Identification of vulnerability within a child and family health service

Measuring success: program fidelity of Queensland's child health home visiting services. A document analysis

BACKGROUND

The Family CA.R.E. (Community-based Assistance Resourcing and Education) program was introduced in Queensland two decades ago. It aimed to redress health inequalities for infants from families experiencing specific social stressors. The program has been locally adapted over time and has not been evaluated against the original program. This study assessed the extent to which selected hospital and health services in Queensland, Australia have modified the original Family C.A.R.E.

PROGRAM

METHODS

Altheide's model was used to facilitate a critical document analysis of policies and guidelines for adapted Family C.A.R.E. home visiting programs in use by hospital and health services (target n =7).

RESULTS

Five of seven eligible services provided service model documentation. There was low alignment with the original Family C.A.R.E. program across four of the five participating services. While the program delivered within Service 4 was highly aligned to the structure and intent of the original model, variation to the program was still evident. Importantly, four of the five participating programs were not collecting evaluation measures.

CONCLUSIONS

Health services have adapted the original Family C.A.R.E program format to 'fit' the local service environment but have largely failed to collect data to facilitate evaluation. Inability to evaluate the program leads to uncertainty about program success and benefits as well as any unintended consequences for families engaging in unevaluated home visiting programs. This study highlights the importance of monitoring program fidelity and evaluating success given the potential ramifications for this vulnerable cohort and for health service delivery.

Predicting risk factors for pediatric mortality in clinical trial research: A retrospective, cross-sectional study using a Healthcare Cost and Utilization Project database

Introduction

Incorporating real-world data using "big data" analysis in healthcare are useful to extract specific information for healthcare delivery system improvement. All-cause mortality is an essential measure to enhance patient safety in clinical trial research, especially for underrepresented pediatric participants.

Objective

This study aimed to determine the associations between pediatric mortality and patient-specific factors using the Healthcare Cost and Utilization Project (HCUP) database.

Methods

Data from the 2019 the HCUP Kids' Inpatient Database (KID) were used to conduct a logistic regression analysis to determine associations between pediatric patients' the chance of survival and their demographic and socioeconomic background, discharge records, and hospital information.

Results

Total number of diagnoses (OR = 0.84), total number of procedures (OR = 0.86), length of stay (OR = 1.04), age intervals greater than 1 year (OR > 1.0), transfer into the hospital from a different acute care (OR = 0.34), major diagnoses of multiple significant trauma (OR = 0.03) or hepatobiliary system and pancreas (OR = 0.10), region of hospital - west and midwest (OR > 1.0), and medium or larger hospital bed size (OR > 1.0) were all significantly associated with the chance of survival for patients participating in pediatric clinical trials (p < 0.05).

Conclusion

Real-world clinical trial data analysis showed the potential improvement area including reallocating trial resources to promote trial quality and safe participation for pediatric patients. Pediatric trials need tools that are developed using user-centered design approaches to satisfy the unique needs and requirements of pediatric patients and their caregivers. Safe intrahospital transfer procedures and active dissemination of successful trial best practices are crucial to trial management, adherence, quality, and safety.

Clinical supervision practice by community-based child and family health nurses: A mixed-method systematic review

Aims

To systematically search the literature to identify studies related to clinical supervision in child and family health nurse contexts, and to determine the role it has in professional practice and the characteristics required for effective supervision.

Design

A mixed‐method systematic review using a convergent integrative approach to data synthesis.

Data source

Studies only in English language were identified from searches of CINAHL, MEDLINE and EMBASE databases covering the years of publication from January 1990 to December 2020.

Review methods

Primary research studies of clinical supervision with child and family health nurses in community settings were included. Studies were critically appraised for methodological quality and data extracted, coded and analysed for themes in keeping with the review aims and key findings of each study.

Results

Of 2185 records screened, 63 full‐text papers were assessed for eligibility, which yielded 12 publications for inclusion—11 from the United Kingdom and one from Sweden. The majority (75%) of included studies were qualitative or mixed method. Four main themes with sub‐themes were identified: structural features, supportive experience, ensuring safety and strengthening practice.

Conclusion

Clinical supervision across child and family health nurse contexts is limited. This study highlighted organizational commitment to clinical supervision as an important component of safe and quality practice. Supervisor training and supervisee orientation to supervision is required to optimize effective participation, together with shared agreement of the goals and purpose of supervision.

Impact

The findings from this review confirm the potential for clinical supervision to support improved outcomes for children and families. Understanding what models work best and in what contexts will inform workplace policy and educational programs for child and family nurses across diverse settings.