860 PMCID: PMC10106436 DOI: 10.1016/j.jpainsymman.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 02/05/2023]
Abstract
Pediatric palliative care (PPC) programs vary widely in structure, staffing, funding, and patient census, resulting in inconsistency in service provision. Improving the quality of palliative care for children living with serious illness and their families requires measuring care quality, ensuring that quality measurement is embedded into day-to-day clinical practice, and aligning quality measurement with healthcare policy priorities. Yet, numerous challenges exist in measuring PPC quality. This paper provides an overview of PPC quality measurement, including challenges, current initiatives, and future opportunities. While important strides toward addressing quality measurement challenges in PPC have been made, including ongoing quality measurement initiatives like the Cambia Metrics Project, the PPC What Matters Most study, and collaborative learning networks, more work remains. Providing high-quality PPC to all children and families will require a multi-pronged approach. In this paper, we suggest several strategies for advancing high-quality PPC, which includes 1) considering how and by whom success is defined, 2) evaluating, adapting, and developing PPC measures, including those that address care disparities within PPC for historically marginalized and excluded communities, 3) improving the infrastructure with which to routinely and prospectively measure, monitor, and report clinical and administrative quality measures, 4) increasing endorsement of PPC quality measures by prominent quality organizations to facilitate accountability and possible reimbursement, and 5) integrating PPC-specific quality measures into the administrative, funding, and policy landscape of pediatric healthcare.
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Affiliation(s)
- Jackelyn Y Boyden
- Department of Family and Community Health, School of Nursing (J.Y.B.), University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Jori F Bogetz
- Department of Pediatrics, Division of Bioethics and Palliative Care (J.F.B.), University of Washington School of Medicine, Seattle, Washington, USA; Center for Clinical and Translational Research (J.F.B.), Seattle Children's Research Institute, Seattle, Washington, USA
| | - Emily E Johnston
- Department of Pediatrics, Division of Hematology and Oncology (E.E.J.), University of Alabama at Birmingham, Birmingham, Alabama, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham (E.E.J.), Birmingham, Alabama, USA
| | - Rachel Thienprayoon
- Department of Anesthesia, Division of Palliative Care, Cincinnati Children's Hospital Medical Center (R.T.), Cincinnati, Ohio, USA; Department of Pediatrics, Cincinnati Children's Hospital Medical Center (R.T.), Cincinnati, Ohio, USA
| | - Conrad S P Williams
- Palliative Care Program and Department of Pediatrics (C.S.P.W.), Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michael J McNeil
- St. Jude Children's Research Hospital, Department of Global Pediatric Medicine (M.J.M.), Memphis, Tennessee, USA; St. Jude Children's Research Hospital, Division of Quality and Life and Palliative Care, Department of Oncology (M.J.M.), Memphis, Tennessee, USA
| | - Arika Patneaude
- Bioethics and Palliative Care, Seattle Children's Hospital (A.P.), Seattle, Washington, USA; University of Washington School of Social Work (A.P.), Seattle, Washington, USA; Treuman Katz Center for Pediatric Bioethics (A.P.), Seattle, Washington, USA
| | - Kimberley A Widger
- Lawrence S. Bloomberg Faculty of Nursing (K.A.W.), University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children (K.A.W.), Toronto, Ontario, Canada
| | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care (A.R.S.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School (A.R.S.), Boston, Massachusetts, USA
| | - Prasanna Ananth
- Department of Pediatrics, Yale School of Medicine (P.A.), New Haven, Connecticut, USA; Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center (P.A.), New Haven, Connecticut, USA
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Balbale SN, Cho M, Raval MV, Close SM. Role of patient and family engagement in quality improvement for pediatric surgery. Semin Pediatr Surg 2023; 32:151281. [PMID: 37094531 DOI: 10.1016/j.sempedsurg.2023.151281] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
In recent decades, the role of quality improvement (QI) in pediatric surgery has grown substantially. Patient and family engagement can help to maximize the impact of QI by enhancing safety and patient outcomes. Yet, broader, systematic efforts to actively involve patients and families in QI initiatives remain a persistent gap in pediatric surgery. To address this gap, we propose an agenda centered on three key goals for future quality improvement efforts: (1) building partnerships with patients and their families; (2) expanding the use of patient-reported outcomes (PROs) and novel, cross-disciplinary research methods; and (3) engaging patients and families consistently across all stages of pediatric surgical care. Fulfilling this agenda will be essential in shifting our mindset to view QI as a collective that involves patients, families, clinicians, and payers in continuous, system-wide opportunities to evaluate and improve care. Actively listening to and collaborating with patients and families may also help renew our focus on narrowing the gap between current practice and the best possible practice for children undergoing surgery.
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Affiliation(s)
- Salva N Balbale
- Division of Gastroenterology and Hepatology, Department of Medicine; Department of Medical Social Sciences; Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Department of Surgery; & Center for Health Services and Outcomes Research, Institute of Public Health and Medicine (IPHAM), Northwestern University Feinberg School of Medicine, Chicago, IL; Center of Innovation for Complex Chronic Healthcare, Health Services Research & Development, Edward Hines, Jr. VA Hospital, Hines, IL.
| | | | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sharron M Close
- Department of Pediatric Advanced Practice Nursing, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
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Integration of Patient-reported Outcome Measures in Pediatric Hematology: A Qualitative Methods Study. J Pediatr Hematol Oncol 2023; 45:e60-e64. [PMID: 35462386 DOI: 10.1097/mph.0000000000002465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/03/2022] [Indexed: 02/03/2023]
Abstract
Patient-reported outcome measures (PROMs) are self-reported questionnaires that allow patients and families to evaluate health-related experiences without influence or oversight from health care professionals. This study aimed to rate the relevance of existing PROMs for pediatric hematology patients, as identified by a recent systematic review, as well as to evaluate the receptivity of electronic PROM integration into clinical practice. Focus groups and interviews were conducted with children (10) and parents (19) impacted by nonmalignant hematological disorders, as well as with health care professionals (6). We observed strong support for the TranQol in thalassemia (100% for both parents [P] and children [C]); the Canadian Haemophilia Outcomes-Kids' Life Assessment Tool (CHO-KLAT) (100% P, 75% C) and Haemophilia Quality of Life questionnaire (Haemo-QoL) (100% P and C) in hemophilia; the Pediatric Quality of Life Inventory (PedsQL) Sickle Cell Module (75% P, 100% C); and the Kids ITP Tool in immune thrombocytopenia (100% P, 66.7% C). Generic tools such as the PedsQL Generic were met with mixed support. Electronic PROM integration received universal support. We obtained strong support for the integration of a web-based platform into clinical practice and a preference for disease-specific PROMs over generic PROMs. Future projects may explore the development of a child-friendly Canadian web-based platform to standardize quality-of-life evaluation within the clinical encounter.
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Chen M, Jones CM, Bauer HE, Osakwe O, Ketheeswaran P, Baker JN, Huang IC. Barriers and Opportunities for Patient-Reported Outcome Implementation: A National Pediatrician Survey in the United States. CHILDREN 2022; 9:children9020185. [PMID: 35204906 PMCID: PMC8870373 DOI: 10.3390/children9020185] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 11/16/2022]
Abstract
Purpose: To characterize pediatricians’ perceived barriers and areas of confidence in assessing patient-reported outcomes (PROs) in the U.S., and to test associations of these factors with implementing PRO assessment. Methods: Using a random sample from the members of American Medical Association, we recruited general pediatricians and pediatric subspecialists to complete a survey (July 2011 to December 2013). Perceived barriers and confidence in PRO assessment were compared by age, pediatric specialty (general pediatrics, seven subspecialties), practice settings (academic, private), and region of practice. Multivariable logistic regressions tested associations of demographic factors, barriers, and confidence factors with the implementation of PRO assessment. Findings: The survey was completed by 458 participants (response rate 48.5%); of these, 40.4%, 15.9%, 15.5%, and 8.1% were general pediatricians, cardiology, hematology/oncology, and pulmonary specialists, respectively. PRO assessment was implemented by 29.0% of the pediatricians. The top five barriers for PRO assessment included limited time/manpower (79.0%), limited training (77.4%), lengthy PRO instruments (76%), lack of meaningful cut-offs on PRO scores (75.5%), and unavailable PRO instruments (75.0%). Limited knowledge of PROs (OR 4.10; 95% CI 2.21, 7.60) and unavailability of PRO instruments (OR 1.87; 95% CI 1.01, 3.49) increased the odds of not implementing the assessment, whereas confidence in PRO assessments compatible with norms (OR 0.41; 95% CI 0.23, 0.72) and perceived benefit over clinical judgment alone (OR 0.53; 95% CI 0.31, 0.93) decreased the odds of not implementing the assessment. Interpretation: significant barriers to PRO assessment in pediatric settings suggest the need for providing training, resources, and practical guidance toward implementation. Patient or Public Contribution: healthcare service users contributed to this study by completing a survey and providing feedback about the barriers and areas of confidence in assessing PROs for pediatric populations.
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Affiliation(s)
- Ming Chen
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA;
| | - Conor M. Jones
- Weill Medical College, Cornell University, New York, NY 10021, USA;
| | - Hailey E. Bauer
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
| | | | | | - Justin N. Baker
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
- Correspondence: ; Tel.: +1-901-595-8369
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Anthony SJ, Pol SJ, Lin J, Barwick M, Brudno M, Manase D, Parekh RS, Silva A, Stinson J. Creation of an electronic patient-reported outcome measure platform Voxe: a mixed methods study protocol in paediatric solid organ transplantation. BMJ Open 2021; 11:e053119. [PMID: 34667013 PMCID: PMC8527113 DOI: 10.1136/bmjopen-2021-053119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/29/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Patient-reported outcome measures (PROMs) provide an opportunity for meaningful patient engagement and shared decision-making. The objective of this research programme is to improve health outcomes for paediatric solid organ transplant patients by implementing PROMs into clinical care. The current study aims to create Voxe, a paediatric user-centred electronic PROM platform, by engaging patients and healthcare providers throughout the design and development process. METHODS AND ANALYSIS The creation of Voxe will occur over two phases that build on previous research. The user interface design phase employs a 'user-centric' approach to identify end-users' needs and iteratively refine the look and layout of Voxe to meet these needs. Transplant recipients, aged 10-17, and healthcare providers will participate in three rounds of testing (24 participants total). Participants will: (1) complete task-based activities (outcomes-effectiveness and efficiency), (2) complete questionnaires (outcome-satisfaction) and (3) participate in a semi-structured interview. The following phase involves software development and Voxe usability testing. Transplant recipients, aged 8-17, and healthcare providers will participate in four rounds of iterative testing (24-40 participants total). The think-aloud technique will be employed, and participants will describe their thoughts and feelings while interacting with a Voxe prototype. Participants will: (1) log into Voxe and complete tasks (outcomes-time on task, successful task completion, frequency of critical and non-critical errors and error-free rate), (2) complete questionnaires (outcome-satisfaction) and (3) participate in a semi-structured interview. Findings will result in the creation and launch of a user-centred electronic PROM platform. ETHICS AND DISSEMINATION Research ethics board approval has been provided by The Hospital for Sick Children. This research is critical to answering methodological and operational questions to inform Voxe implementation in paediatric clinical settings and facilitate PROM data collection. Future investigations will include an implementation-effectiveness evaluation.
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Affiliation(s)
- Samantha J Anthony
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah J Pol
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jia Lin
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melanie Barwick
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Michael Brudno
- Data Aggregation, Translation and Architecture, University Health Network, Toronto, Ontario, Canada
- Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada
| | - Dorin Manase
- Data Aggregation, Translation and Architecture, University Health Network, Toronto, Ontario, Canada
| | - Rulan Savita Parekh
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amanda Silva
- Data Aggregation, Translation and Architecture, University Health Network, Toronto, Ontario, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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10
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Anthony SJ, Young K, Pol SJ, Selkirk EK, Blydt-Hansen T, Boucher S, Goldberg A, Hamiwka L, Haverman L, Mitchell J, Urschel S, Santana M, Stinson J, Sutherland K, West LJ. Patient-reported outcome measures in pediatric solid organ transplantation: Exploring stakeholder perspectives on clinical implementation through qualitative description. Qual Life Res 2021; 30:1355-1364. [PMID: 33447959 PMCID: PMC8068689 DOI: 10.1007/s11136-020-02743-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 12/05/2022]
Abstract
PURPOSE Patient-reported outcome measures (PROMs) are standardized instruments used to collect data about the subjective assessment of medical care from the patient perspective. Implementing PROMs within pediatric clinical settings has gained increasing importance as health services prioritize patient-centred pediatric care. This study explores the perspectives of pediatric solid organ transplant patients, caregivers, and healthcare practitioners (HCPs) on implementing PROMs into clinical practice. METHODS Qualitative description methods were used to elicit stakeholder perspectives. Semi-structured interviews were conducted across five Canadian transplant centres. Purposive sampling was used to obtain maximum variation across age, gender, and transplant program for all participants, as well as discipline for HCPs. RESULTS The study included a total of 63 participants [patients (n = 20), caregivers (n = 22) and HCPs (n = 21)]. Nearly all participants endorsed the implementation of PROMs to enhance pediatric transplant clinical care. Three primary roles for PROMs emerged: (1) to bring a transplant patient's overall well-being into the clinical care conversation; (2) to improve patient communication and engagement; and, (3) to inform the practice of clinical pediatric transplant care. Insights for effective implementation included completing electronic PROMs remotely and prior to clinical appointments by patients who are eight to 10 years of age or older. CONCLUSIONS This study contributes to current research that supports the use of PROMs in clinical pediatric care and guides their effective implementation into practice. Future directions include the development, usability testing, and evaluation of a proposed electronic PROM platform that will inform future research initiatives.
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Affiliation(s)
- Samantha J Anthony
- Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.
- Canadian Donation and Transplantation Research Program, Edmonton, Canada.
| | - Katarina Young
- Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - Sarah J Pol
- Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - Enid K Selkirk
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Tom Blydt-Hansen
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
- British Columbia Children's Hospital, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Suzanne Boucher
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
| | - Aviva Goldberg
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
- Health Science Centre Winnipeg, Winnipeg, Canada
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Lorraine Hamiwka
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
- Alberta Children's Hospital, Calgary, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Lotte Haverman
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Psychosocial, Amsterdam, The Netherlands
| | - Joanna Mitchell
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
| | - Simon Urschel
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
- Stollery Children's Hospital, Edmonton, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Maria Santana
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jennifer Stinson
- Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Katie Sutherland
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
| | - Lori J West
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
- Stollery Children's Hospital, Edmonton, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Canada
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11
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Piette V, Beernaert K, Cohen J, Pauwels NS, Scherrens AL, van der Werff Ten Bosch J, Deliens L. Healthcare interventions improving and reducing quality of life in children at the end of life: a systematic review. Pediatr Res 2021; 89:1065-1077. [PMID: 32645707 DOI: 10.1038/s41390-020-1036-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/15/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Children with serious illness suffer from symptoms at the end of life that often fail to be relieved. An overview is required of healthcare interventions improving and decreasing quality of life (QOL) for children with serious illness at the end of life. METHODS A systematic review was performed in five databases, January 2000 to July 2018 without language limit. Reviewers selected quantitative studies with a healthcare intervention, for example, medication or treatment, and QOL outcomes or QOL-related measures, for example, symptoms, for children aged 1-17 years with serious illness. One author assessed outcomes with the QualSyst and GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) Framework; two authors checked a 25% sample. QOL improvement or reduction was categorized. RESULTS Thirty-six studies met the eligibility criteria studying 20 unique interventions. Designs included 1 randomized controlled trial, 1 cross-sectional study, and 34 cohort studies. Patient-reported symptom monitoring increased QOL significantly in cancer patients in a randomized controlled trial. Dexmedetomidine, methadone, ventilation, pleurodesis, and palliative care were significantly associated with improved QOL, and chemotherapy, stem cell transplant, and hospitalization with reduced QOL, in cohort studies. CONCLUSIONS Use of patient-controlled symptom feedback, multidisciplinary palliative care teams with full-time practical support, inhalation therapy, and off-label sedative medication may improve QOL. Curative therapy may reduce QOL. IMPACT QOL for children at the end of life may be improved with patient-controlled symptom feedback, multidisciplinary palliative care teams with full-time practical support, inhalation therapy, and off-label sedative medication. QOL for children at the end of life may be reduced with therapy with a curative intent, such as curative chemotherapy or stem cell transplant. A comprehensive overview of current evidence to elevate currently often-failing QOL management for children at the end of life. New paradigm-level indicators for appropriate and inappropriate QOL management in children at the end of life. New hypotheses for future research, guided by the current knowledge within the field. Various healthcare interventions (as described above) could or might be employed as tools to provide relief in QOL management for children with serious illness, such as cancer, at the end of life, and therefore could be discussed in pediatrician end-of-life training to limit the often-failed QOL management in this population, cave the one-size-fits-all approach for individual cases. Multidisciplinary team efforts and 24/7 presence, especially practical support for parents, might characterize effective palliative care team interventions for children with serious illness at the end of life, suggesting a co-regulating link between well-being of the child partly to that of the parents Hypothesis-oriented research is needed, especially for children with nonmalignant disorders, such as genetic or neurological disorders at the end of life, as well as QOL outcomes for intervention research and psychosocial or spiritual outcomes.
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Affiliation(s)
- Veerle Piette
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels Health Campus-Building K Laarbeeklaan 103, 1090, Brussels, Belgium. .,Department of Public Health and Primary Care, Universitair Ziekenhuis Gent, Ghent University, Entrance 42 (K3), 6th floor, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Kim Beernaert
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels Health Campus-Building K Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Public Health and Primary Care, Universitair Ziekenhuis Gent, Ghent University, Entrance 42 (K3), 6th floor, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels Health Campus-Building K Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Public Health and Primary Care, Universitair Ziekenhuis Gent, Ghent University, Entrance 42 (K3), 6th floor, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Nele S Pauwels
- Knowledge Centre for Health Ghent, Universitair Ziekenhuis Gent, Ghent University, Entrance 42 (K3), 1st floor Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Anne-Lore Scherrens
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels Health Campus-Building K Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Public Health and Primary Care, Universitair Ziekenhuis Gent, Ghent University, Entrance 42 (K3), 6th floor, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Jutte van der Werff Ten Bosch
- Department of Paediatrics, KidZ Health Castle Children's Hospital, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Dikke-Beuklaan 128, 1090, Brussels, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels Health Campus-Building K Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Public Health and Primary Care, Universitair Ziekenhuis Gent, Ghent University, Entrance 42 (K3), 6th floor, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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12
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Cox ED, Dobrozsi SK, Forrest CB, Gerhardt WE, Kliems H, Reeve BB, Rothrock NE, Lai JS, Svenson JM, Thompson LA, Tran TDN, Tucker CA. Considerations to Support Use of Patient-Reported Outcomes Measurement Information System Pediatric Measures in Ambulatory Clinics. J Pediatr 2021; 230:198-206.e2. [PMID: 33271193 PMCID: PMC7914197 DOI: 10.1016/j.jpeds.2020.11.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To identify challenges to the use of Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric measures in the ambulatory pediatric setting and possible solutions to these challenges. STUDY DESIGN Eighteen semistructured telephone interviews of health system leaders, measurement implementers, and ambulatory pediatric clinicians were conducted. Five coders used applied thematic analysis to iteratively identify and refine themes in interview data. RESULTS Most interviewees had roles in leadership or the implementation of patient-centered outcomes; 39% were clinicians. Some had experience using PROMIS clinically (44%) and 6% were considering this use. Analyses yielded 6 themes: (1) selection of PROMIS measures, (2) method of administration, (3) use of PROMIS Parent Proxy measures, (4) privacy and confidentiality of PROMIS responses, (5) interpretation of PROMIS scores, and (6) using PROMIS scores clinically. Within the themes, interviewees illuminated specific unique considerations for using PROMIS with children, including care transitions and privacy. CONCLUSIONS Real-world challenges continue to hamper PROMIS use. Ongoing efforts to disseminate information about the integration of PROMIS measures in clinical care is critical to impacting the health of children.
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Affiliation(s)
- Elizabeth D. Cox
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Sarah K. Dobrozsi
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | | | - Wendy E. Gerhardt
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center (retired), Cincinnati, OH
| | - Harald Kliems
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Bryce B. Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Nan E. Rothrock
- Departments of Medical Social Sciences, Psychiatry and Behavioral Sciences, and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jin-Shei Lai
- Departments of Medical Social Sciences and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jacob M. Svenson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Lindsay A. Thompson
- Departments of Pediatrics and Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL
| | - Thuy Dan N. Tran
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Carole A. Tucker
- Department of Health and Rehabilitation Sciences, Temple University College of Public Health, Philadelphia, PA
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13
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The Majority of Patient-reported Outcome Measures in Pediatric Orthopaedic Research Are Used Without Validation. J Pediatr Orthop 2021; 41:e74-e79. [PMID: 32804862 DOI: 10.1097/bpo.0000000000001659] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Given that patient-reported outcome measures (PROMs) are increasingly used to inform clinical decision-making, it is vital that they are validated, reliable, responsive, and appropriate for the population under study. The purpose of this systematic review was to assess the rate of PROM use in the pediatric orthopaedic literature, characterize whether each use was in the PROM-validated demographic, and analyze the association between bibliometric factors and the use of PROMs with incomplete validation. METHODS The Institute for Scientific Information (ISI) Web of Science database was queried for all clinical pediatric orthopaedic studies from 2014 to 2017. All PROMs were recorded for each study independently by 2 reviewers and cross-referenced with the published orthopaedic literature as of 2017 to determine if the PROM had been validated for the study population. PROMs that had not been validated, had been shown to be invalid, or had conflicting validity studies for use in the population of interest were designated as incompletely validated or used without complete validation. The following covariates were recorded for each study: subspecialty, inclusion of a statistician coauthor, sample size, journal, and the journal impact factor. χ analysis was used to evaluate the association between categorical variables and the use of at least 1 incompletely validated PROM. RESULTS In total, 1000 articles were screened, yielding 653 studies that met our inclusion criteria. A total of 104/653 (16%) publications-reported PROMs. PROMs were used without complete validation 120/165 (73%) times, and 77/104 (74%) studies used at least 1 PROM without complete validation. The most frequent reasons for incomplete validation were (1) using PROMs that had been validated in adults, but not pediatrics (n=47; 28.5%), and (2) using PROMs that had been designated in the literature as invalid for pediatrics (n=27; 16.4%). The incomplete validation of at least 1 PROM was associated with smaller sample size (P=0.01) and subspecialty (P<0.01). Overall rates of PROM use and the proportion of PROMs used without complete validation were both found to be higher than those previously reported. CONCLUSION The majority of pediatric orthopaedic studies reporting PROMs used at least 1 PROM without complete validation for their study population. LEVEL OF EVIDENCE Level IV-systematic review of level I, II, III, and IV studies.
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14
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Plevinsky JM, Gutierrez-Colina AM, Carmody JK, Hommel KA, Crosby LE, McGrady ME, Pai ALH, Ramsey RR, Modi AC. Patient-Reported Outcomes for Pediatric Adherence and Self-Management: A Systematic Review. J Pediatr Psychol 2020; 45:340-357. [PMID: 31845997 DOI: 10.1093/jpepsy/jsz096] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/23/2019] [Accepted: 11/15/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Treatment adherence is approximately 50% across pediatric conditions. Patient-reported outcomes (PROs) are the most common method of measuring adherence and self-management across research and clinical contexts. The aim of this systematic review is to evaluate adherence and self-management PROs, including measures of adherence behaviors, adherence barriers, disease management skills, and treatment responsibility. METHODS Following PRISMA guidelines for systematic reviews, literature searches were performed. Measures meeting inclusion/exclusion criteria were evaluated using Hunsley and Mash's (2018) criteria for evidence-based assessment across several domains (e.g., internal consistency, interrater reliability, test-retest reliability, content validity, construct validity, validity generalization, treatment sensitivity, and clinical utility). Rating categories were adapted for the present study to include the original categories of adequate, good, and excellent, as well as an additional category of below adequate. RESULTS After screening 172 articles, 50 PROs across a variety of pediatric conditions were reviewed and evaluated. Most measures demonstrated at least adequate content validity (n = 44), internal consistency (n = 34), and validity generalization (n = 45). Findings were mixed regarding interrater reliability, test-retest reliability, and treatment sensitivity. Less than half of the measures (n = 22) exhibited adequate, good, or excellent construct validity. CONCLUSIONS Although use of adherence and self-management PROs is widespread across several pediatric conditions, few PROs achieved good or excellent ratings based on rigorous psychometric standards. Validation and replication studies with larger, more diverse samples are needed. Future research should consider the use of emerging technologies to enhance the feasibility of broad implementation.
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Affiliation(s)
- Jill M Plevinsky
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Ana M Gutierrez-Colina
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Julia K Carmody
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Kevin A Hommel
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
| | - Lori E Crosby
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
| | - Meghan E McGrady
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
| | - Ahna L H Pai
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
| | - Rachelle R Ramsey
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
| | - Avani C Modi
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
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15
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Anthony SJ, Stinson H, Lazor T, Young K, Hundert A, Santana MJ, Stinson J, West L. Patient-reported outcome measures within pediatric solid organ transplantation: A systematic review. Pediatr Transplant 2019; 23:e13518. [PMID: 31210404 DOI: 10.1111/petr.13518] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 04/09/2019] [Accepted: 04/26/2019] [Indexed: 02/06/2023]
Abstract
Subjective evaluation of medical care and disease outcomes from patients' perspectives has become increasingly important. Patient-reported outcome measures (PROMs) play a prominent role in engaging patients, capturing their experiences and improving patient care. This systematic review sought to identify PROMs that are used in the field of pediatric solid organ transplantation, with the aim to inform the implementation of PROMs into clinical practice for this population. A systematic review of English language, peer-reviewed articles was performed on key health science databases to identify publications using PROMs in pediatric solid organ transplantation. The search yielded 3670 articles, with a final data set of 62 articles that included 47 different PROMs. The three most frequently used PROMs included the following: (a) PedsQL™ Generic Core Scales (n = 25); (b) Children's Depression Inventory (n = 6); and (c) Child Health Questionnaire (n = 6). Of the 47 PROMs, 42 were generic and five were disease-specific; only six PROMS had a documented psychometric evaluation within a pediatric solid organ transplant population. This review outlines the attributes of the instruments (eg, domains captured), as well as the psychometric properties of those evaluated. PROMs are increasingly used in the field of pediatric transplantation; however, there are limited details in the current literature about their conceptual underpinnings and psychometric properties. This review highlights the need for additional psychometric evaluation of identified measures to establish the necessary foundation to inform the implementation of PROMs into clinical care for pediatric solid organ transplant patients.
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Affiliation(s)
- Samantha J Anthony
- Hospital for Sick Children, Toronto, Ontario, Canada.,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | | | - Tanya Lazor
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Amos Hundert
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maria J Santana
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer Stinson
- Hospital for Sick Children, Toronto, Ontario, Canada.,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Lori West
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada.,Cardiac Transplantation, Pediatrics, Surgery and Immunology, University of Alberta, Edmonton, Alberta, Canada
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16
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Grout RW, Cheng ER, Aalsma MC, Downs SM. Let Them Speak for Themselves: Improving Adolescent Self-Report Rate on Pre-Visit Screening. Acad Pediatr 2019; 19:581-588. [PMID: 31029741 DOI: 10.1016/j.acap.2019.04.010] [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: 12/19/2018] [Revised: 04/16/2019] [Accepted: 04/20/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Adolescent pre-visit screening on patient-generated health data is a common and efficient practice to guide clinical decision making. However, proxy informants (eg, parents or caregivers) often complete these forms, which may lead to incorrect information or lack of confidentiality. Our objective was to improve the adolescent self-report rate on pre-visit screening. METHODS We conducted an interventional study using an interrupted time series design to compare adolescent self-report rates (percent of adolescents ages 12-18 years completing their own pre-visit screening) over 16 months in general pediatric ambulatory clinics. We collected data using a computerized clinical decision support system with waiting room electronic tablet screening. Preintervention rates were low, and we created and implemented 2 electronic workflow alerts, one each to the patient/caregiver and clinical staff, reminding them that the adolescent should answer the questions independently. We included the first encounter from each adolescent and evaluated changes in adolescent self-reporting between pre- and postintervention periods using interrupted time series analysis. RESULTS Patients or caregivers completed 2670 qualifying pre-visit screenings across 19 preintervention, 7 intervention, and 44 postintervention weeks. Self-reporting by younger adolescents nearly doubled, with a significant increase of 19.3 percentage points (confidence interval [CI], 9.1-29.5) from the baseline 20.5%. Among older adolescents, the stable baseline rate of 53.6% increased by 9.2 absolute percentage points (CI, -7.0 to 25.3). There were no significant pre- or postintervention secular trends. CONCLUSIONS Two automated alerts directing clinic personnel and families to have adolescents self-report significantly and sustainably improved younger adolescent self-reporting on electronic patient-generated health data instruments.
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Affiliation(s)
- Randall W Grout
- Children's Health Services Research (RW Grout, ER Cheng, and SM Downs); Regenstrief Institute, Inc (RW Grout and SM Downs), Indianapolis.
| | - Erika R Cheng
- Children's Health Services Research (RW Grout, ER Cheng, and SM Downs)
| | - Matthew C Aalsma
- Adolescent Behavioral Health Research Program, Adolescent Medicine (MC Aalsma), Department of Pediatrics, School of Medicine, Indiana University
| | - Stephen M Downs
- Children's Health Services Research (RW Grout, ER Cheng, and SM Downs); Regenstrief Institute, Inc (RW Grout and SM Downs), Indianapolis
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17
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Gmuca S, Xiao R, Sherry DD. Patient-proxy agreement on health-related quality of life in juvenile fibromyalgia syndrome. Pediatr Rheumatol Online J 2019; 17:21. [PMID: 31072338 PMCID: PMC6507148 DOI: 10.1186/s12969-019-0320-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/11/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) measures serve as important indicators of pain-related physical and psychosocial function in youth with juvenile fibromyalgia syndrome (JFMS). While the administration of parent-proxy reported HRQoL measures in the assessment of JFMS is common, its added clinical value to patient self-reports is unclear. We aimed to determine the level of agreement on HRQoL among patients with JFMS as well as their parent-proxies and to determine factors associated with this agreement. METHODS We performed a retrospective, cross-sectional cohort study of children aged 8 to 17 years diagnosed with JFMS and presenting for initial evaluation to a pediatric rheumatology pain clinic between April 2017 and May 2018. All patients and proxies were administered the Pediatric Quality of Life Short Form 15 Generic Core Scales (PedsQL SF-15) as part of routine clinical care. We calculated absolute discrepancy scores (absolute value of parent-proxy score minus patient score) to describe the extent of difference in HRQoL scores between parent-proxies and patients. We examined agreement between parent-proxy report and patient self-report via intraclass correlation coefficients (ICCs), stratified by age and sex, as well as Bland-Altman plots. We also used multivariate regression models to determine factors associated with level of agreement. RESULTS A total of 65 patient-proxy pairs were included in this study. ICCs demonstrated good to excellent agreement between all parent-proxy and patient measures of HRQoL irrespective of the patient's age or sex. The level of agreement was not associated with pain duration or pain severity but less agreement on psychosocial HRQoL was associated with older patient age (β = 1.30; p < 0.05). CONCLUSIONS This study in youth with JFMS demonstrated good to excellent patient-proxy agreement across all domains of the PedsQL SF-15 irrespective of patient's age or sex. Our findings suggest that parent-proxy reports do not provide additional information beyond that obtained from the patient self-report of HRQoL according to the PedsQL SF-15. In order to facilitate children and adolescents with JFMS becoming partners in their own healthcare, and to decrease the burden of multiple questionnaires, we propose focusing on patients' own perceptions of HRQoL in the clinical setting.
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Affiliation(s)
- Sabrina Gmuca
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, 34th St and Civic Center Blvd, Philadelphia, PA, 19104, USA. .,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19146, USA. .,PolicyLab, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19146, USA. .,Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, 11214, Philadelphia, PA, 19146, USA.
| | - Rui Xiao
- 0000 0004 1936 8972grid.25879.31Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, USA
| | - David D. Sherry
- 0000 0001 0680 8770grid.239552.aDepartment of Pediatrics, Division of Rheumatology, Children’s Hospital of Philadelphia, 34th St and Civic Center Blvd, Philadelphia, PA 19104 USA
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18
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Bele S, Mohamed B, Chugh A, Haverman L, Santana MJ. Impact of using patient-reported outcome measures in routine clinical care of paediatric patients with chronic conditions: a systematic review protocol. BMJ Open 2019; 9:e027354. [PMID: 30928963 PMCID: PMC6475156 DOI: 10.1136/bmjopen-2018-027354] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/07/2019] [Accepted: 02/22/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Chronic diseases among children are associated with lower health-related quality of life (HRQOL) and higher utilisation of healthcare services. Integrating Patient-Reported Outcomes Measures (PROMs) in routine clinical care has been shown to reduce utilisation of healthcare services while improving patient outcomes. The objectives of our study are to: (1) identify previously implemented and evaluated PROMs for chronic conditions in paediatric settings; (2) consolidate the evidence to evaluate the impact of using PROMs on HRQOL, healthcare utilisation, patient outcomes (eg, symptoms control) and quality of care among paediatric patients with chronic conditions. The findings from this review will inform the future integration of PROMs in paediatric clinical practice. METHODS AND ANALYSIS We will systematically search the following electronic databases: MEDLINE, EMBASE, CINAHL, PsychINFO and Cochrane library. Reference lists of included studies will also be searched in Web of Science (Thomson Reuters) database to ensure more complete coverage. Two reviewers will independently screen the studies and abstract the data using standardised form. Extracted data will be analysed and synthesised. Finally, a narrative synthesis of summarised data will be presented. ETHICS AND DISSEMINATION Ethical approval is not required, as the proposed systematic review will use data from published research articles. The results of this study will be disseminated through publication in peer-reviewed journals, scientific conferences and meetings, and the lead author's doctoral dissertation. PROSPERO REGISTRATION NUMBER CRD42018109035.
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Affiliation(s)
- Sumedh Bele
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Bijan Mohamed
- Department of Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Ashton Chugh
- Department of Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Lotte Haverman
- Psychosocial Department, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Maria-Jose Santana
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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19
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Leahy AB, Feudtner C, Basch E. Symptom Monitoring in Pediatric Oncology Using Patient-Reported Outcomes: Why, How, and Where Next. THE PATIENT 2018; 11:147-153. [PMID: 29071524 PMCID: PMC5845473 DOI: 10.1007/s40271-017-0279-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Symptom monitoring using patient-reported outcomes (PROs) is not common in pediatric oncology, despite interest from stakeholders-including patients, families, clinicians, and regulatory organizations-and proven clinical benefit in adult oncology. This article examines the foundational data for patient-reported symptom reporting in this population and posits the next investigative steps toward the implementation of patient-reported symptom monitoring in the care and research of pediatric oncology patients. The reasoning behind, and feasibility of, monitoring symptoms in pediatric oncology patients using PRO measures are discussed, as well as specific tools that have been developed to track symptoms in this population, including innovative electronic self-reporting platforms built to engage children in the symptom reporting process. Aspects of engaging both patients and clinicians in the symptom self-report process are reviewed, as are the experiences of "early adopters" of this process in pediatric oncology and across pediatrics. It is clear that there are key issues that remain regarding the use of PROs for symptom monitoring, including selection of specific outcomes to monitor, how to resolve discrepant reports, and determination of benefit. The next steps for investigation of these issues are discussed. Unanswered questions notwithstanding, work should continue to make patient-reported symptom monitoring an established, evidence-based part of routine and research practice in pediatric oncology.
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Affiliation(s)
- Allison Barz Leahy
- Division of Oncology, Children's Hospital of Philadelphia, Colket Translational Research Building, 10th floor, 3501 Civic Center Blvd Philadelphia, Philadelphia, PA, 19104, USA.
- Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Chris Feudtner
- Pediatric Advanced Care Team, Department of Medical Ethics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Medical Ethics and Health Policy, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ethan Basch
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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20
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Jensen RE, Snyder CF, Basch E, Frank L, Wu AW. All together now: findings from a PCORI workshop to align patient-reported outcomes in the electronic health record. J Comp Eff Res 2016; 5:561-567. [PMID: 27586855 PMCID: PMC5549656 DOI: 10.2217/cer-2016-0026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 07/29/2016] [Indexed: 01/14/2023] Open
Abstract
In recent years, patient-reported outcomes have become increasingly collected and integrated into electronic health records. However, there are few cross-cutting recommendations and limited guidance available in this rapidly developing research area. Our goal is to report key findings from a 2013 Patient-Centered Outcomes Research Institute workshop on this topic and a summary of actions that followed from the workshop, and present resulting recommendations that address patient, clinical and research/quality improvement barriers to regular use. These findings provide actionable guidance across research and practice settings to promote and sustain widespread adoption of patient-reported outcomes across patient populations, healthcare settings and electronic health record systems.
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Affiliation(s)
- Roxanne E Jensen
- Department of Oncology, Georgetown University, Washington DC, USA
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Claire F Snyder
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Ethan Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Patient-Centered Outcomes Research Institute, Washington, DC, USA
| | - Lori Frank
- Patient-Centered Outcomes Research Institute, Washington, DC, USA
| | - Albert W Wu
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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21
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Lindly OJ, Zuckerman KE, Mistry KB. Clarifying the Predictive Value of Family-Centered Care and Shared Decision Making for Pediatric Healthcare Outcomes Using the Medical Expenditure Panel Survey. Health Serv Res 2016; 52:313-345. [PMID: 27072197 DOI: 10.1111/1475-6773.12488] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To estimate (1) family-centered care (FCC) and shared decision-making (SDM) prevalence, and (2) associations of FCC and SDM (FCC/SDM) with health care outcomes among U.S. children. DATA SOURCE The Medical Expenditure Panel Survey Household Component (MEPS-HC), a nationally representative survey of the noninstitutionalized, civilian population. STUDY DESIGN Secondary analyses of prospectively collected data on 15,764 U.S. children were conducted to examine FCC/SDM prevalence in year 1 and associations of FCC/SDM in year 1 with health services utilization, medical expenditures, and unmet health care needs in year 2. DATA COLLECTION/EXTRACTION METHODS We combined four MEPS-HC longitudinal files from 2007 to 2011. PRINCIPAL FINDINGS FCC/SDM prevalence in year 1 varied from 38.6 to 93.7 percent, and it was lower for composites with more stringent scoring approaches. FCC/SDM composites with stringent scoring approaches in year 1 were associated with reduced unmet needs in year 2. FCC/SDM, across all year 1 composites, was not associated with health services utilization or medical expenditures in year 2. FCC/SDM year 1 subcomponents describing consensus building and mutual agreement were consistently associated with unmet health care needs in year 2. CONCLUSIONS FCC/SDM composites with stringent scoring approaches measuring consensus building and mutual agreement may have the greatest utility for pediatric health care quality improvement efforts.
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Affiliation(s)
- Olivia J Lindly
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR.,Division of General Pediatrics, Oregon Health & Science University, Portland, OR
| | | | - Kamila B Mistry
- Agency for Healthcare Research and Quality, Office of Extramural Research, Education, and Priority Populations, Rockville, MD
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22
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Contreras GA, Bell CS, Del Bianco G, Pérez N, Benjamins L, Kleinosky MT, Rodriguez G, Murphy JR, Heresi GP. Incidence and predictors of antiretroviral resistance in perinatally HIV-1 infected children and adolescents. J Infect 2015; 72:353-61. [PMID: 26711193 DOI: 10.1016/j.jinf.2015.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 12/09/2015] [Accepted: 12/11/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Individuals with perinatally acquired HIV infection have benefited from antiretroviral therapy. However, they often have complex patterns of major resistance mutations that limit the effectiveness of available antiretroviral medications. Knowledge of incidence rates of major antiretroviral resistance mutations should provide a benchmark enabling comparisons of different HIV care delivery modalities. METHODS We test the hypothesis that incidence rate of major antiretroviral resistance mutations will decline with improvement in HIV care between 1998 and 2009 to NRTI, NNRTI, PI and triple class resistance in perinatally HIV infected individuals. Logistic regression is used to evaluate predictors of single and triple class resistance. RESULTS Sixty-six individuals are included from a total population of 97 perinatally HIV infected individuals. The incidence rate of NRTI, NNRTI, PI and triple class resistance decreases with decreasing age in parallel with the introduction of new HIV treatment regimens. The youngest children (born 2000-2007) are free of triple class resistance. Mono-therapy associates with major resistance mutations to NRTI (OR 8.7, CI 1.5-50.9, P 0.02); NNRTI exposure associates with major resistance mutations to NNRTI (OR 24.4, CI 5.7-104.5, P 0.01) and triple class resistance (OR 10.7, CI 1.8-67.1, P 0.01). Cumulative viral load is an important predictor of PI resistance (OR 4.0, CI 1.3-12.3, P 0.02). CONCLUSIONS There is a progressive decrease in the incidence rate of major resistance mutations to antiretroviral drugs and triple class resistance from the oldest to the youngest birth cohort; where adolescents have the highest risk of harboring resistant viruses. The incidence rate of major antiretroviral resistance mutations provides a benchmark for the comparative measurement of effectiveness of different HIV care delivery modalities.
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Affiliation(s)
- German A Contreras
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Texas UTHealth, 6431 Fannin Street, MSB 3.002 Houston, TX 77030, USA; Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogotá, Colombia Av. Cra 9 No. 131 A - 02.
| | - Cynthia S Bell
- Division of Pediatric Nephrology, Department of Pediatrics, University of Texas UTHealth, 6431 Fannin, MSB 3.121 Houston, TX 77030, USA
| | - Gabriela Del Bianco
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Texas UTHealth, 6431 Fannin Street, MSB 3.002 Houston, TX 77030, USA
| | - Norma Pérez
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Texas UTHealth, 6431 Fannin Street, MSB 3.002 Houston, TX 77030, USA
| | - Laura Benjamins
- Adolescent Division, Department of Pediatrics, University of Texas UTHealth, 6431 Fannin Street, MSB 3.002 Houston, TX 77030, USA
| | - Matthew T Kleinosky
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Texas UTHealth, 6431 Fannin Street, MSB 3.002 Houston, TX 77030, USA
| | - Gilhen Rodriguez
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Texas UTHealth, 6431 Fannin Street, MSB 3.002 Houston, TX 77030, USA
| | - James R Murphy
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Texas UTHealth, 6431 Fannin Street, MSB 3.002 Houston, TX 77030, USA
| | - Gloria P Heresi
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Texas UTHealth, 6431 Fannin Street, MSB 3.002 Houston, TX 77030, USA
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23
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Kuhlthau KA, Mistry KB, Forrest CB, Dougherty D. Advancing the science of measurement in pediatric quality of care. Acad Pediatr 2014; 14:S1-3. [PMID: 25169448 DOI: 10.1016/j.acap.2014.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 06/24/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Karen A Kuhlthau
- From the Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, Mass.
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