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Colquitt G, Keko M, Rochani HD, Modlesky CM, Vova J, Maitre NL. A Cross-Sectional Study of Disparities in Healthcare Transition in Cerebral Palsy. J Clin Med 2024; 13:3759. [PMID: 38999322 PMCID: PMC11242745 DOI: 10.3390/jcm13133759] [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: 06/10/2024] [Revised: 06/16/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Cerebral palsy (CP) is the most common physical disability among children, affecting their lifespan. While CP is typically nonprogressive, symptoms can worsen over time. With advancements in healthcare, more children with CP are reaching adulthood, creating a greater demand for adult care. However, a significant lack of adult healthcare providers exists, as CP is predominantly considered a pediatric condition. This study compares the transition experiences of children with CP compared to those with other developmental disabilities (DDs) and typically developing children (TDC). Methods: This study utilizes cross-sectional data from the National Survey of Children's Health (NSCH) from 2016-2020, including 71,973 respondents aged 12-17. Children were categorized into three groups: CP (n = 263), DD (n = 9460), and TDC (n = 36,053). The analysis focused on the receipt of transition services and identified demographic and socioeconomic factors influencing these services. Results: Only 9.7% of children with CP received necessary transition services, compared to 19.7% of children with DDs and 19.0% of TDC. Older age, female sex, non-Hispanic white ethnicity, and higher household income were significant predictors of receiving transition services. Children with CP were less likely to have private time with healthcare providers and receive skills development assistance compared to other groups. Conclusions: The findings highlight disparities and critical needs for targeted interventions and structured transition programs to improve the transition from pediatric to adult healthcare for children with CP. Addressing disparities in service receipt and ensuring coordinated, continuous care are essential for improving outcomes for children with CP.
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Affiliation(s)
- Gavin Colquitt
- Appalachian Institute for Health and Wellness, Beaver College of Health Sciences, Appalachian State University, Boone, NC 28607, USA
| | - Mario Keko
- Karl E. Peace Center for Biostatistics, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30458, USA
| | - Haresh D Rochani
- Karl E. Peace Center for Biostatistics, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30458, USA
| | | | - Joshua Vova
- Department of Physical Medicine and Rehabilitation, Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Nathalie Linda Maitre
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
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2
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Simpson K, Nham W, Thariath J, Schafer H, Greenwood-Eriksen M, Fetters MD, Serlin D, Peterson T, Abir M. How health systems facilitate patient-centered care and care coordination: a case series analysis to identify best practices. BMC Health Serv Res 2022; 22:1448. [PMID: 36447273 PMCID: PMC9710067 DOI: 10.1186/s12913-022-08623-w] [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: 04/30/2022] [Accepted: 09/29/2022] [Indexed: 12/05/2022] Open
Abstract
Large- and small-scale transformation of healthcare delivery toward improved patient experience through promotion of patient-centered and coordinated care continues to be at the forefront of health system efforts in the United States. As part of a Quality Improvement (QI) project at a large, midwestern health system, a case series of high-performing organizations was explored with the goal of identifying best practices in patient-centered care and/or care coordination (PCC/CC). Identification of best practices was done through rapid realist review of peer-reviewed literature supporting three PCC/CC interventions per case. Mechanisms responsible for successful intervention outcomes and associated institutional-level facilitators were evaluated, and cross-case analysis produced high-level focus items for health system leadership, including (1) institutional values surrounding PCC/CC, (2) optimization of IT infrastructure to enhance performance and communication, (3) pay structures and employment models that enhance accountability, and (4) organizing bodies to support implementation efforts. Health systems may use this review to gain insight into how institutional-level factors may facilitate small-scale PCC/CC behaviors, or to conduct similar assessments in their own QI projects. Based on our analysis, we recommend health systems seeking to improve PCC/CC at any level or scale to evaluate how IT infrastructure affects provider-provider and provider-patient communication, and the extent to which institutional prioritization of PCC/CC is manifest and held accountable in performance feedback, incentivization, and values shared among departments and settings. Ideally, this evaluation work should be performed and/or supported by cross-department organizing bodies specifically devoted to PCC/CC implementation work.
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Affiliation(s)
- Kaitlyn Simpson
- grid.214458.e0000000086837370Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI USA ,grid.214458.e0000000086837370University of Michigan Medical School, University of Michigan, Ann Arbor, MI USA
| | - Wilson Nham
- grid.214458.e0000000086837370Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI USA
| | - Josh Thariath
- grid.214458.e0000000086837370Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI USA ,grid.214458.e0000000086837370University of Michigan Medical School, University of Michigan, Ann Arbor, MI USA
| | - Hannah Schafer
- grid.214458.e0000000086837370Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI USA ,grid.214458.e0000000086837370University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI USA
| | - Margaret Greenwood-Eriksen
- grid.214458.e0000000086837370Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI USA ,grid.266832.b0000 0001 2188 8502Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico USA
| | - Michael D. Fetters
- grid.214458.e0000000086837370Michigan Mixed Methods Program, University of Michigan, Ann Arbor, MI USA ,grid.214458.e0000000086837370Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI USA
| | - David Serlin
- grid.214458.e0000000086837370Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI USA ,grid.214458.e0000000086837370Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI USA
| | - Timothy Peterson
- grid.214458.e0000000086837370Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI USA ,grid.214458.e0000000086837370Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI USA
| | - Mahshid Abir
- grid.214458.e0000000086837370Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI USA ,grid.34474.300000 0004 0370 7685RAND Corporation, Santa Monica, CA USA
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3
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Fremion E, Cowley R, Berens J, Staggers KA, Kemere KJ, Kim JL, Acosta E, Peacock C. Improved health care transition for young adults with developmental disabilities referred from designated transition clinics. J Pediatr Nurs 2022; 67:27-33. [PMID: 35882113 DOI: 10.1016/j.pedn.2022.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/16/2022] [Accepted: 07/16/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE Young adults with intellectual/developmental disabilities (YAIDD) are a vulnerable population during HCT due to their complex care coordination and adaptive needs, yet factors associated with transition preparedness are not well defined. We aimed to determine factors associated with health care transition (HCT) preparation satisfaction for YAIDD establishing care with an adult medical home. DESIGN AND METHODS 408 YAIDD or their families completed the HCT Feedback Survey 2.0 upon establishing adult care. Logistic regression models were used to determine associations between a composite of six HCT Feedback Survey questions that most correlated with the 2019 National Survey of Children's Health transition questions. RESULTS YADD who had HCT preparation visits with a designated HCT clinic were 9 times more likely to have met all six composite HCT criteria after controlling for the number of technologies required and race/ethnicity (adj OR 9.04, 95% CI: 4.35, 18.76) compared to those referred from the community. Compared to patients who were referred from the community, the odds of feeling very prepared versus somewhat or not prepared were 3.7 times higher (adj OR 3.73, 95% CI: 1.90, 7.32) among patients referred from a designated HCT program. CONCLUSIONS YAIDD who participated in a structured HCT program prior to transfer to adult care experienced higher transition preparation satisfaction. PRACTICAL IMPLICATIONS A structured HCT clinic model to prepare adolescents with DD for transition to adult care may improve HCT preparation satisfaction for this population.
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Affiliation(s)
- Ellen Fremion
- Baylor College of Medicine, Department of Internal Medicine, Section Transition Medicine, 7200 Cambridge St Suite 8a, Houston, TX 77030, USA.
| | - Rachel Cowley
- Baylor College of Medicine, Student Affairs, One Baylor Plaza, Houston, TX 77030, USA
| | - John Berens
- Baylor College of Medicine, Department of Internal Medicine, Section Transition Medicine, 7200 Cambridge St Suite 8a, Houston, TX 77030, USA
| | - Kristen A Staggers
- Baylor College of Medicine, Dan L Duncan Institute for Clinical and Translational Research, One Baylor Plaza, Houston, TX 77030, USA
| | - K Jordan Kemere
- Baylor College of Medicine, Department of Internal Medicine, Section Transition Medicine, 7200 Cambridge St Suite 8a, Houston, TX 77030, USA
| | - Judy Lu Kim
- Baylor College of Medicine, Department of Internal Medicine, Section Transition Medicine, 7200 Cambridge St Suite 8a, Houston, TX 77030, USA
| | - Elisha Acosta
- Baylor College of Medicine, Department of Internal Medicine, Section Transition Medicine, 7200 Cambridge St Suite 8a, Houston, TX 77030, USA
| | - Cynthia Peacock
- Baylor College of Medicine, Department of Internal Medicine, Section Transition Medicine, 7200 Cambridge St Suite 8a, Houston, TX 77030, USA
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4
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Bailey K, Lee S, de Los Reyes T, Lo L, Cleverley K, Pidduck J, Mahood Q, Gorter JW, Toulany A. Quality Indicators for Youth Transitioning to Adult Care: A Systematic Review. Pediatrics 2022; 150:188245. [PMID: 35665828 DOI: 10.1542/peds.2021-055033] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Transition from pediatric to adult care is associated with adverse health outcomes for many adolescents with chronic illness. We identified quality indicators for transition to adult care that are broadly applicable across chronic illnesses and health systems. METHODS Medline, Embase, and the Cumulative Index to Nursing and Allied Health Literature were searched, covering earliest available date to July 2021. The Gray Matters framework was used to search gray literature. Two independent reviewers screened articles by title and abstract, followed by full-text review. Disagreements were resolved by a third reviewer. Studies were included that identified quality indicators developed via consensus-building methods. Indicators were organized into a framework categorized by illness specificity, level of care, Donabedian model, and Institute of Medicine quality domain. Appraisal of Guidelines for Research and Evaluation tool was used for critical appraisal. RESULTS The search identified 4581 articles, of which 321 underwent full-text review. Eight peer-reviewed studies and 1 clinical guideline were included, identifying 169 quality indicators for transition. Of these, 56% were illness specific, 43% were at the patient level of care, 44% related to transition processes, and 51% were patient centered and 0% equity focused. Common indicator themes included education (12%), continuity of care (8%), satisfaction (8%), and self-management/self-efficacy (7%). The study was limited by quality indicators developed through consensus-building methodology. CONCLUSIONS Although most quality indicators for transition were patient-centered outcomes, few were informed by youth and parents/caregivers, and none focused on equity. Further work is needed to prioritize quality indicators across chronic illness populations while engaging youth and parents/caregivers in the process.
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Affiliation(s)
- Katherine Bailey
- Temerty Faculty of Medicine.,Institute of Health Policy, Management and Evaluation
| | - Stephanie Lee
- Department of Medicine, Royal Children's Hospital, Melbourne, Australia.,Department of Adolescent Medicine, Monash Children's Hospital, Melbourne, Australia
| | | | - Lisha Lo
- Centre for Quality Improvement and Patient Safety
| | - Kristin Cleverley
- Temerty Faculty of Medicine.,Lawrence S. Bloomberg School of Nursing, University of Toronto, Toronto, Ontario, Canada.,Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | | | - Jan Willem Gorter
- Department of Rehabilitation, Physical Therapy Science & Sports.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,CanChild, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Alene Toulany
- Temerty Faculty of Medicine.,Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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5
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Thind K, Wiedrick J, Walker S, Hasan R. Emergency Department Visits Increase in Transition-Age Patients Empaneled in a Primary Care Network at a Major Academic Medical Center. J Adolesc Health 2022; 70:77-82. [PMID: 34481734 DOI: 10.1016/j.jadohealth.2021.07.024] [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: 04/06/2021] [Revised: 07/10/2021] [Accepted: 07/21/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study is to identify important predictors of emergency department (ED) utilization within a population of transition-aged patients empaneled within a primary care network, particularly with high-risk chronic conditions of childhood (HRC). METHODS We analyzed cross-sectional data of patients aged 12-29 within a primary care network (n = 19,989). We used negative binomial regression modeling to identify important predictors of ED visits in the last year. RESULTS Nearly 10% (n = 1,975) of the patients had one or more identified HRCs. Our final adjusted model showed that, among others, age 18-23 years (incidence rate ratio [IRR] 1.94, 95% confidence interval [CI] 1.74-2.15), presence of a high-risk condition (IRR 1.74, 95% CI 1.54-1.96]), transfer between two primary care providers in system (IRR 1.43, 95% CI 1.18-1.72), presence of care manager (IRR 2.19, 95% CI 1.68-1.72), and public insurance status (IRR 2.85, 95% CI 2.62-3.10) were all independent predictors of higher ED utilization. Conditions associated with a high incidence of ED utilization included sickle cell anemia (IRR 5.41, 95% CI 2.78-10.54), history of transplant (IRR 2.53, 95% CI 1.11-5.80), type 1 diabetes (IRR 2.12, 95% CI 1.42-3.15), and seizure disorder (IRR 2.01, 95% CI 1.61-2.51). We estimated that for each added chronic condition, the IRR increased 1.23-fold (95% CI 1.00-1.51). CONCLUSIONS Our results demonstrate significantly greater use of high-cost healthcare services for patients in the 18- to 23-year age group and for patients with multiple complex medical conditions. These findings prompt a call for systems-wide processes to improve the pediatric-to-adult transition process.
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Affiliation(s)
- Kanwarabijit Thind
- School of Medicine, Oregon Health & Science University, Portland, Oregon.
| | - Jack Wiedrick
- Biostatistics & Design Program, Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon
| | - Sydney Walker
- Department of Pediatrics, University of Utah, Portland, Oregon
| | - Reem Hasan
- Departments of Internal Medicine and Pediatrics, Oregon Health & Science University, Portland, Oregon
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6
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Ruediger M, Kupfer M, Leiby BE. Decreasing re-hospitalizations and emergency department visits in persons with recent spinal cord injuries using a specialized medical home. J Spinal Cord Med 2021; 44:221-228. [PMID: 31603396 PMCID: PMC7952066 DOI: 10.1080/10790268.2019.1671075] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objective: To determine whether a specialized medical home can reduce re-hospitalizations and emergency department (ED) visits as compared to reports in the literature for persons with spinal cord injury (SCI) in the first year post-discharge from acute inpatient rehabilitation.Design: A three-year prospective cohort study.Setting: An academic free standing inpatient rehabilitation hospital (IRF), participating in the SCI Model Systems network, serving urban, rural and suburban settings in the mid-Atlantic region of the United States of America.Participants: 176 successive individuals with varying levels of SCI, inclusive of patients requiring mechanical ventilation, discharged from rehabilitation from 2/1/15 to 7/1/17, who met criteria and consented to participate.Interventions: Pre-discharge communication between the inpatient and outpatient staff was initiated, medication education by a pharmacist was added, 1 month of discharge medications was offered, and proactive phone calls to patients after discharge were instituted. In addition, patients were offered a 24/7 hotline to reach physician and nursing staff, and multidisciplinary outpatient follow-up was provided in conjunction with extensive proactive case management.Outcome measures: All-cause hospital readmission and ED visits.Results: Thirty percent of the individuals were readmitted within the first year after discharge from an IRF, and 24% were readmitted within the first year after onset. The incidence of readmission was 0.46 and 0.36 respectively. Forty-one percent had an ED visit.Conclusion: The results suggest that the medical home interventions decreased the rate and incidence of readmission and the rate of ED usage in the first year.
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Affiliation(s)
- Marci Ruediger
- Perfomance Excellence Department, Magee Rehabilitation – Jefferson Health, Philadelphia, Pennsylvania, USA,Correspondence to: Marci Ruediger, Magee Rehabilitation, 1513 Race Street, Philadelphia, Pennsylvania19102, USA. Ph: 215-587-3454.
| | - Mendel Kupfer
- Department of Rehabilitation Medicine, Magee Rehabilitation – Jefferson Health, Philadelphia, Pennsylvania, USA
| | - Benjamin E. Leiby
- Department of Pharmacoloy and Experimental Therapeutics, Division of Biostatistics, Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
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7
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Bolesta S, Berger A, Black E, Greskovic GA, Davis TW. Disease and medication burden of medically complex adolescents seen in an interdisciplinary transitional care clinic. J Pediatr Rehabil Med 2021; 14:605-612. [PMID: 34864698 DOI: 10.3233/prm-200705] [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] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Transitional care for adolescents with complex diseases, who are entering adulthood, is challenging. The purpose of this study is to quantify the disease and medication burden of this population, who are transitioning though an interdisciplinary specialty clinic. METHODS This study is a retrospective observational study of all patients seen in a transitional care clinic between July 2012 and March 2015. The main outcomes assessed included disease state and medication burden. Descriptive statistics, along with the paired t-test and McNemar's test, were used. RESULTS The study cohort included 216 patients. The median patient age was 20.7 years, and the median number of clinic encounters was 6. Patients had at least 1 of 8 primary diagnoses. On average, patients took medications from 5 classes and used 3 dose forms. Among 163 patients who had medication reconciliation performed, the average number of medication classes increased by 0.44±1.53 (p = 0.0003). There was an average increase of 3.70%(SD±36.31%; p = 0.27) in the number of required medication lab assessments ordered for patients who had medication reconciliation performed. CONCLUSION There is a high disease and medication burden among adolescent patients with complex disease states who are to transition to adult care.
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Affiliation(s)
- Scott Bolesta
- Department of Pharmacy Practice, Wilkes University, Wilkes-Barre, PA, USA
| | - Andrea Berger
- Department of Population Health Sciences Geisinger, Geisinger Health System, Danville, PA, USA
| | - Emily Black
- Vanderbilt Discharge and Transitions, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Thomas W Davis
- Medicine Institute, Geisinger Health System, Danville, PA, USA
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8
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Parker CL, Wall B, Tumin D, Stanley R, Warren L, Deal K, Stroud T, Crickmore K, Ledoux M. Care Coordination Program for Children With Complex Chronic Conditions Discharged From a Rural Tertiary-Care Academic Medical Center. Hosp Pediatr 2020; 10:687-693. [PMID: 32641383 DOI: 10.1542/hpeds.2019-0323] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Hospital discharge offers an opportunity to initiate coordination of follow-up care, preventing readmissions or emergency department (ED) recidivism. We evaluated how revisits and costs of care varied in a 12-month period between children in a care coordination program at our center (enrolled after hospital discharge with a tracheostomy or on a ventilator) and children with complex chronic condition discharges who were not enrolled. METHODS Children ages 1 to 17 years were retrospectively included if they had a hospital discharge in 2017 with an International Classification of Diseases, 10th Revision code meeting complex chronic condition criteria or if they were in active follow-up with the care coordination program. Revisits and total costs of care were compared over 2018 for included patients. RESULTS Seventy patients in the program were compared with 56 patients in the control group. On bivariate analysis, the median combined number of hospitalizations and ED visits in 2018 was lower among program participants (0 vs 1; P = .033), and program participation was associated with lower median total costs of care in 2018 ($700 vs $3200; P = .024). On multivariable analysis, care coordination program participation was associated with 59% fewer hospitalizations in 2018 (incidence rate ratio: 0.41; 95% confidence interval: 0.23 to 0.75; P = .004) but was not significantly associated with reduced ED visits or costs. CONCLUSIONS The care coordination program is a robust service spanning the continuum of patient care. We found program participation to be associated with reduced rehospitalization, which is an important driver of costs for children with medical complexity.
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Affiliation(s)
| | - Bennett Wall
- Vidant Medical Center, Greenville, North Carolina; and
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | | | - Lana Warren
- Vidant Medical Center, Greenville, North Carolina; and
| | - Kathy Deal
- Vidant Medical Center, Greenville, North Carolina; and
| | - Tara Stroud
- Vidant Medical Center, Greenville, North Carolina; and
| | - Kim Crickmore
- Vidant Medical Center, Greenville, North Carolina; and
| | - Matthew Ledoux
- Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, North Carolina
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9
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Robbins BW, McLaughlin S, Finn PW, Spencer AL, Coleman DL. Young Adults: Addressing the Health Needs of a Vulnerable Population. Am J Med 2020; 133:999-1002. [PMID: 32387083 DOI: 10.1016/j.amjmed.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Brett W Robbins
- Professor of Medicine and Pediatrics, Vice Chair for Education, Department of Medicine, Director, Medicine-Pediatrics Residency Program, University of Rochester, Rochester, NY.
| | - Suzanne McLaughlin
- Director, Medicine-Pediatrics Residency Program, Brown Medical School, Providence, RI
| | - Patricia W Finn
- Professor and Chair, Department of Medicine, Associate Dean for Strategic Initiatives, University of Illinois College of Medicine, Chicago
| | - Abby L Spencer
- Associate Professor of Medicine, Director, Internal Medicine Training Program, Vice Chair of Education-Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - David L Coleman
- Professor and Chair, Department of Medicine, Boston University School of Medicine, Boston, Mass
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10
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Zisman D, Samad A, Ardoin SP, Chira P, White P, Lavi I, von Scheven E, Lawson EF, Hing M, Mellins ED. US Adult Rheumatologists' Perspectives on the Transition Process for Young Adults With Rheumatic Conditions. Arthritis Care Res (Hoboken) 2020; 72:432-440. [PMID: 30740937 DOI: 10.1002/acr.23845] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 02/05/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the attitudes and common practices of adult rheumatologists in the US regarding health care transition (HCT) for young adults with rheumatic diseases. METHODS An anonymous online survey was sent to US adult rheumatologist members of the American College of Rheumatology to collect demographic data and information on attitudes and common practices regarding the transition process. RESULTS Of 4,064 contacted rheumatologists, 203 (5%) completed the survey. Almost half of respondents (45.1%) were never trained in transition practices, and 74.7% were not familiar with the American Academy of Pediatrics/American Academy of Family Physicians/American College of Physicians Consensus Statement About Transitions for Youth with Special Healthcare Needs. Only 56.2% felt comfortable caring for former pediatric patients. The vast majority of respondents (90.7%) did not have a multidisciplinary transition team, and 37% did not have a plan for transitioning pediatric patients into their practice. Most adult rheumatologists were unsatisfied with the current transition process (92.9%), due to insufficient resources, personnel (91.1%), and time in clinic (86.9%). They also were unsatisfied with referral data received concerning previous treatments (48.9%), hospitalization history (48%), disease activity index (45.1%), medical history summary (43.9%), comorbidities (36.4%), medication list (34.1%), and disease classification (32.6%). Three major barriers to HCT were lack of insurance reimbursement (33.7%), knowledge about community resources (30.8%), and lapses in care between primary provider and specialist (27.8%). CONCLUSION This survey identified substantial gaps in knowledge and resources regarding HCT for young adults with rheumatic diseases. These may be best addressed by further training, research, dedicated resources, adequate payment, and practice guidelines.
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Affiliation(s)
- Devy Zisman
- Carmel Medical Center and Technion, Haifa, Israel
| | - Aaida Samad
- Case Western Reserve University, Cleveland, Ohio
| | | | | | | | - Idit Lavi
- Carmel Medical Center, Haifa, Israel
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11
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LaRochelle JM, Smith KP, Benavides S, Bobo K, Chung AM, Farrington E, Kennedy A, Knoppert D, Lee B, Manasco KB, Pettit R, Phan H, Potts AL, Sandritter T, Hagemann T. Evidence demonstrating the pharmacist's direct impact on clinical outcomes in pediatric patients: An opinion of the pediatrics practice and research network of the American College of Clinical Pharmacy. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Joseph M. LaRochelle
- Xavier University of Louisiana College of Pharmacy and Louisiana State University School of Medicine New Orleans Louisiana
| | - Katherine P. Smith
- College of Pharmacy Roseman University of Health Sciences South Jordan Utah
| | | | - Kelly Bobo
- Le Bonheur Children's Hospital Memphis Tennessee
| | | | | | | | | | - Bernard Lee
- Mease Countryside Hospital, BayCare Health Safety Harbor Florida
| | | | - Rebecca Pettit
- Riley Hospital for Children Indiana University Health Indianapolis Indiana
| | - Hanna Phan
- The University of Arizona—Colleges of Pharmacy and Medicine Tucson Arizona
| | - Amy L. Potts
- Monroe Carell Jr. Children's Hospital at Vanderbilt Nashville Tennessee
| | | | - Tracy Hagemann
- College of Pharmacy University of Tennessee Nashville Tennessee
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12
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Lu M, Yee BJ, Fitzgerald DA. Transition to adult care in sleep medicine. Paediatr Respir Rev 2020; 33:9-15. [PMID: 31806562 DOI: 10.1016/j.prrv.2019.09.008] [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: 09/25/2019] [Accepted: 09/25/2019] [Indexed: 11/15/2022]
Abstract
More children with chronic and complex care needs are transitioned to adulthood due to advancements in medical technology including the use of non-invasive ventilation [NIV] at home and innovative medical therapies. Sleep medicine is becoming a common and at times vital component of the management plan. Various challenges are experienced in transitioning sleep patients depending on the underlying condition. These include the direct conflict between the desires of a young person for independence and their declining ability to provide self-care in neuromuscular patients, the behavioural challenges inherent in the management of children with various syndromes and the funding of equipment, care needs and multidisciplinary team input in an already resource limited adult setting. These patients should be transitioned in an early and coordinated approach following core principles of transition. Ongoing advocacy is required to raise awareness of the increased trend for technology supported young people being transitioned. Further research is required to track and assess the transition process in patients with various sleep conditions.
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Affiliation(s)
- Mimi Lu
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| | - Brendon J Yee
- Centre for Sleep and Chronobiology (CIRUS), Woolcock Institute of Medical Research, University of Sydney, New South Wales, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Garnett D, Hardy L, Fitzgerald E, Fisher T, Graham L, Overcash J. Nurse Case Manager: Measurement of Care Coordination Activities and Quality and Resource Use Outcomes When Caring for the Complex Patient With Hematologic Cancer. Clin J Oncol Nurs 2020; 24:65-74. [PMID: 31961839 DOI: 10.1188/20.cjon.65-74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The lack of coordination of care for complex patients in the hematology setting has prompted nurse case managers (NCMs) to coordinate that care. OBJECTIVES This article aimed to identify the frequency of NCM care coordination activities and quality and resource use outcomes in the complex care of patients in the hematology setting. METHODS NCM aggregate data from complex outpatients with hematologic cancer were retrieved from electronic health records at a comprehensive cancer center in the midwestern United States. Total volume of activities and outcomes were calculated as frequency and percentage. FINDINGS Care coordination activities included communicating; monitoring, following up, and responding to change; and creating a proactive plan of care. Quality outcomes included improving continuity of care and change in health behavior, and resource use outcomes most documented were patient healthcare cost savings.
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Affiliation(s)
- Doris Garnett
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| | | | | | - Taylor Fisher
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| | - Lisa Graham
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
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Komaromy M, Bartlett J, Gonzales-van Horn SR, Zurawski A, Kalishman SG, Zhu Y, Davis HT, Ceballos V, Sun X, Jurado M, Page K, Hamblin A, Arora S. A Novel Intervention for High-Need, High-Cost Medicaid Patients: a Study of ECHO Care. J Gen Intern Med 2020; 35:21-27. [PMID: 31667743 PMCID: PMC6957626 DOI: 10.1007/s11606-019-05206-0] [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: 01/19/2018] [Revised: 08/28/2018] [Accepted: 05/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND A small number of high-need patients account for a disproportionate amount of Medicaid spending, yet typically engage little in outpatient care and have poor outcomes. OBJECTIVE To address this issue, we developed ECHO (Extension for Community Health Outcomes) Care™, a complex care intervention in which outpatient intensivist teams (OITs) provided care to high-need high-cost (HNHC) Medicaid patients. Teams were supported using the ECHO model™, a continuing medical education approach that connects specialists with primary care providers for case-based mentoring to treat complex diseases. DESIGN Using an interrupted time series analysis of Medicaid claims data, we measured healthcare utilization and expenditures before and after ECHO Care. PARTICIPANTS ECHO Care served 770 patients in New Mexico between September 2013 and June 2016. Nearly all had a chronic mental illness, and over three-quarters had a chronic substance use disorder. INTERVENTION ECHO Care patients received care from an OIT, which typically included a nurse practitioner or physician assistant, a registered nurse, a licensed mental health provider, and at least one community health worker. Teams focused on addressing patients' physical, behavioral, and social issues. MAIN MEASURES We assessed the effect of ECHO Care on Medicaid costs and utilization (inpatient admissions, emergency department (ED) visits, other outpatient visits, and dispensed prescriptions. KEY RESULTS ECHO Care was associated with significant changes in patients' use of the healthcare system. At 12 months post-enrollment, the odds of a patient having an inpatient admission and an ED visit were each reduced by approximately 50%, while outpatient visits and prescriptions increased by 23% and 8%, respectively. We found no significant change in overall Medicaid costs associated with ECHO Care. CONCLUSIONS ECHO Care shifts healthcare utilization from inpatient to outpatient settings, which suggests decreased patient suffering and greater access to care, including more effective prevention and early intervention for chronic conditions.
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Affiliation(s)
- Miriam Komaromy
- Medical Director, Grayken Center for Addiction, Boston Medical Center, Boston University, 801 Massachusetts Ave, #1039, Boston, MA, 02118, USA.
| | - Judy Bartlett
- Division of General Internal Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA
| | | | - Andrea Zurawski
- University of New Mexico Health Sciences Center, ECHO Institute™, Albuquerque, NM, USA
| | - Summers G Kalishman
- University of New Mexico Health Sciences Center, ECHO Institute™, Albuquerque, NM, USA
| | - Yiliang Zhu
- Division of Epidemiology, Biostatistics and Prevention, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Herbert T Davis
- Division of Epidemiology, Biostatistics and Prevention, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Venice Ceballos
- University of New Mexico Health Sciences Center, ECHO Institute™, Albuquerque, NM, USA
| | - Xi Sun
- University of New Mexico Health Sciences Center, ECHO Institute™, Albuquerque, NM, USA
| | - Martin Jurado
- University of New Mexico Health Sciences Center, ECHO Institute™, Albuquerque, NM, USA
| | - Kimberly Page
- Division of Epidemiology, Biostatistics and Prevention, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | | | - Sanjeev Arora
- University of New Mexico Health Sciences Center, ECHO Institute™, Albuquerque, NM, USA
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Brenner M, O'Shea MP, Larkin P, Luzi D, Pecoraro F, Tamburis O, Berry J, Alexander D, Rigby M, Blair M. Management and integration of care for children living with complex care needs at the acute-community interface in Europe. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 2:822-831. [PMID: 30336896 DOI: 10.1016/s2352-4642(18)30272-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/30/2018] [Accepted: 08/07/2018] [Indexed: 01/10/2023]
Abstract
With improvements in neonatal and paediatric care, more children living with complex care needs are surviving beyond infancy into late childhood and adulthood than in the past. We examined the current approach to the management and integration of care of children living with complex care needs in 30 European countries, as well as the implications for primary care service delivery. This descriptive study, with an embedded qualitative aspect, consisted of questions adapted from the Standards for Systems of Care for Children and Youth with Special Health Care Needs, and included questions on a complex care European survey of change, adapted from the Eurobarometer survey. The analysis indicates that few systems are in place in countries across Europe to identify all the health-care providers who deliver care to a child living with complex care needs, and that less than half of all countries surveyed have policies in place to support care coordination for these children. Primary care physicians have little involvement in care planning for children before their discharge to the community setting, and there is little parental participation in policy development. Access to, and governance of, care for these children varies widely. Particular issues identified pertain to parents as catalysts of optimum integration of care, pathways to specialist care, and the need for comprehensive national integrated care programmes.
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Affiliation(s)
- Maria Brenner
- School of Nursing & Midwifery, Trinity College Dublin, University of Dublin, Dublin, Ireland.
| | - Miriam P O'Shea
- School of Nursing & Midwifery, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Philip Larkin
- Lausanne University Medical Centre, Lausanne, Switzerland
| | - Daniela Luzi
- Institute for Research on Population and Social Policies, Italian National Research Council, Rome, Italy
| | - Fabrizio Pecoraro
- Institute for Research on Population and Social Policies, Italian National Research Council, Rome, Italy
| | - Oscar Tamburis
- Institute for Research on Population and Social Policies, Italian National Research Council, Rome, Italy
| | - Jay Berry
- Department of Medicine and Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Denise Alexander
- Imperial College of Science, Technology, and Medicine, London, UK
| | - Michael Rigby
- Section of Paediatrics, Faculty of Medicine, Imperial College of Science, Technology, and Medicine, London, UK
| | - Mitch Blair
- Section of Paediatrics, Faculty of Medicine, Imperial College of Science, Technology, and Medicine, London, UK
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White PH, Cooley WC, Boudreau ADA, Cyr M, Davis BE, Dreyfus DE, Forlenza E, Friedland A, Greenlee C, Mann M, McManus M, Meleis AI, Pickler L. Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home. Pediatrics 2018; 142:peds.2018-2587. [PMID: 30348754 DOI: 10.1542/peds.2018-2587] [Citation(s) in RCA: 415] [Impact Index Per Article: 69.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Risk and vulnerability encompass many dimensions of the transition from adolescence to adulthood. Transition from pediatric, parent-supervised health care to more independent, patient-centered adult health care is no exception. The tenets and algorithm of the original 2011 clinical report, "Supporting the Health Care Transition from Adolescence to Adulthood in the Medical Home," are unchanged. This updated clinical report provides more practice-based quality improvement guidance on key elements of transition planning, transfer, and integration into adult care for all youth and young adults. It also includes new and updated sections on definition and guiding principles, the status of health care transition preparation among youth, barriers, outcome evidence, recommended health care transition processes and implementation strategies using quality improvement methods, special populations, education and training in pediatric onset conditions, and payment options. The clinical report also includes new recommendations pertaining to infrastructure, education and training, payment, and research.
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Affiliation(s)
- Patience H. White
- Got Transition/The National Alliance to Advance Adolescent Health and Department of Medicine and Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia; and
| | - W. Carl Cooley
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
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Sundaresan AS, Schneider G, Reynolds J, Kirchner HL. Identifying Asthma Exacerbation-Related Emergency Department Visit Using Electronic Medical Record and Claims Data. Appl Clin Inform 2018; 9:528-540. [PMID: 30040112 PMCID: PMC6051766 DOI: 10.1055/s-0038-1666994] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background
Asthma exacerbation leading to emergency department (ED) visit is prevalent, an indicator of poor control of asthma, and is a potentially preventable clinical outcome.
Objective
We propose to utilize multiple data elements available in electronic medical records (EMRs) and claims database to create separate algorithms with high validity for clinical and research purposes to identify asthma exacerbation-related ED visit among the general population.
Methods
We performed a retrospective study with inclusion criteria of patients aged 4 to 40 years, a visit to Geisinger ED from January 1, 2006, to October 28, 2013, with asthma on their problem list. Different electronic data elements including chief complaints, vitals, season, smoking, medication use, and discharge diagnoses were obtained to create the algorithm. A stratified random sample was generated to select the charts for review. Chart review was performed to classify patients with asthma-related ED visit, that is, the gold standard. Two reviewers performed the chart review and validation was done on a small subset.
Results
There were 966 eligible ED visits in the EMR sample and 731 in the claims sample. Agreement between reviewers was 95.45% and kappa statistic was 0.91. Mean age of the EMR sample was 22 years, and mostly white (93%). Multiple models conventionally used in studies were evaluated and the final model chosen included principal diagnosis, bronchodilator, and steroid use for both algorithms, chief complaints for EMR, and secondary diagnosis for claims. Area under the curve was 0.93 (95% confidence interval: 0.91–0.94) and 0.94 (0.93–0.96), respectively, for EMR and claims data, with positive predictive value of > 94%. The algorithms are visually presented using nomograms.
Conclusion
We were able to develop two separate algorithms for EMR and claims to identify asthma exacerbation-related ED visit with excellent diagnostic ability and varying discrimination threshold for clinical and research purposes.
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Affiliation(s)
- Agnes S Sundaresan
- Department of Epidemiology and Health Services Research, Geisinger Health System, Danville, Pennsylvania, United States.,Medicine Institute, Geisinger Health System, Danville, Pennsylvania, United States
| | - Gargi Schneider
- MedPeds Program, Geisinger Medical Center, Danville, Pennsylvania, United States
| | - Joy Reynolds
- Lewis Katz School of Medicine at Temple University, Temple University, Philadelphia, Pennsylvania, United States
| | - H Lester Kirchner
- Department of Biomedical and Translational Informatics, Geisinger Health System, Danville, Pennsylvania, United States.,Department of Clinical Sciences, Geisinger Commonwealth School of Medicine, Geisinger Health System, Scranton, Pennsylvania, United States.,Department of Pediatrics, Global and Immigrant Health Section, Baylor College of Medicine, Houston, Texas, United States
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Lestishock L, Daley AM, White P. Pediatric Nurse Practitioners' Perspectives on Health Care Transition From Pediatric to Adult Care. J Pediatr Health Care 2018; 32:263-272. [PMID: 29336920 DOI: 10.1016/j.pedhc.2017.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 11/24/2017] [Accepted: 11/28/2017] [Indexed: 12/16/2022]
Abstract
INTRODUCTION This study examined the perspectives of pediatric nurse practitioners (PNPs) regarding the needs of adolescents, parents/caregivers, clinicians, and institutions in the health care transition (HCT) process for adolescents/young adults. METHODS PNPs (N = 170) participated in a luncheon for those interested in transition at an annual conference. Small groups discussed and recorded their perspectives related to health care transition from adolescent to adult services. Content analysis was used to analyze responses (Krippendorff, 2013). RESULTS Four themes, Education, Health care system, Support, and Communication, emerged from the data analysis. PNPs identified health care informatics and adolescents' use of technology as additional critical aspects to be considered in health care transition. DISCUSSION Opportunities and challenges identified by the PNPs are discussed to improve the quality and process of transitioning adolescents to adult services. This report will help National Association of Pediatric Nurse Practitioners formulate a new Health Care Transition Policy Statement for the organization.
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Mazur A, Dembinski L, Schrier L, Hadjipanayis A, Michaud PA. European Academy of Paediatric consensus statement on successful transition from paediatric to adult care for adolescents with chronic conditions. Acta Paediatr 2017; 106:1354-1357. [PMID: 28471516 DOI: 10.1111/apa.13901] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/06/2017] [Accepted: 04/28/2017] [Indexed: 11/28/2022]
Abstract
Around one in ten adolescents suffer from chronic conditions and disabilities, and the transition from paediatric to adult care can be particularly challenging. Unplanned transfers can complicate education, work and health and result in patients being lost to follow-up, poor treatment adherence and more frequent hospitalisation. The Adolescent Health and Medicine Working Group of the European Academy of Paediatrics has developed a consensus statement for a successful transition. CONCLUSION This statement will help paediatricians, adult care specialists, policymakers and other stakeholders to handle chronic care transitions so that they meet the expectations and needs of adolescents and their families.
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Affiliation(s)
- Artur Mazur
- Medical Faculty; University of Rzeszow; Rzeszow Poland
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