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Loura D, Ferreira AM, Romeiro J, Charepe Z. Health-illness transition processes in children with complex chronic conditions and their parents: a scoping review. BMC Pediatr 2024; 24:446. [PMID: 38992610 PMCID: PMC11238377 DOI: 10.1186/s12887-024-04919-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/01/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND The prevalence of complex chronic conditions (CCC), which cause serious limitations and require specialized care, is increasing. The diagnosis of a CCC is a health-illness transition for children and their parents, representing a long-term change leading to greater vulnerability. Knowing the characteristics of these transitional processes is important for promoting safe transitions in this population. This scoping review aimed to map the available evidence on health-illness transition processes in children with complex chronic conditions and their parents in the context of healthcare. METHODS Six databases were searched for studies focusing on children aged 0-21 years with CCC and their parents experiencing health-illness transition processes, particularly concerning adaptation to illness and continuity of care, in the context of healthcare. Studies within this scope carried out between 2013 and 2023 and written in Portuguese or English were identified. The articles were selected using the PRISMA methodology. The data were extracted to an instrument and then presented with a synthesizing approach supporting the interpretation of the results. RESULTS Ninety-eight methodologically broad but predominantly qualitative articles were included in this review. Children with CCC have specific needs associated with complex and dynamic health-illness transitions with a multiple influence in their daily lives. Several facilitating factors (p.e. positive communication and a supportive therapeutic relationship with parents and professionals, as well as involvement in a collaborative approach to care), inhibiting factors (p.e. the complexity of the disease and therapeutic regime, as well as the inefficient organization and coordination of teams) and both positive (p.e. well-being and better quality of life) and negative response patterns (p.e. negative feelings about the chronic illness) were identified. Some interventions to support the transitional process also emerged from the literature. Pediatric palliative care is seen as a good practice and an integrative approach for these children and families. CONCLUSION Health professionals play a fundamental role in supporting the transitional process and promoting positive response patterns. More significant investment is needed at the clinical and academic levels regarding production and dissemination of knowledge in this area to ensure the awareness of children with CCC and that their needs are fully enhanced. REVIEW REGISTRATION https://doi.org/10.17605/OSF.IO/QRZC8 .
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Affiliation(s)
- David Loura
- Local Health Unit of São José, Dona Estefânia Hospital, St. Jacinta Marto, N. 8A, 1150-192, Lisbon, Portugal.
- Faculty of Health Sciences and Nursing, Catholic University of Portugal, Lisbon, Portugal.
| | - Ana Margarida Ferreira
- Faculty of Health Sciences and Nursing, Catholic University of Portugal, Lisbon, Portugal
- Local Health Unit of Arco Ribeirinho, Nossa Senhora Do Rosário Hospital, Setúbal, Portugal
| | - Joana Romeiro
- Faculty of Health Sciences and Nursing, Catholic University of Portugal, Lisbon, Portugal
- Center for Interdisciplinary Health Research (CIIS), Lisbon, Portugal
- Catholic University of Portugal, Postdoc-Fellowship Program in Integral Human Development (IHD), CADOS, Lisbon, Portugal
| | - Zaida Charepe
- Faculty of Health Sciences and Nursing, Catholic University of Portugal, Lisbon, Portugal
- Center for Interdisciplinary Health Research (CIIS), Lisbon, Portugal
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Pérez-Ardanaz B, Gutiérrez-Rodríguez L, Pelaez-Cantero MJ, Morales-Asencio JM, Gómez-González A, García-Piñero JM, Lupiañez-Perez I. Healthcare service use for children with chronic complex diseases: A longitudinal six-year follow-up study. J Pediatr Nurs 2024; 77:e132-e138. [PMID: 38594165 DOI: 10.1016/j.pedn.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE The objective was analysed the patterns use of healthcare services of this population and the influence of their clinical and sociodemographic characteristics. DESIGN AND METHODS A six-year longitudinal follow-up study was performed to evaluate the annual healthcare resources use and clinical data among children with complex chronic diseases in Spain between 2015 and 2021. The sample trends in healthcare usage and the associated factors were analysed using ANCOVA and multivariable linear regression models. RESULTS Patients had high attendance during the follow-up period, with >15 episodes year. This trend decreased over time, especially in children with oncological diseases compared with other diseases (F (16.75; 825.4) = 32.457; p < 0.001). A multivariable model showed that children with a greater number of comorbidities (β = 0.17), shorter survival time (β = -0.23), who had contact with the palliative care unit (β = 0.16), and whose mothers had a higher professional occupation (β = 0.14), had a greater use of the healthcare system. CONCLUSIONS Children with a higher number of comorbidities and the use of medical devices made a greater frequentation of health services, showing a trend of decreasing use over time. Socioeconomic factors such as mothers' occupational status determine healthcare frequentation. These results suggest the existence of persistent gaps in care coordination sustained over time. PRACTICAL IMPLICATIONS Systematized and coordinated models of care for this population should consider the presence of inequalities in health care use.
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Affiliation(s)
- Bibiana Pérez-Ardanaz
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Instituto de Investigación Biomédica de Málaga-Bionand (IBIMA), Spain.
| | - Laura Gutiérrez-Rodríguez
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Instituto de Investigación Biomédica de Málaga-Bionand (IBIMA), Spain.
| | | | - José Miguel Morales-Asencio
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Instituto de Investigación Biomédica de Málaga-Bionand (IBIMA), Spain.
| | - Alberto Gómez-González
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Instituto de Investigación Biomédica de Málaga-Bionand (IBIMA), Spain.
| | - José Miguel García-Piñero
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Pediatric Intensive Care Unit, Hospital Materno-Infantil, Málaga, Spain
| | - Inmaculada Lupiañez-Perez
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Instituto de Investigación Biomédica de Málaga-Bionand (IBIMA), Spain.
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de Pins AM, Adu-Amankwah D, Shadman KA, Hess SM, Elaiho CR, Butler LR, Ranade SC, Shah BJ, Fields R, Lin EP. A Quality Improvement Project to Improve After-visit Summary Patient Instructions in a Pediatric Multidisciplinary Neuromuscular Program. Pediatr Qual Saf 2024; 9:e743. [PMID: 38993270 PMCID: PMC11236396 DOI: 10.1097/pq9.0000000000000743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/25/2024] [Indexed: 07/13/2024] Open
Abstract
Introduction Multidisciplinary clinics aim to coordinate care between multiple specialties for children with medical complexity yet may result in information overload for caregivers. The after-visit summary (AVS) patient instruction section offers a solution by summarizing visit details and recommendations. No known studies address patient instruction optimization and integration within a multidisciplinary clinic setting. This project aimed to improve the quality of patient instructions to support better postvisit communication between caregivers and providers in a multidisciplinary pediatric neuromuscular program. Methods A multidisciplinary stakeholder team created a key driver diagram to improve postvisit communication between caregivers and providers in the clinic. The first specific aim was to achieve an 80% completion rate of AVS patient instructions within 6 months. To do so, a standardized electronic medical record "text shortcut" was created for consistent information in each patient's instructions. Feedback on AVS from caregivers was obtained using the Family Experiences with Coordination of Care survey and open-ended interviews. This feedback informed the next specific aim: to reduce medical jargon within patient instructions by 25% over 3 months. Completion rates and jargon use were reviewed using control charts. Results AVS patient instruction completion rates increased from a mean of 39.4%-85.0%. Provider education reduced mean jargon usage in patient instructions, from 8.2 to 3.9 jargon terms. Conclusions Provider education and caregiver feedback helped improve patient communication by enhancing AVS compliance and diminishing medical jargon. Interventions to improve AVS patient instructions may enhance patient communication strategies for complex medical visits.
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Affiliation(s)
- Agathe M de Pins
- From the Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, N.Y
| | - Dorothy Adu-Amankwah
- From the Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, N.Y
| | - Kristin A Shadman
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Skylar M Hess
- From the Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, N.Y
| | | | - Liam R Butler
- From the Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, N.Y
| | - Sheena C Ranade
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, N.Y
| | - Brijen J Shah
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, N.Y
| | | | - Elaine P Lin
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Mass
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Harris KW, Ray KN, Yu J. Family Caregivers of Children With Medical Complexity: Changes in Health-Related Quality of Life and Experiences of Care Coordination. Acad Pediatr 2024; 24:605-612. [PMID: 38061581 PMCID: PMC11056298 DOI: 10.1016/j.acap.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 11/17/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE Examine the longitudinal association between family experiences of care coordination (FECC) and health-related quality of life (HR-QOL) for family caregivers of children with medical complexity (CMC). METHODS A longitudinal survey of family caregivers of CMC was completed between July 2018 and June 2020. Baseline data were collected at initial contact with a regional complex care center; follow-up data were collected 12 to 16 months later. Assessed receipt of care coordination and caregiver HR-QOL via FECC questionnaire and Center for Disease Control's HR-QOL-14 measure, respectively. Baseline and follow-up results were compared via McNemar's and Wilcoxon signed-rank tests. Relationships between changes in FECC and changes in HR-QOL were examined using multivariable logistic regression. RESULTS Of 185 eligible, 136 caregivers enrolled and completed baseline surveys (74%) and 103 (76% initial sample) follow-up surveys. Caregivers reported significant improvements in 8 of 9 FECC measures after 1 year of care within a complex care center (all P < .05). In contrast, caregiver HR-QOL (general health status, unhealthy days, symptom days) remained stable over the study period (all P > .05) except for monthly days of poor sleep (baseline vs follow-up median; 16 vs 15 [P = .05]). At both timepoints, >20% participants rated their general health status as fair-to-poor, and >50% reported frequent poor sleep and fatigue. No significant associations were observed between changes in FECC and changes in HR-QOL. CONCLUSIONS After receiving 1 year of care through a complex care center, CMC family caregivers report improvement in care coordination but not in HR-QOL. Caregivers' continued mentally unhealthy days and negative mental symptom days highlight the need for a directed intervention.
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Affiliation(s)
- Kelly W Harris
- Division of Palliative Medicine and Supportive Care (KW Harris and J Yu), Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pa.
| | - Kristin N Ray
- Division of General Academic Pediatrics (KN Ray), Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pa.
| | - Justin Yu
- Division of Palliative Medicine and Supportive Care (KW Harris and J Yu), Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pa.
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Williams V, Franco-Rowe C, Lopez C, Allison MA, Olds DL, Tung GJ. Coordination of family's care in an evidence-based nurse home visiting program. J Interprof Care 2024; 38:234-244. [PMID: 37855719 DOI: 10.1080/13561820.2023.2266452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/27/2023] [Indexed: 10/20/2023]
Abstract
Interprofessional care coordination within evidence-based prevention programs like Nurse-Family Partnership® (NFP) is necessary to meet family needs and maximize program impact. This study aimed to describe the coordination of families' care in the NFP home visiting context. We used an adapted grounded theory approach and purposively sampled seven NFP sites. We conducted telephone interviews with 95 participants: 51 NFP staff (54%), 39 healthcare providers (41%), and 5 social service providers (5%). All interviews were recorded, transcribed, validated, and analyzed in NVivo11. Many community providers in all sites described their knowledge of the characteristics of the NFP intervention, including the strength of its evidence to achieve outcomes. Care coordination was dynamic and changed over time based on client needs and staff willingness to work together. Effective care coordination in the NFP context from the provider perspective is driven by shared knowledge, integrated systems, mission alignment, and individual champions who value the program.
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Affiliation(s)
- Venice Williams
- Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Carol Franco-Rowe
- Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Connie Lopez
- Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mandy A Allison
- Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Adult & Child Consortium for Health Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - David L Olds
- Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gregory Jackson Tung
- Colorado School of Public Health, Department of Health Systems, Management & Policy, Aurora, CO, USA
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Hess SM, Adu-Amankwah D, Elaiho CR, Butler LR, Ranade SC, Shah BJ, Shadman K, Fields R, Lin EP. Qualitative feedback from caregivers in a multidisciplinary pediatric neuromuscular clinic. J Pediatr Rehabil Med 2024; 17:237-246. [PMID: 38427510 DOI: 10.3233/prm-230011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVE This study explored family satisfaction and perceived quality of care in a pediatric neuromuscular care clinic to assess the value of the multidisciplinary clinic (MDC) model in delivering coordinated care to children with neuromuscular disorders, such as cerebral palsy. METHODS Caregivers of 22 patients were administered a qualitative survey assessing their perceptions of clinic efficiency, care coordination, and communication. Surveys were audio-recorded and transcribed. Thematic analysis was completed using both deductive and inductive methods. RESULTS All caregivers reported that providers adequately communicated next steps in the patient's care, and most reported high confidence in caring for the patient as a result of the clinic. Four major themes were identified from thematic analysis: Care Delivery, Communication, Care Quality, and Family-Centeredness. Caregivers emphasized that the MDC model promoted access to care, enhanced efficiency, promoted provider teamwork, and encouraged shared care planning. Caregivers also valued a physical environment that was suitable for patients with complex needs. CONCLUSION This study demonstrated that caregivers believed the MDC model was both efficient and convenient for pediatric patients with neuromuscular disorders. This model has the potential to streamline medical care and can be applied more broadly to improve care coordination for children with medical complexity.
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Affiliation(s)
- Skylar M Hess
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dorothy Adu-Amankwah
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Liam R Butler
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sheena C Ranade
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brijen J Shah
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kristin Shadman
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Robert Fields
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elaine P Lin
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Materula D, Currie G, Jia XY, Finlay B, Richard C, Yohemas M, Lachuk G, Estes M, Dewan T, MacEachern S, Gall N, Gibbard B, Zwicker JD. Measure what matters: considerations for outcome measurement of care coordination for children with neurodevelopmental disabilities and medical complexity. Front Public Health 2023; 11:1280981. [PMID: 38026305 PMCID: PMC10656699 DOI: 10.3389/fpubh.2023.1280981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Care Coordination (CC) is a significant intervention to enhance family's capacity in caring for children with neurodevelopmental disability and medical complexity (NDD-MC). CC assists with integration of medical and behavioral care and services, partnerships with medical and community-based supports, and access to medical, behavioral, and educational supports and services. Although there is some consensus on the principles that characterize optimal CC for children with NDD-MC, challenges remain in measuring and quantifying the impacts of CC related to these principles. Two key challenges include: (1) identification of measures that capture CC impacts from the medical system, care provider, and family perspectives; and (2) recognition of the important community context outside of a hospital or clinical setting. Methods This study used a multilevel model variant of the triangulation mixed methods design to assess the impact of a CC project implemented in Alberta, Canada, on family quality of life, resource use, and care integration at the broader environmental and household levels. At the broader environmental level, we used linked administrative data. At the household level we used quantitative pre-post survey datasets, and aggregate findings from qualitative interviews to measure group-level impacts and an embedded multiple-case design to draw comparisons, capture the nuances of children with NDD-MC and their families, and expand on factors driving the high variability in outcome measures. Three theoretical propositions formed the basis of the analytical strategy for our case study evidence to explore factors affecting the high variability in outcome measures. Discussion This study expanded on the factors used to measure the outcomes of CC and adds to our understanding of how CC as an intervention impacts resource use, quality of life, and care integration of children with NDD-MC and their families. Given the heterogeneous nature of this population, evaluation studies that account for the variable and multi-level impacts of CC interventions are critical to inform practice, implementation, and policy of CC for children with NDD-MC.
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Affiliation(s)
- Dércia Materula
- School of Public Policy, University of Calgary, Calgary, AB, Canada
| | - Genevieve Currie
- School of Public Policy, University of Calgary, Calgary, AB, Canada
- School of Nursing and Midwifery, Mount Royal University, Calgary, AB, Canada
| | - Xiao Yang Jia
- School of Public Policy, University of Calgary, Calgary, AB, Canada
| | - Brittany Finlay
- School of Public Policy, University of Calgary, Calgary, AB, Canada
| | | | | | - Gina Lachuk
- Alberta Health Services, Calgary, AB, Canada
| | - Myka Estes
- Alberta Health Services, Calgary, AB, Canada
| | | | - Sarah MacEachern
- Alberta Health Services, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nadine Gall
- Alberta Health Services, Calgary, AB, Canada
| | - Ben Gibbard
- Alberta Health Services, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jennifer D. Zwicker
- School of Public Policy, University of Calgary, Calgary, AB, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
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