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Sharma P, Kularatna S, Abell B, McPhail SM, Senanayake S. Preferences for Neurodevelopmental Follow-Up Care for Children: A Discrete Choice Experiment. THE PATIENT 2024:10.1007/s40271-024-00717-3. [PMID: 39210193 DOI: 10.1007/s40271-024-00717-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/18/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Identifying and addressing neurodevelopmental delays in children can be challenging for families and the healthcare system. Delays in accessing services and early interventions are common. The design and delivery of these services, and associated outcomes for children, may be improved if service provision aligns with families' needs and preferences for receiving care. The aim of this study is to identify families' preferences for neurodevelopmental follow-up care for children using an established methodology. METHODS We used a discrete choice experiment (DCE) to elicit families' preferences. We collected data from families and caregivers of children with neurodevelopmental needs. The DCE process included four stages. In stage 1, we identified attributes and levels to be included in the DCE using literature review, interviews, and expert advice. The finalised attributes were location, mode of follow-up, out-of-pocket cost per visit, mental health counselling for parents, receiving educational information, managing appointments, and waiting time. In stage 2, we generated choice tasks that contained two alternatives and a 'neither' option for respondents to choose from, using a Bayesian d-efficient design. These choice tasks were compiled in a survey that also included demographic questions. We conducted pre- and pilot tests to ensure the functionality of the survey and obtain priors. In stage 3, the DCE survey was administered online. We received 301 responses. In stage 4, the analysis was conducted using a latent class model. Additionally, we estimated the relative importance of attributes and performed a scenario analysis. RESULTS Two latent classes were observed. More families with full-time employees, higher incomes, postgraduate degrees, and those living in metropolitan areas were in class 1 compared with class 2. Class 1 families preferred accessing local public health clinics, face-to-face follow-up, paying AUD100 to AUD500, mental health support, group educational activities, health service-initiated appointments, and waiting < 3 months. Class 2 families disliked city hospitals when compared with private, preferred paying AUD100 or no cost, and had similar preferences regarding mental health support and wait times as class 1. However, no significant differences were noted in follow-up modality, receiving educational information, and appointment management. The relative importance estimation suggested that location was most important for class 1 (28%), whereas for class 2, cost accounted for nearly half of the importance when selecting an alternative. The expected uptake of follow-up care, estimated under three different hypothetical scenarios, may increase by approximately 24% for class 2 if an 'ideal' scenario taking into account preferences was implemented. CONCLUSION This study offers insights into aspects that may be prioritised by health services and policymakers to improve the design and delivery of neurodevelopmental follow-up care for children. The findings may enhance the organisation and functioning of existing care programmes; and therefore, improve the long-term outcomes of children with neurodevelopmental needs and their families.
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Affiliation(s)
- Pakhi Sharma
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia.
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Bridget Abell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia
- Digital Health and Informatics Directorate, Metro South Health, Brisbane, QLD, Australia
| | - Sameera Senanayake
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
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Abell B, Rodwell D, Eagleson KJ, Parsonage W, Auld B, Bora S, Kasparian NA, Justo R, McPhail SM. "It's more than just a conversation about the heart": exploring barriers, enablers, and opportunities for improving the delivery and uptake of cardiac neurodevelopmental follow-up care. Front Pediatr 2024; 12:1364190. [PMID: 38863525 PMCID: PMC11165703 DOI: 10.3389/fped.2024.1364190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/08/2024] [Indexed: 06/13/2024] Open
Abstract
Introduction Surveillance, screening, and evaluation for neurodevelopmental delays is a pivotal component of post-surgical care for children with congenital heart disease (CHD). However, challenges exist in implementing such neurodevelopmental follow-up care in international practice. This study aimed to characterise key barriers, enablers, and opportunities for implementing and delivering outpatient cardiac neurodevelopmental follow-up care in Australia. Methods an exploratory descriptive qualitative study was conducted with healthcare professionals across Australia who had lived experience of designing, implementing, or delivering neurodevelopmental care for children with CHD. Online semi-structured interviews were conducted using a guide informed by the Consolidated Framework for Implementation Research to explore contextual influences. Interview transcripts were analysed using a rapid qualitative approach including templated summaries and hybrid deductive-inductive matrix analysis. Results fifty-two participants were interviewed. Perceived barriers and enablers were organised into six higher-order themes: factors in the broader environmental, economic, and political context; healthcare system factors; organisational-level factors; provider factors; patient and family factors; and care model factors. The largest number of barriers occurred at the healthcare system level (service accessibility, fragmentation, funding, workforce), while service providers demonstrated the most enabling factors (interprofessional relationships, skilled teams, personal characteristics). Strategies to improve practice included building partnerships; generating evidence; increasing funding; adapting for family-centred care; and integrating systems and data. Discussion Australia shares many similar barriers and enablers to cardiac neurodevelopmental care with other international contexts. However, due to unique geographical and health-system factors, care models and implementation strategies will require adaption to the local context to improve service provision.
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Affiliation(s)
- Bridget Abell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Facultyof Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - David Rodwell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Facultyof Health, Queensland University of Technology, Brisbane, QLD, Australia
- Centre for Accident Research & Road Safety—Queensland (CARRS-Q), School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Karen J. Eagleson
- Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, South Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - William Parsonage
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Facultyof Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Ben Auld
- Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, South Brisbane, QLD, Australia
| | - Samudragupta Bora
- Health Services Research Center, University Hospitals Research & Education Institute and Department of Pediatrics, University Hospitals Rainbow Babies & Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Nadine A. Kasparian
- Heart and Mind Wellbeing Center, Heart Institute and the Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Robert Justo
- Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, South Brisbane, QLD, Australia
| | - Steven M. McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Facultyof Health, Queensland University of Technology, Brisbane, QLD, Australia
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Abell BR, Eagleson K, Auld B, Bora S, Justo R, Parsonage W, Sharma P, Kularatna S, McPhail SM. Implementing neurodevelopmental follow-up care for children with congenital heart disease: A scoping review with evidence mapping. Dev Med Child Neurol 2024; 66:161-175. [PMID: 37421232 PMCID: PMC10953404 DOI: 10.1111/dmcn.15698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/04/2023] [Accepted: 06/07/2023] [Indexed: 07/10/2023]
Abstract
AIM To identify and map evidence describing components of neurodevelopmental follow-up care for children with congenital heart disease (CHD). METHOD This was a scoping review of studies reporting components of neurodevelopmental follow-up programmes/pathways for children with CHD. Eligible publications were identified through database searches, citation tracking, and expert recommendations. Two independent reviewers screened studies and extracted data. An evidence matrix was developed to visualize common characteristics of care pathways. Qualitative content analysis identified implementation barriers and enablers. RESULTS The review included 33 studies. Twenty-one described individual care pathways across the USA (n = 14), Canada (n = 4), Australia (n = 2), and France (n = 1). The remainder reported surveys of clinical practice across multiple geographical regions. While heterogeneity in care existed across studies, common attributes included enrolment of children at high-risk of neurodevelopmental delay; centralized clinics in children's hospitals; referral before discharge; periodic follow-up at fixed ages; standardized developmental assessment; and involvement of multidisciplinary teams. Implementation barriers included service cost/resourcing, patient burden, and lack of knowledge/awareness. Multi-level stakeholder engagement and integration with other services were key drivers of success. INTERPRETATION Defining components of effective neurodevelopmental follow-up programmes and care pathways, along with enhancing and expanding guideline-based care across regions and into new contexts, should continue to be priorities. WHAT THIS PAPER ADDS Twenty-two different neurodevelopmental follow-up care pathways/programmes were published, originating from four countries. Twelve additional publications described broad practices for neurodevelopmental follow-up across regions Common attributes across eligibility, service structure, assessment processes, and care providers were noted. Studies reported programme acceptability, uptake, cost, and effectiveness. Implementation barriers included service cost/resourcing, patient burden, and lack of knowledge/awareness.
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Affiliation(s)
- Bridget R. Abell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of HealthQueensland University of TechnologyBrisbaneQLDAustralia
| | - Karen Eagleson
- Queensland Paediatric Cardiac ServiceQueensland Children's HospitalBrisbaneQLDAustralia
- Faculty of MedicineThe University of QueenslandBrisbaneQLDAustralia
| | - Benjamin Auld
- Queensland Paediatric Cardiac ServiceQueensland Children's HospitalBrisbaneQLDAustralia
| | - Samudragupta Bora
- Faculty of MedicineThe University of QueenslandBrisbaneQLDAustralia
- University Hospitals Rainbow Babies & Children's HospitalCase Western Reserve University School of MedicineClevelandOHUSA
| | - Robert Justo
- Queensland Paediatric Cardiac ServiceQueensland Children's HospitalBrisbaneQLDAustralia
- Faculty of MedicineThe University of QueenslandBrisbaneQLDAustralia
| | - William Parsonage
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of HealthQueensland University of TechnologyBrisbaneQLDAustralia
- Royal Brisbane and Women's HospitalMetro North HealthBrisbaneQLDAustralia
| | - Pakhi Sharma
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of HealthQueensland University of TechnologyBrisbaneQLDAustralia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of HealthQueensland University of TechnologyBrisbaneQLDAustralia
| | - Steven M. McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of HealthQueensland University of TechnologyBrisbaneQLDAustralia
- Digital Health and Informatics Directorate, Metro South HealthBrisbaneQLDAustralia
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Bolduc ME, Rennick JE, Gagnon I, Sokol E, Majnemer A, Brossard-Racine M. Navigating the healthcare system with my child with CHD: parental perspectives on developmental follow-up practices. Cardiol Young 2024; 34:37-43. [PMID: 37138527 DOI: 10.1017/s1047951123001051] [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: 05/05/2023]
Abstract
BACKGROUND Parents of children with CHD face several barriers when trying to access the services needed to support their child's development. In fact, current developmental follow-up practices may not identify developmental challenges in a timely manner and important opportunities for interventions may be lost. This study aimed to explore the perspectives of parents of children and adolescents with CHD with respect to developmental follow-up in Canada. METHODS Interpretive description was used as a methodological approach for this qualitative study. Parents of children aged 5-15 years with complex CHD were eligible. Semi-structured interviews that aimed to explore their perspectives regarding their child's developmental follow-up were conducted. RESULTS Fifteen parents of children with CHD were recruited for this study. They expressed that the lack of systematic and responsive developmental follow-up services and limited access to resources to support their child's development placed an undue burden on their families, and as a result, they needed to assume new roles as case managers or advocates to address these limitations. This additional burden resulted in a high level of parental stress, which, in turn, affected the parent-child relationship and siblings. CONCLUSIONS The limitations of the current Canadian developmental follow-up practices put undue pressure on the parents of children with complex CHD. The parents stressed the importance of implementing a universal and systematic approach to developmental follow-up to allow for the timely identification of challenges, enabling the initiation of interventions and supports and promoting more positive parent-child relationships.
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Affiliation(s)
- Marie-Eve Bolduc
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Janet E Rennick
- Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Nursing, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada
- Ingram School of Nursing, McGill University, Montreal, Canada
- Department of Pediatrics, McGill University, Montreal, Canada
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Eva Sokol
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Annette Majnemer
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Pediatrics, McGill University, Montreal, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Marie Brossard-Racine
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Pediatrics, McGill University, Montreal, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
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Verrall CE, Tran DL, Yang JYM, Lubans DR, Winlaw DS, Ayer J, Celermajer D, Cordina R. Exercise as therapy for neurodevelopmental and cognitive dysfunction in people with a Fontan circulation: A narrative review. Front Pediatr 2023; 11:1111785. [PMID: 36861078 PMCID: PMC9969110 DOI: 10.3389/fped.2023.1111785] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/25/2023] [Indexed: 02/15/2023] Open
Abstract
People with a Fontan circulation are at risk of neurodevelopmental delay and disability, and cognitive dysfunction, that has significant implications for academic and occupational attainment, psychosocial functioning, and overall quality of life. Interventions for improving these outcomes are lacking. This review article discusses current intervention practices and explores the evidence supporting exercise as a potential intervention for improving cognitive functioning in people living with a Fontan circulation. Proposed pathophysiological mechanisms underpinning these associations are discussed in the context of Fontan physiology and avenues for future research are recommended.
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Affiliation(s)
- Charlotte Elizabeth Verrall
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Derek Lee Tran
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia.,Charles Perkins Centre, Heart Research Institute, Sydney, NSW, Australia
| | - Joseph Yuan-Mou Yang
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Neuroscience Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Department of Neurosurgery, Neuroscience Advanced Clinical Imaging Service (NACIS), Royal Children's Hospital, Melbourne, VIC, Australia
| | - David Revalds Lubans
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - David Scott Winlaw
- Cardiothoracic Surgery, the Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Julian Ayer
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - David Celermajer
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia.,Charles Perkins Centre, Heart Research Institute, Sydney, NSW, Australia
| | - Rachael Cordina
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia.,Charles Perkins Centre, Heart Research Institute, Sydney, NSW, Australia.,Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
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Anthony L, Hilder A, Newcomb D, Webb KL, Best J, Stocker C, Long D. General practitioner perspectives on a shared-care model for paediatric patients post-intensive care: A cross-sectional survey. Aust Crit Care 2022:S1036-7314(22)00098-4. [DOI: 10.1016/j.aucc.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/26/2022] [Accepted: 07/23/2022] [Indexed: 11/07/2022] Open
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Eagleson K, Justo R. Lessons From the Queensland Paediatric Cardiac Service Neurodevelopmental Follow-up Programme. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2022; 1:101-104. [PMID: 37970490 PMCID: PMC10642086 DOI: 10.1016/j.cjcpc.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 04/30/2022] [Indexed: 11/17/2023]
Affiliation(s)
- Karen Eagleson
- Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, Children’s Hospital and Health Service, Brisbane, Queensland, Australia
- Faculty of Medicine, the University of Queensland, Brisbane, Queensland, Australia
| | - Robert Justo
- Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, Children’s Hospital and Health Service, Brisbane, Queensland, Australia
- Faculty of Medicine, the University of Queensland, Brisbane, Queensland, Australia
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John AS, Jackson JL, Moons P, Uzark K, Mackie AS, Timmins S, Lopez KN, Kovacs AH, Gurvitz M. Advances in Managing Transition to Adulthood for Adolescents With Congenital Heart Disease: A Practical Approach to Transition Program Design: A Scientific Statement From the American Heart Association. J Am Heart Assoc 2022; 11:e025278. [PMID: 35297271 PMCID: PMC9075425 DOI: 10.1161/jaha.122.025278] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is now expected that most individuals with congenital heart disease will survive to adulthood, including those with complex heart conditions. Maintaining lifelong medical care requires those with congenital heart disease to eventually transfer from pediatric to adult-oriented health care systems. Developing health care transition skills and gaining independence in managing one's own health care is imperative to this process and to ongoing medical and psychosocial success. This scientific statement reviews the recent evidence regarding transition and provides resources, components, and suggestions for development of congenital heart disease transition programs with the goals of improving patient knowledge, self-management, and self-efficacy skills to the level they are capable to eventually integrate smoothly into adult-oriented health care. Specifically, the scientific statement updates 3 sections relevant to transition programming. First, there is a review of specific factors to consider, including social determinants of health, psychosocial well-being, and neurocognitive status. The second section reviews costs of inadequate transition including the public health burden and the impairment in individual quality of life. Finally, the last section discusses considerations and suggestions for transition program design including communication platforms, a family-centered approach, and individual models. Although this scientific statement reviews recent literature surrounding transitions of care for individuals with congenital heart disease there remain significant knowledge gaps. As a field, we have yet to determine ideal timing and methods of transition, and barriers to transition and transfer remain, particularly for the underserved populations. The consequences of poor health care transition are great and garnering outcomes and information through organized, multifaceted, collaborative approaches to transition is critical to improving the lifelong care of individuals with congenital heart disease.
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Long DA, Fink EL. Transitions from short to long-term outcomes in pediatric critical care: considerations for clinical practice. Transl Pediatr 2021; 10:2858-2874. [PMID: 34765507 PMCID: PMC8578758 DOI: 10.21037/tp-21-61] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/09/2021] [Indexed: 11/06/2022] Open
Abstract
Most children are surviving critical illness in highly resourced pediatric intensive care units (PICUs). However, in research studies, many of these children survive with multi-domain health sequelae that has the potential to affect development over many years, termed post-intensive care syndrome-pediatrics (PICS-p). Clinically, there are no recommendations for the assessment and follow-up of children with critical illness as exists for the premature neonatal and congenital heart disease populations. In research studies, primary and secondary outcomes are largely assessed at or prior to hospital discharge, disregarding post-hospital outcomes important to PICU stakeholders. Incorporating longer term outcomes into clinical and research programs, however, can no longer be overlooked. Barriers to outcomes assessments are varied and generalized vs. individualized, but some PICU centers are discovering how to overcome them and are providing this service to families-sometimes specific populations-in need. Research programs and funders are increasingly recognizing the value and need to assess long-term outcomes post-PICU. Finally, we should seek the strong backing of the PICU community and families to insist that long-term outcomes become our new clinical standard of care. PICUs should consider development of a multicenter, multinational collaborative to assess clinical outcomes and optimize care delivery and patient and family outcomes. The aim of this review is to present the potential considerations of implementing long-term clinical follow-up following pediatric critical illness.
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Affiliation(s)
- Debbie A. Long
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
- Pediatric Intensive Care Unit, Queensland Children’s Hospital, Brisbane, Queensland, Australia
| | - Ericka L. Fink
- Division of Pediatric Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
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Commentary on "Motor Developmental Delay After Cardiac Surgery in Children With a Critical Congenital Heart Defect: A Systematic Literature Review and Meta-analysis". Pediatr Phys Ther 2021; 33:198-199. [PMID: 34618743 DOI: 10.1097/pep.0000000000000839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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