1
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Yoder EM, Davies SC, Montgomery M, Lundine JP. Exploring the care coordination experiences of professionals and caregivers of youth with acquired brain injuries in rural areas. Disabil Rehabil 2024:1-10. [PMID: 38975700 DOI: 10.1080/09638288.2024.2374487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 06/24/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE Acquired brain injuries (ABIs) can have devastating effects on children and their families. Families living in rural communities experience unique barriers to receiving and coordinating care for complex medical needs, but little research has examined those barriers for rural youth with ABIs. MATERIALS AND METHODS This qualitative study explored the experiences of rural adults caring for children with ABIs through interviews with six caregivers, three school staff members, and three medical professionals who had treated at least one child with an ABI. RESULTS Themes in their accounts include difficulty navigating complex situations, support from small communities, isolation and loneliness, the need for more professional education about ABI, and feelings of hope. Barriers to quality care coordination include navigating complex situations, access to transportation, and a lack of communication and education from healthcare agencies. Facilitators of rural care coordination include support from small communities and interagency communication. CONCLUSIONS The results support the need for more comprehensive coordination among rural agencies involved in ABI care. Suggestions for care improvement include providing flexibility due to transportation barriers, capitalizing on the benefits of a small and caring community, and providing healthcare and education professionals with more education about ABI interventions.
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Affiliation(s)
- Emilie M Yoder
- Department of Counselor Education and Human Services, University of Dayton, Dayton, OH, USA
| | - Susan C Davies
- Department of Counselor Education and Human Services, University of Dayton, Dayton, OH, USA
| | - Meredith Montgomery
- Department of Counselor Education and Human Services, University of Dayton, Dayton, OH, USA
| | - Jennifer P Lundine
- Department of Speech and Hearing Science, The OH State University, Columbus, OH, USA
- Division of Clinical Therapies and Inpatient Rehabilitation Program, Nationwide Children's Hospital, Columbus, OH, USA
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2
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Parpia C, Moore C, Beatty M, Miranda S, Adams S, Stinson J, Desai A, Bartlett L, Culbert E, Cohen E, Orkin J. Evaluation of a Secure Messaging System in the Care of Children With Medical Complexity: Mixed Methods Study. JMIR Form Res 2023; 7:e42881. [PMID: 36821356 PMCID: PMC9999262 DOI: 10.2196/42881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/21/2022] [Accepted: 01/10/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND The Connecting2gether (C2) platform is a web and mobile-based information-sharing tool that aims to improve care for children with medical complexity and their families. A key feature of C2 is secure messaging, which enables parental caregivers (PCs) to communicate with their child's care team members (CTMs) in a timely manner. OBJECTIVE The objectives of this study were to (1) evaluate the use of a secure messaging system, (2) examine and compare the content of messages to email and phone calls, and (3) explore PCs' and CTMs' perceptions and experiences using secure messaging as a method of communication. METHODS This is a substudy of a larger feasibility evaluation of the C2 platform. PCs of children with medical complexity were recruited from a tertiary-level complex care program to use the C2 platform for 6 months. PCs could invite CTMs involved in their child's care to register on the platform. Messages were extracted from C2, and phone and email data were extracted from electronic medical records. Quantitative data from the use of C2 were analyzed using descriptive statistics. Messaging content codes were iteratively developed through a review of the C2 messages and phone and email communication. Semistructured interviews were completed with PCs and CTMs. Communication and interview data were analyzed using thematic analysis. RESULTS A total of 36 PCs and 66 CTMs registered on the C2 platform. A total of 1861 messages were sent on C2, with PCs and nurse practitioners sending a median of 30 and 74 messages, respectively. Of all the C2 messages, 85.45% (1257/1471) were responded to within 24 hours. Email and phone calls focused primarily on clinical concerns and medications, whereas C2 messaging focused more on parent education, proactive check-ins, and nonmedical aspects of the child's life. Four themes emerged from the platform user interviews related to C2 messaging: (1) connection to the care team, (2) efficient communication, (3) clinical uses of secure messaging, and (4) barriers to use. CONCLUSIONS Overall, our study provides valuable insight into the benefits of secure messaging in the care of children with medical complexity. Secure messaging provided the opportunity for continued family teaching, proactive check-ins from health care providers, and casual conversations about family and child life, which contributed to PCs feeling an improved sense of connection with their child's health care team. Secure messaging can be a beneficial additional communication method to improve communication between PCs and their care team, reducing the associated burden of care coordination and ultimately enhancing the experience of care delivery. Future directions include the evaluation of secure messaging when integrated into electronic medical records, as this has the potential to work well with CTM workflow, reduce redundancy, and allow for new features of secure messaging.
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Affiliation(s)
- Camilla Parpia
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Clara Moore
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | - Sherri Adams
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,SickKids Research Institute, Toronto, ON, Canada.,Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer Stinson
- SickKids Research Institute, Toronto, ON, Canada.,Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Arti Desai
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Leah Bartlett
- Royal Victoria Regional Health Center, Barrie, ON, Canada
| | | | - Eyal Cohen
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,SickKids Research Institute, Toronto, ON, Canada
| | - Julia Orkin
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,SickKids Research Institute, Toronto, ON, Canada.,Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
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3
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Min EE, Wheeler H, Hennessy C, Abebe E. Medication management strategies by family caregivers of children with special healthcare needs. Child Care Health Dev 2023. [PMID: 36779227 DOI: 10.1111/cch.13102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND Little is known about the strategies utilized by family caregivers managing medications for their children with special healthcare needs (CSHCN), those who require higher than normal care due to their multifaceted healthcare needs. Medication management strategies are a set of methods or techniques developed or adapted by caregivers to overcome medication-related barriers and ensure successful therapeutic outcomes. An in-depth understanding of such strategies is a requisite first step toward developing interventions that support caregiver-mediated medication management. METHODS We conducted semi-structured qualitative interviews with 20 family caregivers of CSHCN who were recruited as part of a community engaged research between Purdue University College of Pharmacy and Indiana Family to Family. Interviews were conducted through zoom and audio recorded. Each participant was provided with a $50 honorarium. Interviews were professionally transcribed and content analyzed to generate categories of medication management strategies. RESULTS Five overarching categories of medication management strategies were identified. These included (1) medications, supplies and equipment inventory management; (2) organizing and tracking medications, supplies and equipment; (3) medication-related communication, coordination and engagement; (4) medication administration and (5) researching and learning about medications. Within each category, caregivers developed or adapted specific strategies to overcome barriers in diverse care contexts (e.g., when interacting with healthcare systems, school staff or other members of their household). CONCLUSION These findings can inform current clinical practice through improved awareness of different strategies employed by caregivers and lay a foundation to develop interventions designed to support caregiver mediated medication management.
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Affiliation(s)
- Elissa E Min
- College of Pharmacy, Department of Pharmacy Practice, Purdue University, West Lafayette, Indiana, USA
| | - Holly Wheeler
- Indiana Family to Family, Indianapolis, Indiana, USA
| | | | - Ephrem Abebe
- College of Pharmacy, Department of Pharmacy Practice, Purdue University, West Lafayette, Indiana, USA
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4
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Genna C, Thekkan KR, Geremia C, Di Furia M, Campana A, Dall'Oglio I, Tiozzo E, Gawronski O. Parents' process of recognition and response to clinical deterioration of their children with medical complexity at home: A grounded theory. J Clin Nurs 2022. [PMID: 36101491 DOI: 10.1111/jocn.16502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/30/2022] [Accepted: 08/08/2022] [Indexed: 11/27/2022]
Abstract
AIM To explore the process of recognition and response to clinical deterioration of children with medical complexity at home by their parents. BACKGROUND Children with medical complexity are characterised by known chronic conditions associated with frailty and functional limitations, dependence on healthcare services and high use of technology and resources. Their medical complexity often leads to the onset of complications. Targeted care ensures timely recognition and response to clinical deterioration at home, thus avoiding serious sequelae, inappropriate hospitalisations and improving quality of life. Evidence on parents' process of the recognition and response to clinical deterioration at home is limited. DESIGN Qualitative study using a Grounded Theory methodology. METHOD Seven online focus groups were conducted with parents and healthcare providers experienced in their care. The interviews were transcribed verbatim and analysed through open, axial and selective coding, using a constant comparative iterative method. The COREQ guidelines guided the reporting of this work. RESULTS Four categories and one core category were identified: (1) Awareness of the unique and shared characteristics of children with medical complexity; (2) Parents' care maintenance and management; (3) Parents' care monitoring; (4) Parents' response to clinical deterioration and (5) Seeking the Shift of Agency, the core category as the foundation of the Process of Recognition and rEsponse of PAREnts to Deterioration (PRE-PARE-D) theory. CONCLUSION The role of parents of children with medical complexity is evolving into active care leaders, by developing care management and care monitoring competences and negotiating care with healthcare providers. RELEVANCE TO CLINICAL PRACTICE The shift of agency from healthcare providers to parents requires education and counselling pathways to promote the development of parent's self-efficacy, competencies and empowerment in the care management of their children. Home care delivery for children with medical complexity should aim at sustaining this partnership between healthcare providers and parents.
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Affiliation(s)
- Catia Genna
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Kiara Ros Thekkan
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Caterina Geremia
- Department of Emergency, Acceptance and General Paediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Michela Di Furia
- Department of Anesthesiology and Critical Care, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Campana
- Department of Emergency, Acceptance and General Paediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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5
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Foster CC, Shaunfield S, Black LE, Labellarte PZ, Davis MM. Improving Support for Care at Home: Parental Needs and Preferences When Caring for Children with Medical Complexity. J Pediatr Health Care 2022; 36:154-164. [PMID: 34688541 DOI: 10.1016/j.pedhc.2020.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/12/2020] [Accepted: 08/20/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We sought to characterize the current supports used by parents to care for children with medical complexity (CMC) at home and parental preferences for additional supports to meet identified gaps. METHOD Semistructured interviews were conducted with parents of 18 CMC. Interviews were transcribed then analyzed using a constant comparative approach. RESULTS Extended family and community offloaded nonmedical tasks, assisted financially, gave emotional reinforcement, and cared for CMC. Home health providers also directly cared for CMC, but access and quality varied. Government programs paid for in-home care, but eligibility varied. Parents wanted more paid home care but also more support completing nonmedical tasks, mitigating financial strains, and accessing mental health services. DISCUSSION Parents of CMC relied on family and community members to help fill existing gaps in-home care, but gaps remained, suggesting the need for more medical and social supports for the in-home care of CMC and their families.
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6
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Ming DY, Jones KA, Sainz E, Tkach H, Stewart A, Cram A, Morreale MC, Dizon S, deJong NA. Feasibility of implementing systematic social needs assessment for children with medical complexity. Implement Sci Commun 2021; 2:130. [PMID: 34802465 PMCID: PMC8606226 DOI: 10.1186/s43058-021-00237-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 11/05/2021] [Indexed: 11/21/2022] Open
Abstract
Background Children with medical complexity (CMC) have inter-related health and social needs; however, interventions to identify and respond to social needs have not been adapted for CMC. The objective of this study was to evaluate the feasibility of implementing social needs screening and assessment within pediatric complex care programs. Methods We implemented systematic social needs assessment for CMC (SSNAC) at two tertiary care centers in three phases: (1) pre-implementation, (2) implementation, and (3) implementation monitoring. We utilized a multifaceted implementation package consisting of discrete implementation strategies within each phase. In phase 1, we adapted questions from evidence-informed screening tools into a 21-item SSNAC questionnaire, and we used published frameworks to inform implementation readiness and process. In phases 2–3, clinical staff deployed the SSNAC questionnaire to parents of CMC in-person or by phone as part of usual care and adapted to local clinical workflows. Staff used shared decision-making with parents and addressed identified needs by providing information about available resources, offering direct assistance, and making referrals to community agencies. Implementation outcomes included fidelity, feasibility, acceptability, and appropriateness. Results Observations from clinical staff characterized fidelity to use of the SSNAC questionnaire, assessment template, and shared decision-making for follow-up on unmet social needs. Levels of agreement (5-point Likert scale; 1 = completely disagree; 5 = completely agree) rated by staff for key implementation outcomes were moderate to high for acceptability (mean = 4.7; range = 3–5), feasibility (mean = 4.2; range = 3–5), and appropriateness (mean = 4.6; range = 4-5). 49 SSNAC questionnaires were completed with a 91% response rate. Among participating parents, 37 (76%) reported ≥ 1 social need, including food/nutrition benefits (41%), housing (18%), and caregiver needs (29%). Staff responses included information provision (41%), direct assistance (30%), and agency referral (30%). Conclusions It was feasible for tertiary care center-based pediatric complex care programs to implement a standardized social needs assessment for CMC to identify and address parent-reported unmet social needs. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00237-3.
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Affiliation(s)
- David Y Ming
- Department of Pediatrics, DUMC, Duke University School of Medicine, Box 3352, Durham, NC, 27710, USA. .,Department of Medicine, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC, 27710, USA. .,Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, USA.
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, USA
| | - Elizabeth Sainz
- Department of Pediatrics, DUMC, Duke University School of Medicine, Box 3352, Durham, NC, 27710, USA
| | - Heidie Tkach
- Department of Pediatrics, University of North Carolina School of Medicine, 260 MacNider Building, CB#7220, Chapel Hill, NC, 27599, USA
| | - Amy Stewart
- Department of Pediatrics, University of North Carolina School of Medicine, 260 MacNider Building, CB#7220, Chapel Hill, NC, 27599, USA
| | - Ashley Cram
- University of North Carolina School of Public Health, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Madlyn C Morreale
- Department of Pediatrics, University of North Carolina School of Medicine, 260 MacNider Building, CB#7220, Chapel Hill, NC, 27599, USA.,Legal Aid of North Carolina, 224 S. Dawson St, Raleigh, NC, 27601, USA
| | - Samantha Dizon
- Department of Pediatrics, DUMC, Duke University School of Medicine, Box 3352, Durham, NC, 27710, USA.,Department of Medicine, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC, 27710, USA
| | - Neal A deJong
- Department of Pediatrics, University of North Carolina School of Medicine, 260 MacNider Building, CB#7220, Chapel Hill, NC, 27599, USA
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7
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Lin JLL, Quartarone S, Aidarus N, Chan CY, Hubbert J, Orkin J, Fayed N, Major N, Soscia J, Lim A, French SD, Moretti ME, Cohen E. Process Evaluation of a Hub-and-Spoke Model to Deliver Coordinated Care for Children with Medical Complexity across Ontario: Facilitators, Barriers and Lessons Learned. Healthc Policy 2021; 17:104-122. [PMID: 34543180 PMCID: PMC8437255 DOI: 10.12927/hcpol.2021.26574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Complex Care for Kids Ontario (CCKO) is a multi-year strategy aimed at expanding a hub-and-spoke model to deliver coordinated care for children with medical complexity (CMC) across Ontario. Objective: This paper aims to identify the facilitators, barriers and lessons learned from the implementation of the Ontario CCKO strategy. Method: Alongside an outcome evaluation of the CCKO strategy, we conducted a process evaluation to understand the implementation context, process and mechanisms. Semi-structured interviews were conducted with 38 healthcare leaders, clinicians and support staff from four regions involved in CCKO care delivery and/or governance. Results: Facilitators to CCKO implementation were sustained engagement of system-wide stakeholders, inter-organizational partnerships, knowledge sharing and family engagement. Barriers to CCKO implementation were resources and funding, fragmentation of care, aligning perspectives between providers and clinical staff recruitment and retention. Conclusion: A flexible approach is required to implement a complex, multi-centre policy strategy. Other jurisdictions considering such a model of care delivery would benefit from attention to contextual variations in implementation setting, building cross-sector engagement and buy-in, and offering continuous support for modifications to the intervention as and when required.
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Affiliation(s)
- Jia Lu Lilian Lin
- PhD Candidate, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Samantha Quartarone
- Clinical Research Project Coordinator, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
| | - Nasra Aidarus
- Senior Program Manager, Provincial Council for Maternal and Child Health, Toronto, ON
| | - Carol Y Chan
- Clinical Research Project Manager, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
| | - Jackie Hubbert
- Clinical Director, Labatt Family Heart Centre and Critical Care Services, The Hospital for Sick Children, Toronto, ON
| | - Julia Orkin
- Medical Officer, Integrated Community Partnerships and Complex Care Program, The Hospital for Sick Children; Associate Professor, Department of Paediatrics, University of Toronto, Toronto, ON
| | - Nora Fayed
- Assistant Professor, School of Rehabilitation Therapy, Queen's University, Kingston, ON
| | - Nathalie Major
- Medical Director, Champlain Complex Care Program, Children's Hospital of Eastern Ontario; Assistant Professor, Department of Paediatrics, University of Ottawa, Ottawa, ON
| | - Joanna Soscia
- Nurse Practitioner and Clinical Practice Lead, Complex Care Program, The Hospital for Sick Children, Toronto, ON
| | - Audrey Lim
- Medical Lead, Complex Care Program, McMaster Children's Hospital - Hamilton Health Sciences; Associate Professor, Department of Pediatrics, McMaster University, Hamilton, ON
| | - Simon D French
- Professor, Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia
| | - Myla E Moretti
- Health Economist and Senior Research Associate, Clinical Trials Unit, Ontario Child Health Support Unit, The Hospital for Sick Children, Toronto, ON
| | - Eyal Cohen
- Professor, Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto; Senior Scientist and Program Head, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
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8
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Blanco MA, Lilly CM, Bavinger BC, Garcia S, Hojnicki MP. Caring for Medically Complex Children in the Outpatient Setting. Adv Pediatr 2021; 68:89-102. [PMID: 34243861 DOI: 10.1016/j.yapd.2021.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Michelle A Blanco
- Department of Pediatrics, Division of General Pediatrics, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Tampa, FL 33606, USA.
| | - Carol M Lilly
- Department of Pediatrics, Division of General Pediatrics, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Tampa, FL 33606, USA
| | - Brooke C Bavinger
- Department of Pediatrics, Division of General Pediatrics, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Tampa, FL 33606, USA
| | - Sara Garcia
- Department of Pediatrics, Division of General Pediatrics, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Tampa, FL 33606, USA
| | - Michelle P Hojnicki
- Department of Pediatrics, Division of General Pediatrics, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Tampa, FL 33606, USA
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9
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Adams S, Beatty M, Moore C, Desai A, Bartlett L, Culbert E, Cohen E, Stinson J, Orkin J. Perspectives on team communication challenges in caring for children with medical complexity. BMC Health Serv Res 2021; 21:300. [PMID: 33794885 PMCID: PMC8015748 DOI: 10.1186/s12913-021-06304-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children with medical complexity (CMC) require the expertise of many care providers spanning different disciplines, institutions, and settings of care. This leads to duplicate health records, breakdowns in communication, and limited opportunities to provide comprehensive, collaborative care. The objectives of this study were to explore communication challenges and solutions/recommendations from multiple perspectives including (i) parents, (ii) HCPs - hospital and community providers, and (iii) teachers of CMC with a goal of informing patient care. METHODS This qualitative study utilized an interpretive description methodology. In-depth semi-structured interviews were conducted with parents and care team members of CMC. The interview guides targeted questions surrounding communication, coordination, access to information and roles in the health system. Interviews were conducted until thematic saturation was reached. Interviews were audio-recorded, transcribed verbatim, and coded and analyzed using thematic analysis. RESULTS Thirty-two individual interviews were conducted involving parents (n = 16) and care team members (n = 16). Interviews revealed 2 main themes and several associated subthemes (in parentheses): (1) Communication challenges in the care of CMC (organizational policy and technology systems barriers, inadequate access to health information, and lack of partnership in care) (2) Communication solutions (shared systems that can be accessed in real-time, universal access to health information, and partnered contribution to care). CONCLUSION Parents, HCPs, and teachers face multiple barriers to communication and information accessibility in their efforts to care for CMC. Parents and care providers in this study suggested potential strategies to improve communication including facilitating communication in real-time, universal access to health information and meaningful partnerships.
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Affiliation(s)
- Sherri Adams
- Division of Pediatric Medicine, SickKids, The Hospital for Sick Children, Toronto, Canada. .,SickKids Research Institute, Toronto, Canada. .,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
| | | | - Clara Moore
- SickKids Research Institute, Toronto, Canada
| | - Arti Desai
- Department of Pediatrics, University of Washington, Seattle, USA
| | | | | | - Eyal Cohen
- Division of Pediatric Medicine, SickKids, The Hospital for Sick Children, Toronto, Canada.,SickKids Research Institute, Toronto, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Jennifer Stinson
- SickKids Research Institute, Toronto, Canada.,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.,Department of Anesthesia and Pain Medicine, Toronto, Canada
| | - Julia Orkin
- Division of Pediatric Medicine, SickKids, The Hospital for Sick Children, Toronto, Canada.,SickKids Research Institute, Toronto, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada
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10
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Pulcini CD, Belardo Z, Ketterer T, Zorc JJ, Mollen CJ. Improving Emergency Care for Children With Medical Complexity: Parent and Physicians' Perspectives. Acad Pediatr 2021; 21:513-520. [PMID: 32947009 DOI: 10.1016/j.acap.2020.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/08/2020] [Accepted: 09/13/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Children with medical complexity (CMC) have high rates of emergency department (ED) utilization, but little evidence exists on the perceptions of parents and pediatric emergency medicine (PEM) physicians about emergency care. We sought to explore parent and PEM physicians' perspectives about 1) ED care for CMC, and 2) how emergency care can be improved. METHODS We performed semistructured interviews with parents and PEM physicians at a single academic, children's hospital. English-speaking parents were selected utilizing a standard definition of CMC during an ED visit in which their child was admitted to the hospital. All PEM physicians were eligible. We developed separate interview guides utilizing open-ended questions. The trained study team developed and modified a coding tree through an iterative process, double-coded transcripts, monitored inter-rater reliability to ensure adherence, and performed thematic analysis. RESULTS Twenty interviews of parents of CMC and 16 of PEM physicians were necessary for saturation. Parents identified specific challenges related to ED care of their children involving time, information gathering, logistics/convenience, and multifaceted communication between health teams and parents. PEM physicians identified time, data accessibility and availability, and communication as inter-related challenges in caring for CMC in the ED. Suggestions reflected potential solutions to the challenges identified. CONCLUSIONS Time, data, and communication challenges were the main focus for both parents and PEM physicians, and suggestions mirrored these challenges. Further research and quality improvement efforts to better characterize and mitigate the identified challenges could be of value for this vulnerable population.
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Affiliation(s)
- Christian D Pulcini
- Department of Surgery & Pediatrics, University of Vermont Medical Center and Children's Hospital, University of Vermont Larner College of Medicine (CD Pulcini) Burlington, VT.
| | - Zoe Belardo
- University of Pennsylvania (Z Belardo), Philadelphia, Pa
| | - Tara Ketterer
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia (T Ketterer, JJ Zorc, and CJ Mollen), Philadelphia, Pa
| | - Joseph J Zorc
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia (T Ketterer, JJ Zorc, and CJ Mollen), Philadelphia, Pa
| | - Cynthia J Mollen
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia (T Ketterer, JJ Zorc, and CJ Mollen), Philadelphia, Pa
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11
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Williams LJ, Waller K, Chenoweth RP, Ersig AL. Stakeholder perspectives: Communication, care coordination, and transitions in care for children with medical complexity. J SPEC PEDIATR NURS 2021; 26:e12314. [PMID: 33098752 PMCID: PMC8063923 DOI: 10.1111/jspn.12314] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/08/2020] [Accepted: 10/08/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to obtain feedback on communication, care coordination, and transitions in care for hospitalized children with medical complexity (CMC). DESIGN AND METHODS This descriptive, mixed-methods study used online surveys with forced-choice and open-ended questions to obtain stakeholder feedback. Stakeholders included parents, healthcare providers, and nurses. Participants over 18 years of age were recruited from a Midwest children's hospital inpatient unit dedicated to care of CMC. Quantitative data were analyzed using t-tests and one-way analysis of variance. Qualitative description was used to analyze responses to open-ended questions. RESULTS Parents' ratings of communication, care coordination, and transitions in care were generally high. Transitions from other facilities to the emergency department and unit received lower ratings. Providers and nurses gave high ratings to overall care, communication among providers and nurses on the patient unit, and experiences with discharge; however, between unit communication and unit-based coordination received lower ratings. Providers and nurses had higher ratings for discharge preparation than parents (p ≤ .001). Three themes were identified in responses to the open-ended questions: establishing balanced and collaborative relationships between the care team and families, taking a proactive approach to care coordination, and the importance of an inclusive, interdisciplinary, and centralized approach to care coordination and communication. PRACTICE IMPLICATIONS Collaboration among all stakeholders is needed to achieve coordinated care, inclusive communication, and transitions with positive outcomes during hospitalization. Parents identified a need for consistent communication from care teams, with the primary inpatient team taking a lead role. Including parents in care coordination and transitions in care is key, as they are the experts in their children's health and well-being.
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Affiliation(s)
- Lori J Williams
- American Family Children's Hospital, Madison, Wisconsin, USA
| | | | - Rachel P Chenoweth
- The University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, USA
| | - Anne L Ersig
- The University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, USA
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12
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Pankewicz A, Davis RK, Kim J, Antonelli R, Rosenberg H, Berhane Z, Turchi RM. Children With Special Needs: Social Determinants of Health and Care Coordination. Clin Pediatr (Phila) 2020; 59:1161-1168. [PMID: 32672059 DOI: 10.1177/0009922820941206] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Care coordination (CC) facilitates access to resources/services for children/youth with special health care needs (CYSHCN). We conducted a cross-sectional analysis of the 2009-2010 National Survey of CSHCN to examine socioeconomic factors related to report of receiving adequate CC services for CYSHCN. Descriptive statistics were used to describe sociodemographic characteristics of respondents and examine socioeconomic factors. Receiving adequate CC varied by socioeconomic variables including income (100% to 199% federal poverty line [FPL]; aOR [adjusted odds ratio] = 0.848; 95% CI [confidence interval] = 0.722-0.997; P < .05), insurance (uninsured; aOR = 0.446; 95% CI = 0.326-0.609; P < .0001), and marital status (never married; aOR = 0.79; 95% CI = 0.64-0.97; P < .05). More families reporting adequate CC had private insurance, non-Hispanic white ethnicity, income >400% federal poverty level, and 2-parent households. Findings suggest unmet needs in terms of adequate access or knowledge leading to insufficient provision of CC for families with the greatest needs. Further analysis identifying specific deficits and implementing strategies to address these disparities is warranted.
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Affiliation(s)
| | | | - John Kim
- Drexel University, Philadelphia, PA, USA
| | - Richard Antonelli
- Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Hannah Rosenberg
- Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Renee M Turchi
- Drexel University, Philadelphia, PA, USA.,St Christopher's Hospital for Children, Philadelphia, PA, USA
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13
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Abstract
Coordinating care to meet the robust needs of children with medical complexity and their families is challenging, especially in the setting of a busy primary care practice. This article describes the experience of one family and pediatrician and highlights specific factors, such as a focus on building relationships, meaningful and structured information-sharing, and partnership with a complex care program, that can positively affect care. [Pediatr Ann. 2020;49(11):e486-e490.].
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14
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Braganza SF, Tyrrell H, Rosen C, Mogilner L, Phillips A, Slovin S, Sharif I. CORNET Card Study #1: Do You See What I See? Provider Confidence in Caring for Children With Special Health Care Needs. Acad Pediatr 2020; 20:250-257. [PMID: 31627005 DOI: 10.1016/j.acap.2019.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 10/04/2019] [Accepted: 10/10/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Understanding differences between trainee and faculty experience with and confidence caring for children with special health care needs (CSHCN) can inform pediatric resident education. METHODS Residents and faculty across the continuity research network (CORNET) reported on a consecutive series of 5 primary care encounters. Respondents answered questions about visit characteristics, patient demographics, and applied the CSHCN Screener. Respondents also reported on how confident they felt addressing the patient's health care needs over time. We dichotomized confidence at "very confident" versus all other values. We used logistic regression to describe the correlates of provider confidence managing the patient's care. RESULTS We collected data on 381 (74%) resident-patient and 137 (26%) attending-patient encounters. A higher proportion of attending encounters compared to resident encounters were with CSHCN (49% vs 39%, P < .05), including children with complex needs (17% vs 10%, P < .05). The odds of feeling "very confident" (AOR [95% CI]) was lower with increasing CSHCN score (0.61[0.51-0.72]) and was lower for resident versus attending encounters (0.39 [0.16-0.95]). Confidence was higher if the provider had previously seen that patient (2.07 [1.15-3.72]), and for well (2.50 [1.35-4.64]) or sick visits (3.18 [1.46-6.94]) (vs follow-up). Differences between residents and attending pediatricians regarding the relationship between confidence and visit characteristics for subsets of CSHCN are reported. CONCLUSION All providers felt less confident caring for CSHCN; however, for certain needs, resident confidence did not increase with level of training. The data suggest potential educational/programmatic opportunities.
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Affiliation(s)
- Sandra F Braganza
- Department of Pediatrics, Children's Hospital at Montefiore (SF Braganza), Bronx, NY.
| | - Hollyce Tyrrell
- Research and Network Coordinator, Academic Pediatric Association (H Tyrrell), McLean, Va
| | - Carolyn Rosen
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai (C Rosen, L Mogilner), New York, NY
| | - Leora Mogilner
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai (C Rosen, L Mogilner), New York, NY
| | - Ann Phillips
- Delaware Family Voices Inc. (A Phillips), Wilmington, Del
| | - Sara Slovin
- Nemours/Alfred I. duPont Hospital for Children (S Slovin), Wilmington, Del
| | - Iman Sharif
- Department of Pediatrics, New York University School of Medicine (I Sharif), Brooklyn, NY
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15
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Huth K, Amar-Dolan L, Perez JM, Luff D, Cohen AP, Glader L, Leichtner A, Newman LR. Visiting Jack: Mixed Methods Evaluation of a Virtual Home Visit Curriculum With a Child With Medical Complexity. Acad Pediatr 2020; 20:1020-1028. [PMID: 32437880 PMCID: PMC7983129 DOI: 10.1016/j.acap.2020.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/18/2020] [Accepted: 05/02/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND There are limited training opportunities for pediatricians in caring for children with medical complexity (CMC) in the home and community. Prior studies have described a lack of comfort caring for CMC among pediatric residents. OBJECTIVE 1) To evaluate the impact of participation in a virtual home visit curriculum on pediatric residents' confidence, knowledge, and application of knowledge in complex care; 2) to explore changes in perspectives relating to the care of CMC after participation in the curriculum. METHODS This was a prospective pre-post intervention study in 2019 with first-year pediatric residents, using quantitative and qualitative methods. The intervention, co-created with a family partner, was an online video-based curriculum followed by an in-person seminar. Pre- and postassessments were compared using paired t tests. Follow-up interviews and focus groups were performed 5 to 8 weeks after training. Transcripts were analyzed using inductive thematic analysis. RESULTS Twenty-four residents (100%) participated. Residents reported increased confidence in all aspects of complex care presented in the curriculum, with significant increase in knowledge and application of knowledge (all P < .001). Twelve residents (50%) participated in a follow-up interview or focus group. Four themes were identified: 1) recognizing prior attitudes toward complexity, 2) new mental framework for complex care at home, 3) drivers of behavior change, and 4) commitment to change practice. CONCLUSIONS Participation in this curriculum was associated with increased confidence, knowledge, and application of knowledge in complex care outside of the hospital. Qualitative findings align with transformative learning theory, lending insight into effective approaches to complex care training.
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Affiliation(s)
- Kathleen Huth
- Department of Pediatrics, Boston Children's Hospital (K Huth and L Glader), Boston, Mass.
| | - Laura Amar-Dolan
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA
| | - Jennifer M Perez
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA
| | - Donna Luff
- Institute for Professionalism and Ethical Practice, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA
| | - Amy P Cohen
- Department of Health Policy and Management, Harvard Chan School of Public Health, Boston MA
| | - Laurie Glader
- Department of Pediatrics, Boston Children’s Hospital, Boston MA
| | - Alan Leichtner
- Department of Education, Boston Children’s Hospital, Boston, MA
| | - Lori R Newman
- Department of Education, Boston Children’s Hospital, Boston, MA
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Parrish II RH, Casher D, van den Anker J, Benavides S. Creating a Pharmacotherapy Collaborative Practice Network to Manage Medications for Children and Youth: A Population Health Perspective. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E58. [PMID: 30970616 PMCID: PMC6518168 DOI: 10.3390/children6040058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 02/07/2023]
Abstract
Children with special health care needs (CSHCN) use relatively high quantities of healthcare resources and have overall higher morbidity than the general pediatric population. Embedding clinical pharmacists into the Patient-Centered Medical Home (PCMH) to provide comprehensive medication management (CMM) through collaborative practice agreements (CPAs) for children, especially for CSHCN, can improve outcomes, enhance the experience of care for families, and reduce the cost of care. Potential network infrastructures for collaborative practice focused on CSHCN populations, common language and terminology for CMM, and clinical pharmacist workforce estimates are provided. Applying the results from the CMM in Primary Care grant, this paper outlines the following: (1) setting up collaborative practices for CMM between clinical pharmacists and pediatricians (primary care pediatricians and sub-specialties, such as pediatric clinical pharmacology); (2) proposing various models, organizational structures, design requirements, and shared electronic health record (EHR) needs; and (3) outlining consistent documentation of CMM by clinical pharmacists in CSHCN populations.
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Affiliation(s)
- Richard H Parrish II
- Department of Pharmacy Services, St. Christopher's Hospital for Children ⁻ American Academic Health System, 160 East Erie Avenue, Philadelphia, PA 19134, USA.
- School of Pharmacy, Virginia Commonwealth University, Richmond, VA 23298, USA.
| | - Danielle Casher
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA 19134, USA.
| | - Johannes van den Anker
- Universitäts-Kinderspital beider Basel (UKBB), Spitalstrasse 33, CH-4031 Basel, Switzerland.
- Children's National Health System, 111 Michigan Avenue, Washington, DC 20010, USA.
- Erasmus Medical Center-Sophia Children's Hospital, s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
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17
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Cordeiro A, Davis RK, Antonelli R, Rosenberg H, Kim J, Berhane Z, Turchi R. Care Coordination for Children and Youth With Special Health Care Needs: National Survey Results. Clin Pediatr (Phila) 2018; 57:1398-1408. [PMID: 29932000 DOI: 10.1177/0009922818783501] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
We analyzed findings from the 2009-2010 National Survey of Children with Special Health Care Needs to identify associations between families with children and youth with special health care needs (CYSHCN) reporting adequate care coordination (CC) with family-provider relations, shared decision making (SDM), and child outcomes. Eligible subjects were the 98% of families asked about CC, service use, and communication. Bivariate analysis using χ2 tests were performed on binary outcome variables to determine the strength of the associations between CC and independent and dependent variables. Weighted, multivariate logistic regression models were constructed to assess independent associations of adequate CC with child outcomes and associations of SDM on adequate CC. Among families of CYSHCN asked about CC, 72% reported receiving help with CC. Of these, 55% reported receiving adequate CC. Family report of adequate CC was favorably associated with family-provider relations, child outcomes, and report of provider participation in SDM.
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Affiliation(s)
| | | | | | | | - John Kim
- 2 Drexel University, Philadelphia, PA, USA
| | | | - Renee Turchi
- 2 Drexel University, Philadelphia, PA, USA.,4 St Christopher's Hospital for Children, Philadelphia, PA, USA
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18
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Abstract
BACKGROUND The management of patients in primary care is often complicated by the presence of multiple chronic conditions and psychosocial issues that increase the complexity of the encounter and have important impacts on care. There is a paucity of literature on this subject in the pediatric population. OBJECTIVES The aim of this study was to quantify the burden of chronic conditions in pediatric primary care. METHODS The problem lists of 3995 randomly selected patients from a community pediatric clinic and an academic hospital-based pediatric clinic in the same metropolitan area were analyzed for the presence and number of any chronic condition. RESULTS In total, 53% of patients suffered from at least one chronic problem, 25% had two or more chronic conditions and 5.1% had four or more conditions. Compared with the community clinic, the academic clinic had significantly more children with catastrophic complex conditions (P<0.001). A regression analysis showed a significant positive correlation between the number of chronic medical conditions and mental health diagnoses. CONCLUSIONS The burden of chronic disease in the pediatric primary care setting may be significantly higher than has been previously suggested. To ensure optimal quality of care, health planners should take into account the high burden of chronic illness, psychosocial issues and multimorbidity among patients in the pediatric primary care setting, as well as the higher complexity profile of patients attending academic clinics.
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19
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Belshaw Z, Robinson NJ, Dean RS, Brennan ML. "I Always Feel Like I Have to Rush…" Pet Owner and Small Animal Veterinary Surgeons' Reflections on Time during Preventative Healthcare Consultations in the United Kingdom. Vet Sci 2018; 5:E20. [PMID: 29419766 PMCID: PMC5876559 DOI: 10.3390/vetsci5010020] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/30/2018] [Accepted: 02/05/2018] [Indexed: 12/05/2022] Open
Abstract
Canine and feline preventative healthcare consultations can be more complex than other consultation types, but they are typically not allocated additional time in the United Kingdom (UK). Impacts of the perceived length of UK preventative healthcare consultations have not previously been described. The aim of this novel study was to provide the first qualitative description of owner and veterinary surgeon reflections on time during preventative healthcare consultations. Semi-structured telephone interviews were conducted with 14 veterinary surgeons and 15 owners about all aspects of canine and feline preventative healthcare consultations. These qualitative data were thematically analysed, and four key themes identified. This paper describes the theme relating to time and consultation length. Patient, owner, veterinary surgeon and practice variables were recalled to impact the actual, versus allocated, length of a preventative healthcare consultation. Preventative healthcare consultations involving young, old and multi-morbid animals and new veterinary surgeon-owner partnerships appear particularly susceptible to time pressures. Owners and veterinary surgeons recalled rushing and minimizing discussions to keep consultations within their allocated time. The impact of the pace, content and duration of a preventative healthcare consultation may be influential factors in consultation satisfaction. These interviews provide an important insight into the complex nature of preventative healthcare consultations and the behaviour of participants under different perceived time pressures. These data may be of interest and relevance to all stakeholders in dog and cat preventative healthcare.
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Affiliation(s)
- Zoe Belshaw
- Centre for Evidence-based Veterinary Medicine, University of Nottingham, Sutton Bonington Campus, Leicestershire LE12 5RD, UK.
| | - Natalie J Robinson
- Centre for Evidence-based Veterinary Medicine, University of Nottingham, Sutton Bonington Campus, Leicestershire LE12 5RD, UK.
| | - Rachel S Dean
- Centre for Evidence-based Veterinary Medicine, University of Nottingham, Sutton Bonington Campus, Leicestershire LE12 5RD, UK.
| | - Marnie L Brennan
- Centre for Evidence-based Veterinary Medicine, University of Nottingham, Sutton Bonington Campus, Leicestershire LE12 5RD, UK.
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20
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Simon TD, Whitlock KB, Haaland W, Wright DR, Zhou C, Neff J, Howard W, Cartin B, Mangione-Smith R. Effectiveness of a Comprehensive Case Management Service for Children With Medical Complexity. Pediatrics 2017; 140:peds.2017-1641. [PMID: 29192004 DOI: 10.1542/peds.2017-1641] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To assess whether children with medical complexity (CMC) exposed to a hospital-based comprehensive case management service (CCMS) experience improved health care quality, improved functional status, reduced hospital-based utilization, and/or reduced overall health care costs. METHODS Eligible CMC at Seattle Children's Hospital were enrolled in a cluster randomized controlled trial between December 1, 2010, and September 29, 2014. Participating primary care providers (PCPs) were randomly assigned, and CMC either had access to an outpatient hospital-based CCMS or usual care directed by their PCP. The CCMS included visits to a multidisciplinary clinic ≥ every 6 months for 1.5 years, an individualized shared care plan, and access to CCMS providers. Differences between control and intervention groups in change from baseline to 12 months and baseline to 18 months (difference of differences) were tested. RESULTS Two hundred PCPs caring for 331 CMC were randomly assigned. Intervention group (n = 181) parents reported more improvement in the Consumer Assessment of Healthcare Providers and Systems version 4.0 Child Health Plan Survey global health care quality ratings than control group parents (6.7 [95% confidence interval (CI): 3.5-9.8] vs 1.3 [95% CI: 1.9-4.6] at 12 months). We did not detect significant differences in child functional status and most hospital-based utilization between groups. The difference in change of overall health care costs was higher in the intervention group (+$8233 [95% CI: $1701-$16 937]) at 18 months). CCMS clinic costs averaged $3847 per child-year. CONCLUSIONS Access to a CCMS generally improved health care quality, but was not associated with changes in child functional status or hospital-based utilization, and increased overall health care costs among CMC.
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Affiliation(s)
- Tamara D Simon
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington; and .,Centers for Clinical and Translational Research and
| | - Kathryn B Whitlock
- Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Wren Haaland
- Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Davene R Wright
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington; and.,Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Chuan Zhou
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington; and.,Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - John Neff
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington; and
| | - Waylon Howard
- Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Brian Cartin
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington; and
| | - Rita Mangione-Smith
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington; and.,Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
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21
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Samuels C, Harris T, Gonzales T, Mosquera RA. The Case for the Use of Nurse Practitioners in the Care of Children with Medical Complexity. CHILDREN 2017. [PMCID: PMC5406683 DOI: 10.3390/children4040024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although children with medically complex illness represent less than one percent of the total pediatric population, their health care expenditures and health care system utilization far exceed the numbers of other pediatric patients. Nurse practitioners, with their educational background focused on health care promotion and education, are uniquely qualified to reduce this inequity with cost effective care. Currently, nurse practitioners are used in a variety of health care settings and can provide acute and chronic care. Incorporating nurse practitioners at each step in the care of children with medical complexity can improve the quality of life for these children and their families, increase family satisfaction and decrease costs.
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22
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The intensive care medicine clinical research agenda in paediatrics. Intensive Care Med 2017; 43:1210-1224. [PMID: 28315043 DOI: 10.1007/s00134-017-4729-9] [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] [Received: 12/27/2016] [Accepted: 02/16/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Intensive Care Medicine set us the task of outlining a global clinical research agenda for paediatric intensive care (PIC). In line with the clinical focus of this journal, we have limited this to research that may directly influence patient care. METHODS Clinician researchers from PIC research networks of varying degrees of formality from around the world were invited to answer two main questions: (1) What have been the major recent advances in paediatric critical care research? (2) What are the top 10 studies for the next 10 years? RESULTS (1) Inclusive databases are well established in many countries. These registries allow detailed observational studies and feasibility testing of clinical trial protocols. Recent trials are larger and more valuable, and (2) most common interventions in PIC are not evidenced-based. Clinical studies for the next 10 years should address this deficit, including: ventilation techniques and interfaces; fluid, transfusion and feeding strategies; optimal targets for vital signs; multiple organ failure definitions, mechanisms and treatments; trauma, prevention and treatment; improving safety; comfort of the patient and their family; appropriate care in the face of medical complexity; defining post-PICU outcomes; and improving knowledge generation and adoption, with novel trial design and implementation strategies. The group specifically highlighted the need for research in resource-limited environments wherein mortality remains often tenfold higher than in well-resourced settings. CONCLUSION Paediatric intensive care research has never been healthier, but many gaps in knowledge remain. We need to close these urgently. The impact of new knowledge will be greatest in resource-limited environments.
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