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Pérez-Ardanaz B, Gutiérrez-Rodríguez L, Pelaez-Cantero MJ, Morales-Asencio JM, Gómez-González A, García-Piñero JM, Lupiañez-Perez I. Healthcare service use for children with chronic complex diseases: A longitudinal six-year follow-up study. J Pediatr Nurs 2024; 77:e132-e138. [PMID: 38594165 DOI: 10.1016/j.pedn.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE The objective was analysed the patterns use of healthcare services of this population and the influence of their clinical and sociodemographic characteristics. DESIGN AND METHODS A six-year longitudinal follow-up study was performed to evaluate the annual healthcare resources use and clinical data among children with complex chronic diseases in Spain between 2015 and 2021. The sample trends in healthcare usage and the associated factors were analysed using ANCOVA and multivariable linear regression models. RESULTS Patients had high attendance during the follow-up period, with >15 episodes year. This trend decreased over time, especially in children with oncological diseases compared with other diseases (F (16.75; 825.4) = 32.457; p < 0.001). A multivariable model showed that children with a greater number of comorbidities (β = 0.17), shorter survival time (β = -0.23), who had contact with the palliative care unit (β = 0.16), and whose mothers had a higher professional occupation (β = 0.14), had a greater use of the healthcare system. CONCLUSIONS Children with a higher number of comorbidities and the use of medical devices made a greater frequentation of health services, showing a trend of decreasing use over time. Socioeconomic factors such as mothers' occupational status determine healthcare frequentation. These results suggest the existence of persistent gaps in care coordination sustained over time. PRACTICAL IMPLICATIONS Systematized and coordinated models of care for this population should consider the presence of inequalities in health care use.
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Affiliation(s)
- Bibiana Pérez-Ardanaz
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Instituto de Investigación Biomédica de Málaga-Bionand (IBIMA), Spain.
| | - Laura Gutiérrez-Rodríguez
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Instituto de Investigación Biomédica de Málaga-Bionand (IBIMA), Spain.
| | | | - José Miguel Morales-Asencio
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Instituto de Investigación Biomédica de Málaga-Bionand (IBIMA), Spain.
| | - Alberto Gómez-González
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Instituto de Investigación Biomédica de Málaga-Bionand (IBIMA), Spain.
| | - José Miguel García-Piñero
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Pediatric Intensive Care Unit, Hospital Materno-Infantil, Málaga, Spain
| | - Inmaculada Lupiañez-Perez
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Instituto de Investigación Biomédica de Málaga-Bionand (IBIMA), Spain.
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Oliveira PV, Enes CC, Nucci LB. How are children with medical complexity being identified in epidemiological studies? A systematic review. World J Pediatr 2023; 19:928-938. [PMID: 36574212 DOI: 10.1007/s12519-022-00672-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 12/05/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND There are different definitions to identify/classify children with medical complexity (CMC). We aimed to investigate and describe the definitions used to classify CMC in epidemiological studies. METHODS PubMed, SciELO, LILACS, and EMBASE were searched from 2015 to 2020 (last updated September 15th, 2020) for original studies that presented the definition used to classify/identify CMC in the scientific research method. We applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. From the included studies, the following were identified: first author, year of publication, design, population, study period, the definition of CMC used, limitations, and strengths. RESULTS Nine hundred and sixty-seven records were identified in the searched databases, and 42 met the inclusion criteria. Of the 42 studies included, the four most frequent definitions used in the articles included in this review were classification of CMC into nine diagnostic categories based on the International Classification of Diseases, Ninth Revision (ICD-9) (35.7%, 15 articles); update of the previous classification for ICD-10 codes with the inclusion of other conditions in the definition (21.4%, nine articles); definition based on a medical complexity algorithm for classification (16.7%, seven articles); and a risk rating system (7.1%, three articles). CONCLUSIONS CMC definitions using diagnostic codes were more frequent. However, several limitations were found in its uses. Our research highlighted the need to improve health information systems to accurately characterize the CMC population and promote the provision of comprehensive care.
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Affiliation(s)
- Patrícia Vicente Oliveira
- Postgraduate Program in Health Sciences, Center for Life Sciences, Pontifical Catholic University of Campinas, Av. John Boyd Dunlop s/n, Campinas, CEP 13060-904, Brazil.
| | - Carla C Enes
- Postgraduate Program in Health Sciences, School of Nutrition, Pontifical Catholic University of Campinas, São Paulo, Brazil
| | - Luciana B Nucci
- Postgraduate Program in Health Sciences, School of Medicine, Pontifical Catholic University of Campinas, São Paulo, Brazil
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3
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Sokol RL, Victor BG, Yoon M, Ryan JP, Perron BE. Complex, Co-occurring Needs Patterns and Evidence-Based Service Planning for Families Involved in Foster Care: A Map for Research and Practice. CHILD MALTREATMENT 2023; 28:359-371. [PMID: 35624538 DOI: 10.1177/10775595221105889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This study described the complexity of service need co-occurrence among foster care-involved families and identified prevalent patterns of needs to inform future evidence-based service planning research. We utilized state administrative child maltreatment records, and restricted data to cases where the child entered foster care in 2019 and the caseworker indicated the presence of at least one need from the Family Assessment of Needs and Strengths (FANS; n = 1631). We extracted all unique combinations of needs (i.e., needs profiles), and we used association rule mining to identify patterns within these profiles. A total of 780 unique needs profiles emerged among the 1631 cases, which we condensed into 78 patterns. Although the variability and complexity of needs profiles makes evidence-based service planning difficult, the present analysis mapped prevalent needs patterns to guide future research intended to assist caseworkers in this task. Identification of maltreatment determinants among families involved in foster care, and future research into the needs within different needs patterns that might undermine treatment effectiveness, may result in a better balance between parsimonious service plans and a full consideration of co-occurring service needs.
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Affiliation(s)
- Rebeccah L Sokol
- School of Social Work, 1259University of Michigan, Ann Arbor, MI, USA
| | - Bryan G Victor
- School of Social Work, 2954Wayne State University, Detroit, MI, USA
| | - Miyoung Yoon
- Department of Social Welfare, Pusan National University, Busan, South Korea
| | - Joseph P Ryan
- School of Social Work, 1259University of Michigan, Ann Arbor, MI, USA
| | - Brian E Perron
- School of Social Work, 1259University of Michigan, Ann Arbor, MI, USA
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Álvarez-Gálvez J, Ortega-Martín E, Carretero-Bravo J, Pérez-Muñoz C, Suárez-Lledó V, Ramos-Fiol B. Social determinants of multimorbidity patterns: A systematic review. Front Public Health 2023; 11:1081518. [PMID: 37050950 PMCID: PMC10084932 DOI: 10.3389/fpubh.2023.1081518] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/02/2023] [Indexed: 03/28/2023] Open
Abstract
Social determinants of multimorbidity are poorly understood in clinical practice. This review aims to characterize the different multimorbidity patterns described in the literature while identifying the social and behavioral determinants that may affect their emergence and subsequent evolution. We searched PubMed, Embase, Scopus, Web of Science, Ovid MEDLINE, CINAHL Complete, PsycINFO and Google Scholar. In total, 97 studies were chosen from the 48,044 identified. Cardiometabolic, musculoskeletal, mental, and respiratory patterns were the most prevalent. Cardiometabolic multimorbidity profiles were common among men with low socioeconomic status, while musculoskeletal, mental and complex patterns were found to be more prevalent among women. Alcohol consumption and smoking increased the risk of multimorbidity, especially in men. While the association of multimorbidity with lower socioeconomic status is evident, patterns of mild multimorbidity, mental and respiratory related to middle and high socioeconomic status are also observed. The findings of the present review point to the need for further studies addressing the impact of multimorbidity and its social determinants in population groups where this problem remains invisible (e.g., women, children, adolescents and young adults, ethnic groups, disabled population, older people living alone and/or with few social relations), as well as further work with more heterogeneous samples (i.e., not only focusing on older people) and using more robust methodologies for better classification and subsequent understanding of multimorbidity patterns. Besides, more studies focusing on the social determinants of multimorbidity and its inequalities are urgently needed in low- and middle-income countries, where this problem is currently understudied.
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Affiliation(s)
- Javier Álvarez-Gálvez
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cádiz, Spain
- The University Research Institute for Sustainable Social Development (Instituto Universitario de Investigación para el Desarrollo Social Sostenible), University of Cadiz, Jerez de la Frontera, Spain
| | - Esther Ortega-Martín
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cádiz, Spain
- *Correspondence: Esther Ortega-Martín
| | - Jesús Carretero-Bravo
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cádiz, Spain
| | - Celia Pérez-Muñoz
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain
| | - Víctor Suárez-Lledó
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cádiz, Spain
| | - Begoña Ramos-Fiol
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cádiz, Spain
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Fornehed MLC, Svynarenko R, Keim-Malpass J, Cozad MJ, Qualls KA, Stone WL, Lindley LC. Comparison between Rural and Urban Appalachian Children in Hospice Care. South Med J 2022; 115:192-197. [PMID: 35237837 PMCID: PMC8908896 DOI: 10.14423/smj.0000000000001365] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The goal of this study was to compare rural and urban pediatric hospice patients in Appalachia. METHODS Using a retrospective, nonexperimental design, we sought to compare characteristics of Appalachian rural and urban children younger than 21 years enrolled in the Medicaid hospice benefit. Descriptive statistics were calculated on the demographic, hospice, and clinical characteristics of children from Appalachia. Comparisons were calculated using Pearson χ2 for proportions and the Student t test for means. RESULTS Less than half of the 1788 Appalachian children admitted to hospice care resided in rural areas (40%). Compared with children in urban areas of Appalachia, rural children were significantly younger (8 years vs 9.5 years) and more often had a complex chronic condition (56.0% vs 35.1%) and comorbidities (38.5% vs 17.0%) with technology dependence (32.6% vs 17.0%). Children in rural Appalachian were commonly from communities in the southern region of Appalachia (27.9% vs <10.0%), with median household incomes <$50,000/year (96.7% vs 22.4%). Significant differences were present in clinical care between rural and urban Appalachian children. Rural children had longer lengths of stay in hospice care (38 days vs 11 days) and were less likely to use the emergency department during hospice admission (19.0% vs 43.0%). These children more often visited their primary care provider (49.9% vs 31.3%) and sought care for symptoms from nonhospice providers (18.1% vs 10.0%) while admitted to hospice. CONCLUSIONS Our results suggest that children admitted to hospice care in rural versus urban Appalachia have distinct characteristics. Rural children are admitted to hospice care with significant medical complexities and reside in areas of poverty. Hospice care for rural children suggests a continuity of care with longer hospice stays and fewer transitions to the emergency department; however, the potential for care fragmentation is present, with frequent visits to primary care and nonhospice providers for symptom management. Understanding the unique characteristics of children in Appalachia may be essential for advancing knowledge and care for these children at the end of life. Future research examining geographic variation in hospice care in Appalachia is warranted.
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Affiliation(s)
- Mary Lou Clark Fornehed
- From the Whitson-Hester School of Nursing, Tennessee Technological University, Cookeville, the College of Nursing, University of Tennessee, Knoxville, the School of Nursing, University of Virginia, Charlottesville, and the Department of Health Services Policy and Management, Center for Effectiveness Research in Orthopedics, University of South Carolina, Columbia
| | - Radion Svynarenko
- From the Whitson-Hester School of Nursing, Tennessee Technological University, Cookeville, the College of Nursing, University of Tennessee, Knoxville, the School of Nursing, University of Virginia, Charlottesville, and the Department of Health Services Policy and Management, Center for Effectiveness Research in Orthopedics, University of South Carolina, Columbia
| | - Jessica Keim-Malpass
- From the Whitson-Hester School of Nursing, Tennessee Technological University, Cookeville, the College of Nursing, University of Tennessee, Knoxville, the School of Nursing, University of Virginia, Charlottesville, and the Department of Health Services Policy and Management, Center for Effectiveness Research in Orthopedics, University of South Carolina, Columbia
| | - Melanie J Cozad
- From the Whitson-Hester School of Nursing, Tennessee Technological University, Cookeville, the College of Nursing, University of Tennessee, Knoxville, the School of Nursing, University of Virginia, Charlottesville, and the Department of Health Services Policy and Management, Center for Effectiveness Research in Orthopedics, University of South Carolina, Columbia
| | - Kerri A Qualls
- From the Whitson-Hester School of Nursing, Tennessee Technological University, Cookeville, the College of Nursing, University of Tennessee, Knoxville, the School of Nursing, University of Virginia, Charlottesville, and the Department of Health Services Policy and Management, Center for Effectiveness Research in Orthopedics, University of South Carolina, Columbia
| | - Whitney L Stone
- From the Whitson-Hester School of Nursing, Tennessee Technological University, Cookeville, the College of Nursing, University of Tennessee, Knoxville, the School of Nursing, University of Virginia, Charlottesville, and the Department of Health Services Policy and Management, Center for Effectiveness Research in Orthopedics, University of South Carolina, Columbia
| | - Lisa C Lindley
- From the Whitson-Hester School of Nursing, Tennessee Technological University, Cookeville, the College of Nursing, University of Tennessee, Knoxville, the School of Nursing, University of Virginia, Charlottesville, and the Department of Health Services Policy and Management, Center for Effectiveness Research in Orthopedics, University of South Carolina, Columbia
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Mooney-Doyle K, Keim-Malpass J, Svynarenko R, Lindley LC. A Comparison of Young Adults With and Without Cancer in Concurrent Hospice Care: Implications for Transitioning to Adult Health Care. J Adolesc Young Adult Oncol 2022; 11:35-40. [PMID: 33877907 PMCID: PMC8864426 DOI: 10.1089/jayao.2021.0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Purpose: Concurrent hospice care provides important end-of-life care for youth under 21 years. Those nearing 21 years must decide whether to shift to adult hospice or leave hospice for life-prolonging care. This decision may be challenging for young adults with cancer, given the intensity of oncology care. Yet, little is known about their needs. We compared young adults with and without cancer in concurrent hospice care. Methods: Retrospective comparative design used data from 2011 to 2013 U.S. Medicaid data files. Decedents were included if they were 20 years of age, enrolled in Medicaid hospice care, and used nonhospice medical services on the same day as hospice care based on their Medicaid claims activity dates. Results: Among 226 decedents, 21% had cancer; more than half were female (60.6%), Caucasian (53.5%), non-Hispanic (77.4%), urban dwelling (58%), and had mental/behavioral disorder (53%). Young adults with cancer were more often non-Caucasian (68.7% vs. 40.4%), technology dependent (47.9% vs. 24.2%), had comorbidities (83.3% vs. 30.3%), and lived in rural (58.3% vs. 37.6%), southern (41.7% vs. 20.8%) areas versus peers without cancer. Those with cancer had significantly fewer live discharges from hospice (5.7 vs. 17.3) and sought treatment for symptoms more often from nonhospice providers (35.4% vs. 14.0%). Conclusions: Young adults in concurrent hospice experience medical complexity, even at end-of-life. Understanding care accessed at 20 years helps providers guide young adults and families considering options in adult-focused care. Clinical and demographic differences among those with and without cancer in concurrent care highlight needs for research exploring racial and geographic equity.
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Affiliation(s)
- Kim Mooney-Doyle
- School of Nursing, University of Maryland, Baltimore, Maryland, USA.,Address correspondence to: Kim Mooney-Doyle, PhD, RN, CPNP-AC, School of Nursing, University of Maryland, 655 West Lombard Street, Baltimore, MD 21201, USA
| | | | - Radion Svynarenko
- College of Nursing, University of Tennessee, Knoxville, Knoxville, Tennessee, USA
| | - Lisa C. Lindley
- College of Nursing, University of Tennessee, Knoxville, Knoxville, Tennessee, USA
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Lindley LC, Cozad MJ, Mack JW, Keim-Malpass J, Svynarenko R, Hinds PS. Effectiveness of Pediatric Concurrent Hospice Care to Improve Continuity of Care. Am J Hosp Palliat Care 2021; 39:1129-1136. [PMID: 34866426 DOI: 10.1177/10499091211056039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The 2010 Patient Protection and Affordable Care Act (ACA) mandated landmark hospice care legislation for children at end of life. Little is known about the impact of pediatric concurrent hospice care. OBJECTIVE The purpose of this study was to examine the effect of pediatric concurrent vs standard hospice care on end-of-life care continuity among Medicaid beneficiaries. METHODS Using national Medicaid data, we conducted a quasi-experimental designed study to estimate the effect of concurrent vs standard hospice care to improve end-of-life care continuity for children. Care continuity (i.e., hospice length of stay, hospice disenrollment, emergency room transition, and inpatient transition) was measured via claims data. Exposures were concurrent hospice vs standard hospice care. Using instrumental variable analysis, the effectiveness of exposures on care continuity was compared. RESULTS Concurrent hospice care affected care continuity. It resulted in longer lengths of stays in hospice (β = 2.76, P < .001) and reduced hospice live discharges (β = -2.80, P < .05), compared to standard hospice care. Concurrent care was not effective at reducing emergency room (β = 2.09, P < .001) or inpatient care (β = .007, P < .05) transitions during hospice enrollment. CONCLUSION Our study provides critical insight into the quality of care delivered for children at end of life. These findings have policy implications.
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Affiliation(s)
- Lisa C Lindley
- College of Nursing, University of Tennessee, Knoxville, TN, USA
| | - Melanie J Cozad
- Department of Health Services Policy and Management, 2629University of South Carolina, Columbia, SC, USA
| | - Jennifer W Mack
- Department of Pediatric Oncology and Division of Population Sciences, 1862Dana-Farber Cancer Institute, Boston Children's Hospital, Boston, MA, USA
| | | | | | - Pamela S Hinds
- Department of Nursing Science, 8404Children's National Hospital, Washington, DC, USA.,Department of Pediatrics, 8367The George Washington University, Washington, DC, USA
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Lindley LC, Svynarenko R, Mooney-Doyle K, Mendola A, Naumann WC, Fortney CA. End-of-Life Healthcare Service Needs Among Children With Neurological Conditions: A Latent Class Analysis. J Neurosci Nurs 2021; 53:238-243. [PMID: 34593722 PMCID: PMC8578283 DOI: 10.1097/jnn.0000000000000615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT BACKGROUND: At the end of life, children with neurological conditions have complex healthcare needs that can be met by providing care of their life-limiting conditions concurrently with hospice care (ie, concurrent care). Given the limited literature on concurrent care for children with neurologic conditions, this investigation aimed to identify patterns of nonhospice, healthcare service needs and to assess characteristics of children within each group. METHODS: A nationally representative sample children with neurological conditions enrolled in concurrent hospice care was used. Latent class analysis and descriptive statistics were calculated to identify patterns of healthcare needs and characteristics of children within the groups. A subgroup analysis of infants was conducted. RESULTS: Among the 1601 children, the most common types of services were inpatient hospitals, durable medical equipment, and home health. Two classes of service needs were identified: moderate intensity (58%) and high intensity (42%). Children in the moderate-intensity group were predominantly between 1 and 5 years old, male, White, and non-Hispanic. The most common neurological condition was central nervous system degeneration. They also had significant comorbidities, mental/behavioral health conditions, and technology dependence. They commonly resided in urban areas in the South. Children in the high-intensity group had a wide range of neurological conditions and high acuity. The subgroup analysis of infants indicated a different neurological profile. CONCLUSIONS: Two distinct classes of nonhospice, healthcare service needs emerged among children with neurological conditions at the end of life. The groups had unique demographic profiles.
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Svynarenko R, Beebe LH, Lindley LC. Identifying Patterns of Pediatric Mental and Behavioral Health at End of Life: A National Study. J Hosp Palliat Nurs 2021; 23:571-578. [PMID: 34483331 PMCID: PMC8556350 DOI: 10.1097/njh.0000000000000800] [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] [Indexed: 11/25/2022]
Abstract
Children, who enroll in hospice, have complex mental and behavioral health (MHBH) problems. There is limited literature on patterns of these problems among children at their end of life. Using the national database of 6195 children enrolled in hospice between January 1, 2011, and December 31, 2013, and latent class analysis, this study identified 4 distinctive classes of children. Neurodevelopment and anxiety class (26.5% of the sample) had 41.3% of children of 15 years or older, who had an average of 1.4 MHBH comorbidities and took 17 medications; 29.1% had physical health comorbidities, and 23% were dependent on technology. In the Behavior and Neurodevelopment class (20%), 53.1% of the children were between ages 6 and 14 years, who had an average of 2 MHBH comorbidities and took 17 medications. In the Physiology class (43.4%), 65.5% of children were younger than 5 years, had 1 MHBH comorbidity, and took 19 medications. In the Mood, Behaviors, and Anxiety class (10.2%), more than 90% of children were older than 6 years, had 4 MHBH comorbidities, and took 30 medications. In the latter 3 classes, approximately half of the children either had physical health comorbidities or were technology dependent. These findings highlight the importance of end-of-life care that accounts for the likely presence of complicated patterns of MHBH conditions.
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Lindley LC, Svynarenko R, Mooney-Doyle K, Mendola A, Naumann WC, Keim-Malpass J. Patterns of Health Care Services During Pediatric Concurrent Hospice Care: A National Study. Am J Hosp Palliat Care 2021; 39:282-288. [PMID: 34032124 DOI: 10.1177/10499091211018661] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Children at end of life have unique and complex care needs. Although there is increasing evidence about pediatric concurrent hospice care, the health care services received while in hospice have not received sufficient attention. OBJECTIVES To examine the health care services, unique clusters of health care services, and characteristics of the children in the clusters. METHODS Multiple data sources were used including national Medicaid claims data. Children under 21years in pediatric concurrent hospice care were included. Using Medicaid categories assigned to claims, health care services were distributed across 20 categories. Latent class analysis was used to identify clusters of health care services. Demographic profiles of the clusters were created. RESULTS The 6,243 children in the study generated approximately 500,0000 non-hospice, health care service claims while enrolled in hospice care. We identified 3 unique classes of health care services use: low (61.1%), moderate (18.1%), and high (20.8%) intensity. The children in the 3 classes exhibited unique demographic profiles. CONCLUSIONS Health care services cluster together in unique fashion with distinct patterns among children in concurrent hospice care. The findings suggest that concurrent hospice care is not a 1-size-fit all solution for children. Concurrent hospice care may be customized and require attention to care coordination to ensure high-quality care.
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Affiliation(s)
- Lisa C Lindley
- College of Nursing, University of Tennessee, Knoxville, TN, USA
| | | | | | - Annette Mendola
- Department of Medicine, University of Tennessee Medical Center, Knoxville, TN, USA
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Chen X, Hu Y, Jiang T, Xia C, Wang Y, Gao Y. Triiodothyronine Potentiates BMP9-Induced Osteogenesis in Mesenchymal Stem Cells Through the Activation of AMPK/p38 Signaling. Front Cell Dev Biol 2020; 8:725. [PMID: 32850840 PMCID: PMC7413205 DOI: 10.3389/fcell.2020.00725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/14/2020] [Indexed: 12/30/2022] Open
Abstract
Thyroid hormone (TH), triiodothyronine (T3), and thyroxine (T4), which are released from the thyroid, control many cellular processes in various cell types. It is worth noting that TH plays a complex role in skeletal metabolic balance, and few studies have investigated whether TH exerts any effects on osteogenesis in bone mesenchymal stem cells (MSCs). We explored the effects of T3 on bone morphogenetic protein 9 (BMP9)-induced osteogenesis, which process is considered the most important in the osteogenic differentiation of C3H10T1/2 cells. In vitro osteogenesis was analyzed by alkaline phosphatase (ALP) activity and staining, bone mineralisation, and osteocalcin and osteopontin expression. Fetal limb explant cultures and ectopic MSC implantation further confirmed the role of T3. Finally, we examined the effect of AMPK/p38 signaling on the osteoblastic differentiation. T3 synergizes with BMP9 to enhance osteogenic marker expression induced by BMP9. Furthermore, T3 promotes BMP9-induced bone formation by fetal limb explant cultures and ectopic MSC implantation. Co-treatment with BMP9 and T3 can promote AMPK and p38 phosphorylation, and pretreatment with the AMPK inhibitor compound C and siRNA can abolish phosphorylation of p38 and BMP9+T3-induced ALP activity. Our results suggest that BMP9 and T3 promote osteogenic differentiation at least partially via the activation of the AMPK/p38 signaling pathway.
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Affiliation(s)
- Xiaoting Chen
- Department of Geriatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Hu
- Department of Geriatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianyuan Jiang
- Department of Geriatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Xia
- Department of Geriatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Wang
- Department of Geriatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanhong Gao
- Department of Geriatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Lindley LC, Keim-Malpass J, Svynarenko R, Cozad MJ, Mack JW, Hinds PS. Pediatric Concurrent Hospice Care: A Scoping Review and Directions for Future Nursing Research. J Hosp Palliat Nurs 2020; 22:238-245. [PMID: 32282559 PMCID: PMC7716801 DOI: 10.1097/njh.0000000000000648] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In 2010, forgoing curative therapies were removed as a hospice eligibility criterion for children through section 2302 of the Patient Protection and Affordable Care Act called Concurrent Care for Children. Given that concurrent care is a federally mandated option for children and their families, no review of the science has been conducted. The purpose of this study was to systematically collect the evidence on concurrent hospice care, critically appraise the evidence, and identify areas for future nursing research. Of the 186 articles identified for review, 14 met the inclusion and exclusion criteria. Studies in this review described concurrent hospice care from a variety of perspectives: policy, legal, and ethics. However, only 1 article evaluated the impact of concurrent hospice care on outcomes, whereas several studies explained clinical and state-level implementation. There is a need for further studies that move beyond conceptualization and generate baseline and outcomes data. Understanding the effectiveness of concurrent hospice care might provide important information for future nursing research. The approaches used to disseminate and implement concurrent hospice care at state, provider, and family levels should be explored.
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Profiling Modifiable Psychosocial Factors Among Children With Chronic Pain: A Person-Centered Methodology. THE JOURNAL OF PAIN 2020; 21:467-476. [DOI: 10.1016/j.jpain.2019.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 08/21/2019] [Accepted: 08/25/2019] [Indexed: 12/15/2022]
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Bjur KA, Wi CI, Ryu E, Crow SS, King KS, Juhn YJ. Epidemiology of Children With Multiple Complex Chronic Conditions in a Mixed Urban-Rural US Community. Hosp Pediatr 2019; 9:281-290. [PMID: 30923070 PMCID: PMC6434974 DOI: 10.1542/hpeds.2018-0091] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Children with multiple complex chronic conditions (MCCs) represent a small fraction of our communities but a disproportionate amount of health care cost and mortality. Because the temporal trends of children with MCCs within a geographically well-defined US pediatric population has not been previously assessed, health care planning and policy for this vulnerable population is limited. METHODS In this population-based, repeated cross-sectional study, we identified and enrolled all eligible children residing in Olmsted County, Minnesota, through the Rochester Epidemiology Project, a medical record linkage system of Olmsted County residents. The pediatric complex chronic conditions classification system version 2 was used to identify children with MCCs. Five-year period prevalence and incidence rates were calculated during the study period (1999-2014) and characterized by age, sex, ethnicity, and socioeconomic status (SES) by using the housing-based index of socioeconomic status, a validated individual housing-based SES index. Age-, sex-, and ethnicity-adjusted prevalence and incidence rates were calculated, adjusting to the 2010 US total pediatric population. RESULTS Five-year prevalence and incidence rates of children with MCCs in Olmsted County increased from 1200 to 1938 per 100 000 persons and from 256 to 335 per 100 000 person-years, respectively, during the study period. MCCs tend to be slightly more prevalent among children with a lower SES and with a racial minority background. CONCLUSIONS Both 5-year prevalence and incidence rates of children with MCCs have significantly increased over time, and health disparities are present among these children. The clinical and financial outcomes of children with MCCs need to be assessed for formulating suitable health care planning given limited resources.
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Lindley LC, Cohrs AC, Keim-Malpass J, Leslie DL. Children Enrolled in Hospice Care Under Commercial Insurance: A Comparison of Different Age Groups. Am J Hosp Palliat Care 2018; 36:123-129. [DOI: 10.1177/1049909118789868] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Although most children at end of life have commercial insurance, little is known about their demographic and clinical characteristics, what care they are receiving, and how much it costs. Objectives: To describe commercially insured children who enrolled in hospice care during their last year of life and to examine differences across age-groups. Methods: A retrospective cohort study was conducted using 2005 to 2014 data from the MarketScan Commercial Claims and Encounters database from Truven Health Analytics. Variables were created for demographics, health, utilization, and spending. Analyses included χ2 and analysis of variance tests of differences. Results: Among the 17 062 children who utilized hospice, 49% had a preferred provider organization (PPO). Hospice length of stay averaged less than 5 days. Over 80% of children visited their primary care physician. Eight percent had hospital readmissions, and 38% had emergency department (ED) visits. Average expenditures were US$3686 per month or US$44 232 annually. The most common condition for children less than 1 year was cardiovascular (21.96%). Neuromuscular conditions were the most frequent (7.89%) in children aged 1 to 5 years, while malignancies (10.53% and 11.32%, respectively) were prevalent in ages 6 to 14 and 15 to 17. Children less than 1 year had the highest frequency of hospital readmissions (16.25%) with the lowest ED visits (28.67%) while incurring the highest expenses (US$11 211/month). Conclusions: The findings suggest that commercially insured children, who enroll in hospice, have flexible coverage with a PPO. Hospital readmissions and ED visits were relatively low for a population who was seriously ill. There were significant age-group differences.
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Affiliation(s)
- Lisa C. Lindley
- College of Nursing, University of Tennessee, Knoxville, TN, USA
| | - Austin C. Cohrs
- Department of Public Health Sciences, Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Jessica Keim-Malpass
- Department of Pediatrics, School of Nursing & School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Douglas L. Leslie
- Department of Public Health Sciences, Pennsylvania State University, College of Medicine, Hershey, PA, USA
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Nelson KE, Feinstein JA, Gerhardt CA, Rosenberg AR, Widger K, Faerber JA, Feudtner C. Emerging Methodologies in Pediatric Palliative Care Research: Six Case Studies. CHILDREN-BASEL 2018; 5:children5030032. [PMID: 29495384 PMCID: PMC5867491 DOI: 10.3390/children5030032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/13/2018] [Accepted: 02/16/2018] [Indexed: 12/17/2022]
Abstract
Given the broad focus of pediatric palliative care (PPC) on the physical, emotional, and spiritual needs of children with potentially life-limiting illnesses and their families, PPC research requires creative methodological approaches. This manuscript, written by experienced PPC researchers, describes issues encountered in our own areas of research and the novel methods we have identified to target them. Specifically, we discuss potential approaches to: assessing symptoms among nonverbal children, evaluating medical interventions, identifying and treating problems related to polypharmacy, addressing missing data in longitudinal studies, evaluating longer-term efficacy of PPC interventions, and monitoring for inequities in PPC service delivery.
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Affiliation(s)
- Katherine E Nelson
- Pediatric Advanced Care Team, Department of Paediatrics, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada.
| | - James A Feinstein
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, Children's Hospital Colorado, Aurora, CO 80045, USA.
- Division of General Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.
- Departments of Pediatrics and Psychology, The Ohio State University, Columbus, OH 43210, USA.
| | - Abby R Rosenberg
- Department of Pediatrics, University of Washington School of Medicine; Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA 98105, USA.
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA 98101, USA.
| | - Kimberley Widger
- Pediatric Advanced Care Team, Department of Paediatrics, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada.
| | - Jennifer A Faerber
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
| | - Chris Feudtner
- Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
- Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
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Duc JK, Herbert AR, Heussler HS. Paediatric palliative care and intellectual disability—A unique context. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 30:1111-1124. [DOI: 10.1111/jar.12389] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2017] [Indexed: 01/21/2023]
Affiliation(s)
- Jacqueline K Duc
- Paediatric Palliative Care ServiceChildren's Health Queensland Australia
- Centre for Children's Health Ethics and LawQueensland Health Australia
- Faculty of MedicineUniversity of Queensland Brisbane Australia
| | - Anthony Robert Herbert
- Paediatric Palliative Care ServiceChildren's Health Queensland Australia
- Centre for Children's Health Ethics and LawQueensland Health Australia
- Faculty of MedicineUniversity of Queensland Brisbane Australia
| | - Helen S Heussler
- Paediatric Palliative Care ServiceChildren's Health Queensland Australia
- Faculty of MedicineUniversity of Queensland Brisbane Australia
- Mater Research InstituteUniversity of Queensland Brisbane Australia
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Lindley LC, Keim-Malpass J. Quality of paediatric hospice care for children with and without multiple complex chronic conditions. Int J Palliat Nurs 2017; 23:230-237. [PMID: 28548914 DOI: 10.12968/ijpn.2017.23.5.230] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Hospice care for children with multiple complex chronic conditions (MCCC) is complicated given their unique health at the end of life (EOL). Little is known about the quality of the hospice care MCCC children receive and how that might differ from children without MCCC. OBJECTIVE To compare the quality of hospice care (i.e., structures, processes, outcomes) between children with and without MCCC. METHODS This retrospective, comparative study used data from the National Home and Hospice Care Survey, which included a nationally representative sample of paediatric hospice patients. The Pearson chi-square and Wald tests for comparisons were used. RESULTS MCCC children enrolled in hospice care for over 2 months with multiple visits by hospice staff. They had low symptom burden with minimal discontinuity of care at EOL. Children without MCCC had short length of stays in hospice with few visits by nurses and other clinicians. These children had high symptom burden and significant disenrollment from hospice care to receive more aggressive treatment. CONCLUSIONS The findings revealed significant differences in paediatric hospice care between MCCC and non-MCCC children, which provides critical insight into the quality of hospice care.
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Affiliation(s)
- Lisa C Lindley
- Assistant Professor, College of Nursing, University of Tennessee, Knoxville, TN
| | - Jessica Keim-Malpass
- Assistant Professor, School of Nursing, University of Virginia, Charlottesville, VA
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Lindley LC, Nageswaran S. Pediatric Primary Care Involvement in End-of-Life Care for Children. Am J Hosp Palliat Care 2017; 34:135-141. [PMID: 26430133 PMCID: PMC5037050 DOI: 10.1177/1049909115609589] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To examine the relationship between pediatric primary care involvement and hospice and home health care use at end of life. METHODS California Medicaid data were used to estimate the relationship between pediatric primary care involvement and use of hospice and home health care using generalized estimating equations. RESULTS Of the 2037 children who died between 2007 and 2010, 11% used hospice and 23% used home health. Among all children, primary care was not related to hospice use and was associated with home health use, usual source of care (OR = 1.83, P < .05), comprehensive care (OR = 1.60, P < .05), and continuous care (low: OR = 1.49, P < .05; moderate: OR = 2.57, P < .05; high: OR = 2.12, P < .05). Primary care for children aged 15 to 20 years was related to hospice use, usual source of care (OR = 4.06, P < .05) and continuous care (low: OR = 4.92, P < .05; moderate OR = 4.09, P < .05; high OR = 3.92, P < .05). Primary care for children under 5 years was associated with home health use, usual source of care (OR = 2.59, P < .05), comprehensive care (OR = 2.49, P < .05), and continuous care (low: OR = 2.22, P < .05; moderate: OR = 3.64, P < .05; high: OR = 3.62, P < .05). For children aged 6 to 14 years, this association was seen with continuous care (moderate: OR = 2.38, P < .05; high: OR = 2.13, P < .05). Home health for children aged 15 to 20 years was related to continuous care (moderate: OR = 2.32, P < .05). CONCLUSION Primary care involvement affected hospice use among older age-groups and home health use among younger age-groups. These findings underscore the need for clinical knowledge about end-of-life care for children of all ages among primary care providers.
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Affiliation(s)
- Lisa C Lindley
- 1 College of Nursing, University of Tennessee, Knoxville, TN, USA
| | - Savithri Nageswaran
- 2 Maya Angelou Center for Health Equity Social Sciences & Health Policy, Wake Forest Baptist Medical Center, Wake Forest, NC, USA
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Öhlén J, Russell L, Håkanson C, Alvariza A, Fürst CJ, Årestedt K, Sawatzky R. Variations in Care Quality Outcomes of Dying People: Latent Class Analysis of an Adult National Register Population. J Pain Symptom Manage 2017; 53:13-24. [PMID: 27725251 DOI: 10.1016/j.jpainsymman.2016.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 07/12/2016] [Accepted: 08/03/2016] [Indexed: 11/29/2022]
Abstract
CONTEXT Symptom relief is a key goal of palliative care. There is a need to consider complexities in symptom relief patterns for groups of people to understand and evaluate symptom relief as an indicator of quality of care at end of life. OBJECTIVES The aims of this study were to distinguish classes of patients who have different symptom relief patterns during the last week of life and to identify predictors of these classes in an adult register population. METHODS In a cross-sectional retrospective design, data were used from 87,026 decedents with expected deaths registered in the Swedish Register of Palliative Care in 2011 and 2012. Study variables were structured into patient characteristics, and processes and outcomes of quality of care. A latent class analysis was used to identify symptom relief patterns. Multivariate multinomial regression analyses were used to identify predictors of class membership. RESULTS Five latent classes were generated: "relieved pain," "relieved pain and rattles," "relieved pain and anxiety," "partly relieved shortness of breath, rattles and anxiety," and "partly relieved pain, anxiety and confusion." Important predictors of class membership were age, sex, cause of death, and having someone present at death, individual prescriptions as needed (PRN) and expert consultations. CONCLUSION Interindividual variability and complexity in symptom relief patterns may inform quality of care and its evaluation for dying people across care settings.
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Affiliation(s)
- Joakim Öhlén
- Palliative Research Centre and Department of Health Care Science, Ersta Sköndal University College, Stockholm, Sweden; Institute of Health and Care Sciences and University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy at the University of Gothenburg, Sweden.
| | - Lara Russell
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada; School of Nursing, University of Victoria, British Columbia, Canada
| | - Cecilia Håkanson
- Palliative Research Centre and Department of Health Care Science, Ersta Sköndal University College, Stockholm, Sweden; Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden
| | - Anette Alvariza
- Palliative Research Centre and Department of Health Care Science, Ersta Sköndal University College, Stockholm, Sweden; Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden
| | - Carl Johan Fürst
- The Institute for Palliative Care and Department of Clinical Sciences, Lund University, Sweden
| | - Kristofer Årestedt
- Department of Health and Caring Sciences, Linæus University, Kalmar, Sweden; Department of Medical and Health Sciences, Linköping University, Sweden
| | - Richard Sawatzky
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada; School of Nursing, Trinity Western University, Langley, British Columbia, Canada
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Lindley LC. Multiple Complex Chronic Conditions and Pediatric Hospice Utilization among California Medicaid Beneficiaries, 2007-2010. J Palliat Med 2016; 20:241-246. [PMID: 27797636 DOI: 10.1089/jpm.2016.0227] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Over 42,000 children die each year in the United States, including many with multiple complex chronic conditions (MCCCs), but little is known about whether the presence of MCCCs influences families to utilize pediatric hospice care. OBJECTIVE The study objective was to examine the relationship between MCCCs and pediatric hospice utilization among Medicaid beneficiaries. METHODS A retrospective, longitudinal cohort design was conducted with 2007-2010 California Medicaid data to examine the relationship between MCCCs (i.e., two or more MCCCs) and pediatric hospice utilization (i.e., hospice enrollment, hospice length of stay). Multivariate logistic regression with year fixed effects examined the effect of MCCCs on hospice enrollment, and negative binomial model with year fixed effects explored the relationship between MCCCs and hospice length of stay. RESULTS More than 10% of children enrolled in hospice care with an average length of stay of approximately three days. In the study sample, 48.6% of the children had MCCCs. MCCCs were not significantly related to hospice enrollment. However, children with MCCCs (incidence rate ratios = 4.25, p < 0.01) were associated with an increase in the number of days in hospice care. CONCLUSIONS This study demonstrated that children with MCCCs have limited hospice care utilization at end of life. Future research is needed to explore barriers to hospice care for children with MCCCs.
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Affiliation(s)
- Lisa C Lindley
- College of Nursing, University of Tennessee , Knoxville, Knoxville, Tennessee
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