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Conrad AL, Bellucci CC, Heppner CE, Albert M, Crerand CE, Woodard S, Sheikh F, Kapp-Simon KA. Screening for Academic Risk Among Students With Cleft Lip and/or Palate: Patterns of Risk and Qualities of Effective Tools. Cleft Palate Craniofac J 2024; 61:68-78. [PMID: 35892129 PMCID: PMC10176211 DOI: 10.1177/10556656221116008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study evaluated the effectiveness of academic screening measures in relation to parent-reported diagnoses. Multicenter, retrospective cohort study including structured interviews, questionnaires, and chart reviews. Six North American cleft centers. Children (n = 391) with cleft lip and/or palate, ages 8 to 10 years of age (192 male) and their guardians were recruited during regular clinic visits. Parent and child ratings on the Pediatric Quality of Life Inventory (PedsQL) School Scale, child report on CleftQ School Scale, parent report on the Adaptive Behavior Assessment System-Third Edition Functional Academics (ABAS-FA) Scale and Child Behavior Checklist (CBCL) School Competency Scale, parent interview, and medical chart review. Risk for concerns ranged from 12% to 41%, with higher risk reflected on the CBCL-SC compared to other measures. Males with cleft palate were consistently at the highest risk. Only 9% of the sample had a parent-reported diagnosis of a learning or language disability. Ratings from the ABAS-FA and CBCL-SC had the highest utility in identifying those with language and/or learning concerns. As cleft teams work to develop standardized batteries for screening and monitoring of patients, it is important to evaluate the effectiveness of measures in identifying those at highest risk. When screening for language and learning disorders, questions related to potential academic struggles, such as increased school effort or increased school distress, are most useful. Referrals for follow-up evaluation are recommended for those identified at high risk.
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Affiliation(s)
- Amy L Conrad
- The Stead Family Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Claudia Crilly Bellucci
- Cleft-Craniofacial Clinic, Departments of Psychology and Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago
| | - Celia E Heppner
- Department of Psychiatry at the University of Texas Southwestern Medical Center and Psychologist, Fogelson Plastic and Craniofacial Surgery Center, Children’s Health/Children’s Medical Center, Dallas, Texas
| | - Meredith Albert
- Cleft-Craniofacial Clinic, Departments of Psychology and Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, Illinois, and Clinical Assistant Professor Craniofacial Center, Department of Surgery, University of Illinois at Chicago
| | - Canice E Crerand
- Departments of Pediatrics and Plastic Surgery, The Ohio State University College of Medicine and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | | | - Farah Sheikh
- Division of Plastic and Reconstructive Surgery, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kathleen A Kapp-Simon
- Craniofacial Center, Department of Surgery, University of Illinois at Chicago and Psychologist & Research Scientist, Cleft-Craniofacial Clinic, Departments of Research, Psychology and Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, Illinois
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Shimpi N, Hegde H, Glurich I, Ryan M, Acharya A. ESTABLISHING A QUALITY IMPROVEMENT CULTURE WITHIN A LARGE INTEGRATED MEDICAL-DENTAL HEALTH SYSTEM WITH A POPULATION BASED FOCUS. J Evid Based Dent Pract 2021; 21:101589. [PMID: 34922728 DOI: 10.1016/j.jebdp.2021.101589] [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] [Received: 02/23/2021] [Revised: 05/06/2021] [Accepted: 06/03/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Quality improvement strategies have been an integral part of healthcare to attain improved care delivery and effective health outcomes. The dental quality initiative improvement (DQII) presented in this manuscript represents a case study of successful implementation of a quality improvement culture within a large integrated-medical-dental health system serving a largely rural population. METHODS The key elements of DQII included steering committee establishment, definition or dental quality measures and development/implementation of a dental quality analytics dashboard (DQAD) that provides relevant data on dental quality measures. Qualitative metrics were applied to look at the improvement in performance for the various measures relative to quality benchmarks. RESULTS DQII facilitated improved oversight of care continuity and provider performance surrounding quality measures at granular and/or institutional level. Improvement associated with care delivery performance relative to benchmarks was observed. CONCLUSIONS DQII further advanced the quality improvement culture prevalent in our learning healthcare environment with its focus on value-based care delivery. DQII initiative and establishment of DQAD provided ability to track performance in operational care delivery for dental providers in a clinical setting in real time.
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Affiliation(s)
- Neel Shimpi
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Harshad Hegde
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Ingrid Glurich
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Megan Ryan
- Menomonie Dental Center, Family Health Center, Marshfield Clinic Health System, Menomonie, WI, United States; Family Health Center of Marshfield. Inc, Marshfield Clinic Health System, Marshfield, WI, United States
| | - Amit Acharya
- Advocate Aurora Health, Chicago, IL, United States.
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A Short Form of the Child/Youth Health Care Questionnaire on Satisfaction, Utilization, and Needs in Children and Adolescents with a Chronic Condition (CHC-SUN-SF/YHC-SUN-SF). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212196. [PMID: 34831951 PMCID: PMC8621707 DOI: 10.3390/ijerph182212196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 11/24/2022]
Abstract
We decided to develop a short-form of the CHC-SUN/YHC-SUN, a questionnaire aiming at assessing health care satisfaction of children and adolescents with chronic health conditions. Data analysis was based on samples from three different studies. Item selection involved statistical analysis and expert consensus. For independent validation purposes, we calculated descriptive statistics on single-item and composite-scale levels and applied classic test theory, confirmatory factor analyses, and correlation analysis to investigate the psychometric properties of the final short-form by different types of reliability and validity. Internal consistency (Cronbach’s Alpha) reached values of a = 0.89 (self-report) and a = 0.92 (parents report), split-half reliability values reached 0.85 (self-report) and 0.91 (parents report). Confirmatory factor analysis indicated no sufficient fit for the single factor solution, whereas the solution with three factors and one higher order factor indicated the best overall fit amongst three competing models. Validity of the short-form measure can be assumed, e.g., as indicated by its association with a single-item measure on general health care satisfaction. The short-form measures of the CHC-SUN for parents (CHC-SUN-SF) and the YHC-SUN self-report version for adolescents (YHC-SUN-SF) feature excellent psychometric performances, provide economical assessments, and are easy-to-administer questionnaires. They should be used whenever brief measures are needed for economic reasons.
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Verstraete J, Lloyd AJ, Jelsma J. Performance of the Toddler and Infant (TANDI) Health-Related Quality of Life Instrument in 3-4-Year-Old Children. CHILDREN-BASEL 2021; 8:children8100920. [PMID: 34682184 PMCID: PMC8534352 DOI: 10.3390/children8100920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 11/16/2022]
Abstract
The Toddler and Infant (TANDI) dimensions of Health-Related Quality of Life assess 'age appropriate' behaviour and measurement could be extended to older children. A sample of 203 children 3-4 years of age was recruited, and their caregivers completed the TANDI, Pediatric Quality of Life Inventory (PedsQL) and EQ-5D-Y Proxy. Spearman and Pearson's correlation coefficients, and Kruskal-Wallis H-test were used to explore the feasibility, known-group validity, discriminate validity and concurrent validity of the TANDI. Children with a health condition (n = 142) had a lower ceiling effect (p = 0.010) and more unique health profiles (p < 0.001) than the healthy group (n = 61). The TANDI discriminated between those with and without a health condition. In children with a health condition, the TANDI discriminated between clinician rated severity of the health condition. The TANDI had moderate to strong correlations with similar PedsQL and EQ-5D-Y items and scores. The TANDI is valid for children aged 3-4 years and is recommended for children with a health condition, whereas the PedsQL may be better for healthy children. The TANDI is recommended for studies with young children whereas the EQ-5D-Y Proxy is recommended for a sample including older children or for longitudinal studies with preschoolers. Further work on the TANDI is recommended to establish test-retest reliability and responsiveness.
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Affiliation(s)
- Janine Verstraete
- Department of Paediatrics and Child Health, Division of Pulmonology, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town 7700, South Africa
- Correspondence:
| | | | - Jennifer Jelsma
- Deparment of Health and Rehabilitation Sciences, Division of Physiotherapy, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa;
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Grudziąż-Sękowska J, Zamarlik M, Sękowski K. Assessment of Selected Aspects of the Quality of Life of Children with Type 1 Diabetes Mellitus in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042107. [PMID: 33671503 PMCID: PMC7926510 DOI: 10.3390/ijerph18042107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/12/2021] [Accepted: 02/16/2021] [Indexed: 12/18/2022]
Abstract
Type 1 diabetes mellitus (T1D) is, next to obesity and asthma, the most common chronic disease in children in Poland. T1D is not only a medical challenge, but it also affects all areas of a sick child's life and family functionality. New forms of therapy facilitate the daily management of the disease, but their availability is limited and partly dependent on socioeconomic status. This study aimed to assess the incidence and interrelationships between the child's health condition and the applied therapy model, and selected aspects of the child's family functionality and access to health and care services. The survey involved 206 child and youth caregivers with T1D who are members of Facebook support groups. The analysis of the obtained results revealed the existence of links between family income level and the type of insulin therapy applied. Children from families with a better financial situation (subjective and objective) were more likely to have additional medical consultations and make more frequent control visits. In families with a higher level of income, the T1D-induced restriction of child activity was less frequent. Living outside of urban centers was associated with a reduced availability of care or educational facilities adapted to take care of a child with T1D. No statistically significant correlations were observed between demographic and economic factors and the child's health status expressed by the occurrence of complications. The incidence of the latter, however, affected the child's family situation.
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Affiliation(s)
- Justyna Grudziąż-Sękowska
- Centre of Postgraduate Medical Education, School of Public Health, 01-813 Warsaw, Poland
- Correspondence: ; Tel.: +48-225-601-150
| | - Monika Zamarlik
- Faculty of Health Sciences, Institute of Public Health, Jagiellonian University, 31-007 Kraków, Poland;
| | - Kuba Sękowski
- Doctoral School, Law College, Kozminski University, 03-301 Warsaw, Poland;
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Connor J, Hartwell L, Baird J, Cerrato B, Chiloyan A, Porter C, Hickey P. Nurse-Sensitive Quality Metrics to Benchmark in Pediatric Cardiovascular Care. Am J Crit Care 2020; 29:468-478. [PMID: 33130865 DOI: 10.4037/ajcc2020884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Associations between the quality of nursing care and patient outcomes have been demonstrated globally. However, translation and application of this evidence to robust measurement in pediatric specialty nursing care has been limited. OBJECTIVES To test the feasibility and performance of nurse-sensitive measures in pediatric cardiovascular programs. METHODS Ten nurse-sensitive measures targeting nursing workforce, care process, and patient outcomes were implemented, and measurement data were collected for 6 months across 9 children's hospitals in the Consortium of Congenital Cardiac Care-Measurement of Nursing Practice (C4-MNP). Participating sites evaluated the feasibility of collecting data and the usability of the data. RESULTS Variations in nursing workforce characteristics were reported across sites, including proportion of registered nurses with 0 to 2 years of experience, nursing education, and nursing certification. Clinical measurement data on weight gain in infants who have undergone cardiac surgery, unplanned transfer to the cardiac intensive care unit, and pain management highlighted opportunities for improvement in care processes. Overall, each measure received a score of 75% or greater in feasibility and usability. CONCLUSIONS Collaborative evaluation of measurement performance, feasibility, and usability provided important information for continued refinement of the measures, development of systems to support data collection, and selection of benchmarks across C4-MNP. Results supported the development of target benchmarks for C4-MNP sites to compare performance, share best practices for improving the quality of pediatric cardiovascular nursing care, and inform nurse staffing models.
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Affiliation(s)
- Jean Connor
- Jean Connor is director of nursing research, Cardiovascular and Critical Care Services, Department of Nursing Patient Services, Boston Children’s Hospital, and an assistant professor of pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Lauren Hartwell
- Lauren Hartwell is project manager III, Population Health, Tufts Health Plan, Watertown, Massachusetts
| | - Jennifer Baird
- Jennifer Baird is director, Institute for Nursing and Interprofessional Research, Children’s Hospital Los Angeles, California
| | - Benjamin Cerrato
- Benjamin Cerrato is project coordinator, Cardiovascular and Critical Care Services, Boston Children’s Hospital
| | - Araz Chiloyan
- Araz Chiloyan is a quality improvement consultant, Department of Cardiology, Boston Children’s Hospital
| | - Courtney Porter
- Courtney Porter is program manager, Center for Healthy Adolescent Transition, Children’s Hospital Los Angeles
| | - Patricia Hickey
- Patricia Hickey is vice president, Cardiovascular and Critical Care Services, associate chief nursing officer, Department of Nursing Patient Services, Boston Children’s Hospital, and an assistant professor of pediatrics, Harvard Medical School
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Sengler C, Niewerth M, Minden K. Rheumatische Erkrankungen im Kindes- und Jugendalter: Wichtigkeit einer frühzeitigen multiprofessionellen Versorgung. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:846-855. [DOI: 10.1007/s00103-020-03173-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
OBJECTIVE To describe the measure review and evaluation process used to identify new measures of care coordination for children with behavioral health needs conducted as part of Massachusetts' Children's Health Insurance Program Reauthorization Act Quality Demonstration Grant. METHOD The Massachusetts Child Health Quality Coalition identified a shortage of pediatric measures of care coordination in behavioral health. After an extensive literature review, the Measure Development Committee applied the Care Coordination Key Elements Framework (Framework), which was designed as part of the grant work, and used a modified RAND Delphi method to conduct feasibility and validity evaluation and propose the new candidate measures for further rigorous testing. RESULTS Thirty-two measures were evaluated. One existing Healthcare Effectiveness Data and Information Set and 8 newly proposed measures met the criteria for feasibility and reliability. These measures represented each of the key elements contained in the Framework. The measures need further testing to ensure scientific acceptability and wide usability. CONCLUSION A multipronged methodology was used to propose measures of care coordination in the space of pediatric behavioral health to fill the identified gaps in existing measures.
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Goldhagen J, Fafard M, Komatz K, Eason T, Livingood WC. Community-based pediatric palliative care for health related quality of life, hospital utilization and costs lessons learned from a pilot study. BMC Palliat Care 2016; 15:73. [PMID: 27487770 PMCID: PMC4971636 DOI: 10.1186/s12904-016-0138-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/22/2016] [Indexed: 11/12/2022] Open
Abstract
Background Children with chronic complex-medical conditions comprise a small minority of children who require substantial healthcare with major implications for hospital utilization and costs in pediatrics. Community-Based Pediatric Palliative Care (CBPPC) provides a holistic approach to patient care that can improve their quality of life and lead to reduced costs of hospital care. This study's purpose was to analyze and report unpublished evaluation study results from 2007 that demonstrate the potential for CBPPC on Health Related Quality of Life (HRQoL) and hospital utilization and costs in light of the increasing national focus on the care of children with complex-medical conditions, including the Affordable Care Act's emphasis on patient-centered outcomes. Methods A multi-method research design used primary data collected from caregivers to determine the Program's potential impact on HRQoL, and administrative data to assess the Program's potential impact on hospital utilization and costs. Caregivers (n=53) of children enrolled in the Northeast Florida CBPPC program (Community PedsCare) through the years 2002-2007 were recruited for the Health Related Quality of Life (HRQoL) study. Children (n=48) enrolled in the Program through years 2000-2006 were included in the utilization and cost study. Results HRQoL was generally high, and hospital charges per child declined by $1203 for total hospital services (p=.34) and $1047 for diagnostic charges per quarter (p=0.13). Hospital length of stay decreased from 2.92 days per quarter to 1.22 days per quarter (p<.05). Conclusion The decrease in hospital utilization and costs and the high HRQoL results indicate that CBPPC has the potential to influence important outcomes for the quality of care available for children with complex-medical conditions and their caregivers. Electronic supplementary material The online version of this article (doi:10.1186/s12904-016-0138-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jeffrey Goldhagen
- Division of Community and Societal Pediatrics, Department of Pediatrics, UF College of Medicine - Jacksonville, 841 Prudential Drive, Suite 1330 m, Jacksonville, FL, 32207, USA
| | - Mark Fafard
- Baptist Health Research Institute, Baptist Health System, 836 Prudential Drive, Pavilion 6th Floor, Jacksonville, FL, 32207, USA.
| | - Kelly Komatz
- Division of Community and Societal Pediatrics, Department of Pediatrics, UF College of Medicine - Jacksonville, 841 Prudential Drive, Suite 1330 m, Jacksonville, FL, 32207, USA
| | - Terry Eason
- Community PedsCare, Community Hospice of Northeast Florida, 4266 Sunbeam Rd., Jacksonville, FL, 32257, USA
| | - William C Livingood
- Center for Health Equity and Quality Research, UF College of Medicine-Jacksonville, 580 W. 8th St., Tower II, Room 6015, Jacksonville, FL, 32209, USA
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Gomersall T, Spencer S, Basarir H, Tsuchiya A, Clegg J, Sutton A, Dickinson K. Measuring quality of life in children with speech and language difficulties: a systematic review of existing approaches. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2015; 50:416-435. [PMID: 25630911 DOI: 10.1111/1460-6984.12147] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 10/16/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Children's and adolescent's speech and language difficulties (SaLD) can affect various domains of quality of life (QoL), and speech and language therapy interventions are critical to improving QoL. Systematically measuring QoL outcomes in this population is highly complex due to factors such as heterogeneity in impairments and differing targets during intervention. However, measurements of QoL are increasingly required by healthcare commissioners and policy-makers to inform resource allocation. AIMS To review the use of QoL measures in research involving children (age ≤ 18 years) with SaLD. METHODS & PROCEDURES A systematic review was undertaken. A systematic search across various databases was performed. Information on the methodological details of each relevant study, along with descriptions of the QoL measures employed, were extracted into standardized data extraction forms. Findings were discussed in a narrative synthesis. OUTCOMES & RESULTS Twenty-one relevant studies were identified that deal with a range of subpopulations of children with SaLD. For the most part, generic QoL measures were used, although there was little convergence on the type of QoL measures employed throughout the literature. Five studies utilized preference-based QoL measures, including the 16D/17D, HUI3, EQ-5D and QWB-SA. Of these measures, the HUI3 demonstrated the most promising discriminant validity, although the preference weights for this measure were generated with adults. CONCLUSIONS & IMPLICATIONS QoL among children with SaLD is not yet being captured in a systematic way. The HUI3 measure appears to show some promise for generating relevant preference-based QoL estimates, although further testing of the measure is required.
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Affiliation(s)
- Tim Gomersall
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Sarah Spencer
- Human Communication Sciences, University of Sheffield, Sheffield, UK
| | - Hasan Basarir
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Aki Tsuchiya
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- Department of Economics, University of Sheffield, Sheffield, UK
| | - Judy Clegg
- Human Communication Sciences, University of Sheffield, Sheffield, UK
| | - Anthea Sutton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Kath Dickinson
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Villalonga-Olives E, Kawachi I, Almansa J, Witte C, Lange B, Kiese-Himmel C, von Steinbüchel N. Pediatric health-related quality of life: a structural equation modeling approach. PLoS One 2014; 9:e113166. [PMID: 25415751 PMCID: PMC4240546 DOI: 10.1371/journal.pone.0113166] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 10/20/2014] [Indexed: 11/26/2022] Open
Abstract
Objectives One of the most referenced theoretical frameworks to measure Health Related Quality of Life (HRQoL) is the Wilson and Cleary framework. With some adaptions this framework has been validated in the adult population, but has not been tested in pediatric populations. Our goal was to empirically investigate it in children. Methods The contributory factors to Health Related Quality of Life that we included were symptom status (presence of chronic disease or hospitalizations), functional status (developmental status), developmental aspects of the individual (social-emotional) behavior, and characteristics of the social environment (socioeconomic status and area of education). Structural equation modeling was used to assess the measurement structure of the model in 214 German children (3–5 years old) participating in a follow-up study that investigates pediatric health outcomes. Results Model fit was χ2 = 5.5; df = 6; p = 0.48; SRMR = 0.01. The variance explained of Health Related Quality of Life was 15%. Health Related Quality of Life was affected by the area education (i.e. where kindergartens were located) and development status. Developmental status was affected by the area of education, socioeconomic status and individual behavior. Symptoms did not affect the model. Conclusions The goodness of fit and the overall variance explained were good. However, the results between children' and adults' tests differed and denote a conceptual gap between adult and children measures. Indeed, there is a lot of variety in pediatric Health Related Quality of Life measures, which represents a lack of a common definition of pediatric Health Related Quality of Life. We recommend that researchers invest time in the development of pediatric Health Related Quality of Life theory and theory based evaluations.
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Affiliation(s)
- Ester Villalonga-Olives
- Institute of Medical Psychology and Medical Sociology, Georg-August-University Göttingen, Göttingen, Germany
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Josué Almansa
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Claudia Witte
- Institute of Medical Psychology and Medical Sociology, Georg-August-University Göttingen, Göttingen, Germany
| | - Benjamin Lange
- Institute of Medical Psychology and Medical Sociology, Georg-August-University Göttingen, Göttingen, Germany
| | - Christiane Kiese-Himmel
- Institute of Medical Psychology and Medical Sociology, Georg-August-University Göttingen, Göttingen, Germany
| | - Nicole von Steinbüchel
- Institute of Medical Psychology and Medical Sociology, Georg-August-University Göttingen, Göttingen, Germany
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12
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Gilson KM, Davis E, Reddihough D, Graham K, Waters E. Quality of life in children with cerebral palsy: implications for practice. J Child Neurol 2014; 29:1134-40. [PMID: 24870369 DOI: 10.1177/0883073814535502] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 04/03/2014] [Indexed: 11/16/2022]
Abstract
The ability to assess the quality of life of children with cerebral palsy to inform and evaluate individual care plans, service planning, interventions, and policies is crucial. In this article, the recent evidence on quality of life in children with cerebral palsy is reviewed, with attention to the determinants of quality of life and role of this construct as a practical outcome indicator in clinical trials. Quality of life measurement advances for children with cerebral palsy are discussed with a focus on condition-specific quality of life measures, particularly, the Cerebral Palsy Quality of Life-Child, which is the first condition-specific quality of life measure for children with cerebral palsy. The article presents an overview for clinicians and researchers intending to use quality of life measures on children with cerebral palsy and provides recommendations for future research that will better inform practice in the field.
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Affiliation(s)
- Kim-Michelle Gilson
- The Jack Brockhoff Child Health and Wellbeing Program, Academic Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Elise Davis
- The Jack Brockhoff Child Health and Wellbeing Program, Academic Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Dinah Reddihough
- Department of Developmental Medicine, Royal Children's Hospital, Melbourne, Australia Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Kerr Graham
- Department of Orthopaedic Surgery, Royal Children's Hospital, Melbourne, Australia
| | - Elizabeth Waters
- The Jack Brockhoff Child Health and Wellbeing Program, Academic Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Australia
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Abstract
The goal was to present the factor structure of subjective quality of life in adolescents, investigated by means of four questionnaires: the Youth Quality of Life-Research Version (YQOL-R), the Quality of Life Profile-Adolescent Version (QOLP-AV), the KIDSCREEN-52 Questionnaire, and the Quality of Life Questionnaire for Children and Adolescents (QLQ-CA). Two exploratory factor analyses conducted on the results obtained from two samples of adolescents: healthy, N = 252 (144 girls, 108 boys), and chronically ill, suffering from several illnesses, N = 189 (118 girls, 71 boys). Both factor analyses revealed four-factor solutions, each explaining about 60% of the total variance. The factor structure for the healthy group approximately reproduced the structures of the four questionnaires: Developmental quality of life (23%), Health and Well-being (16%), Relational quality of life (14%), and Ego strength (8%). The factor structure for the chronically ill group was similar for three factors: Developmental quality of life (22%), Harmony between the self and the environment (14%), and Coping and Support (12%), but different for another one: Health-related quality of life (10%). The discussion focuses on the specific nature of four aspects of quality of life observed in the healthy sample and their similarities to and differences from the factors in the chronic patients' sample.
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Affiliation(s)
- Maria Oleś
- 1 Institute of Psychology, The John Paul II Catholic University of Lublin, Poland
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Fedele DA, Molzon ES, Eddington AR, Hullmann SE, Mullins LL, Gillaspy SG. Perceived barriers to care in a pediatric medical home: the moderating role of caregiver minority status. Clin Pediatr (Phila) 2014; 53:351-5. [PMID: 24198316 DOI: 10.1177/0009922813507994] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the association of minority status to perceived barriers to care and health-related quality of life in families presenting to a Medical Home. METHOD Fifty-three caregivers were classified as minority or nonminority caregivers based on self-reported race/ethnicity. Caregivers completed a measure of perceived barriers to care and child health-related quality of life. RESULTS Minority caregivers reported more perceived barriers to care with regard to the pragmatics of obtaining health care. The association between perceived barriers to care and child health-related quality of life was moderated by minority status. Perceived barriers to care were only related to child health-related quality of life among minority caregivers. CONCLUSION Minority families may have difficulties with the cost of health care or logistics of obtaining health care for their child. Perceived health care barriers may still exist within pediatric Medical Homes for minority caregivers and affect child health-related quality of life.
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Chang DC, Rhee DS, Zhang Y, Salazar JH, Chrouser K, Choo S, Colombani PM, Abdullah F. Evaluating metrics for quality: death on the same day of elective pediatric surgery. Am J Med Qual 2012; 27:195-200. [PMID: 22294739 DOI: 10.1177/1062860611423727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Surgical mortality is considered a benchmark for measuring quality of care. This study quantifies the incidence of death on the day of elective pediatric surgery, which generally is considered preventable and might be considered a "never" event. The authors conducted a retrospective analysis of national state inpatient databases from 1988 to 2007 that included elective pediatric surgical patients. A descriptive analysis of same-day mortality by demographics, surgical specialties, and age was performed. Of 835 880 elective pediatric surgical cases identified, 174 patients died on the day of surgery-that is, 2.1 deaths/10 000 cases. Surgical specialty mortality rates ranged from 0.06 (otolaryngology) to 17.4 (cardiothoracic surgery) deaths per 10 000 cases. Death on the day of elective pediatric surgery is rare, limiting its utility to compare performance in pediatric surgery. However, this metric may be useful at individual institutions as a case-finding tool for root-cause analysis in quality improvement efforts.
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Affiliation(s)
- David C Chang
- University of California San Diego School of Medicine, CA, USA
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Chang DC, Rhee DS, Papandria D, Aspelund G, Cowles RA, Huang EY, Chen C, Middlesworth W, Arca MJ, Abdullah F. Outcomes research in pediatric surgery. Part 2: how to structure a research question. J Pediatr Surg 2011; 46:226-31. [PMID: 21238673 DOI: 10.1016/j.jpedsurg.2010.09.095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 09/30/2010] [Indexed: 11/17/2022]
Abstract
Innovative treatments and procedures are essential to the advancement of surgery. Outcomes research provides the mechanism to analyze these new treatments as they enter clinical practice and evaluate them against established therapies. Information gained through this methodology is essential because new techniques and innovations often gain rapid acceptance before clinical trials can be conducted to assess them. Increasing national emphasis is placed on comparative effectiveness as health care costs rise. Surgeons must take the lead in surgical outcomes and comparative effectiveness research, with the goal of identifying the most efficient and effective treatment for our patients. The authors show how to structure and design a research project involving pediatric surgical outcomes. The model consists of the following 3 phases: (1) study design, (2) data preparation, and (3) data analysis. The model we present provides the reader with a basic format and research structure to serve as a guide to performing high-quality surgical outcomes research.
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Affiliation(s)
- David C Chang
- Department of Surgery, University of California San Diego School of Medicine, San Diego, CA 92103, USA
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17
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Strieper M, Leong T, Bajaj T, Huckaby J, Frias P, Campbell R. Does Ablation of Supraventricular Tachycardia in Children with a Structurally Normal Heart Improve Quality of Life? CONGENIT HEART DIS 2010; 5:587-93. [DOI: 10.1111/j.1747-0803.2010.00398.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wang HY, Cheng CC, Hung JW, Ju YH, Lin JH, Lo SK. Validating the Cerebral Palsy Quality of Life for Children (CP QOL-Child) questionnaire for use in Chinese populations. Neuropsychol Rehabil 2010; 20:883-98. [PMID: 20859827 DOI: 10.1080/09602011.2010.509190] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to examine the psychometric properties of the Chinese version of Cerebral Palsy Quality of Life for Children (CP QOL-Child) questionnaire. We performed forward (into Chinese) and backward translation of the CP QOL-Child for: (1) the primary caregiver form (for parents of children with CP aged 4-12 years); and (2) the child self-report form (for children with cerebral palsy aged 9-12 years). Psychometric properties assessed included test-retest reliability, internal consistency, item discrimination, construct validity, and concordance between the forms of questionnaire. The Chinese CP QOL-Child was completed by 145 caregivers and 44 children. Excellent test-retest reliability and internal consistency were obtained. Item discrimination analysis revealed a majority of the items have moderate to good discriminating power. Confirmatory factor analysis demonstrated distinguishable domain structure as on the original English version. Significant associations were found between lower QOL and more severe motor disability. Consistent with the English version, the highest correlation between the primary caregiver and child forms on QOL was in the domain of functioning. Results of this study indicate that the Chinese CP QOL-Child appears to be valid for use in Mandarin-Chinese speaking children with cerebral palsy.
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Affiliation(s)
- H-Y Wang
- Department of Physical Therapy, Kaohsiung Medical University, Kaohsiung, Taiwan
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Al-Akour N, Khader YS, Shatnawi NJ. Quality of life and associated factors among Jordanian adolescents with type 1 diabetes mellitus. J Diabetes Complications 2010; 24:43-7. [PMID: 19464929 DOI: 10.1016/j.jdiacomp.2008.12.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 10/08/2008] [Accepted: 12/03/2008] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Quality of life (QoL) is a significant indicator of the outcome of the treatment in chronic diseases. The purpose of the study was to assess the QoL of Jordanian adolescents with type 1 diabetes mellitus and its associated factors. METHODS A total of 145 adolescents with type 1 diabetes mellitus were invited to participate in the study during their regular visits to outpatient clinics. The subjects were recruited from the National Center for Diabetes, Endocrine and Genetic Diseases in Amman, the capital of Jordan, and from three main hospitals in the north of Jordan between October 2007 and February 2008. A short form of the Diabetes Quality of Life for Youth (DQLQY-SF) questionnaire was used. The DQLQY-SF consists of 22 items on two subscales (disease impact and worries) with higher scale scores indicating increase frequency of problems and lower QoL. RESULTS The mean (S.D.) age of the participants was 14.1 (3.1) years and the mean (S.D.) diabetes duration was 3.7 (2.9) years. This study showed that adolescents perceived their QoL as low. The mean (S.D.) of DQLQY-SF total score was 56.4 (18.0). The mean was 36.2 (10.1) for the impact scale, 17.9 (8.9) for worries about diabetes, and 2.2 (1.2) for health perception. Multivariate analysis showed that more impact of diabetes, worries about diabetes, and worse overall QoL were associated with shorter diabetes duration, higher HbA(1c) values, being a girl, and older age. CONCLUSIONS The QoL of Jordanian adolescents with type 1 diabetes was low. Better glycemic control may contribute to the improvement of QoL.
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Affiliation(s)
- Nemeh Al-Akour
- School of Nursing, Jordan University of Science and Technology (JUST), Irbid, Jordan.
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Modi AC, Zeller MH. Validation of a parent-proxy, obesity-specific quality-of-life measure: sizing them up. Obesity (Silver Spring) 2008; 16:2624-33. [PMID: 18833211 PMCID: PMC3490405 DOI: 10.1038/oby.2008.416] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aims of the present study were to develop and validate a new obesity-specific, parent-proxy measure of health-related quality of life (HRQOL), Sizing Them Up. Participants included 220 obese youth (M(age) = 11.6 years, 68% female, 53% African American, M(BMI) = 36.7) and their primary caregivers (88% mothers). Primary caregivers completed a demographics questionnaire and two HRQOL measures: Sizing Them Up (obesity-specific) and PedsQL (generic). Youth height and weight were measured. Psychometric evaluation of Sizing Them Up was completed by conducting a factor analysis and determining internal consistency coefficients, test-retest reliability, convergent and discriminant validity, predictive validity, responsiveness to change, and minimal clinically important difference (MCID) scores. Sizing Them Up is a 22-item measure with six scales (i.e., Emotional Functioning, Physical Functioning, Teasing/Marginalization, Positive Social Attributes, Mealtime Challenges, and School Functioning) that account for 66% of the variance. The measure also includes an Adolescent Developmental Adaptation module. Sizing Them Up had internal consistency coefficients ranging from 0.59 to 0.91 and test-retest reliabilities ranging from 0.57 to 0.80. Validity was demonstrated by significant relations between a majority of Sizing Them Up scales and BMI z-scores. Sizing Them Up also demonstrated good convergent validity with other HRQOL measures and responsiveness to change related to weight loss for adolescents who had undergone bariatric surgery. Overall, Sizing Them Up is a reliable and valid parent-proxy measure of obesity-specific HRQOL that can be used in both clinical and research settings.
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Affiliation(s)
- Avani C Modi
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
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Nansel TR, Weisberg-Benchell J, Wysocki T, Laffel L, Anderson B. Quality of life in children with Type 1 diabetes: a comparison of general and diabetes-specific measures and support for a unitary diabetes quality-of-life construct. Diabet Med 2008; 25:1316-23. [PMID: 19046222 PMCID: PMC2597420 DOI: 10.1111/j.1464-5491.2008.02574.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To assess the factor structure of the Pediatric Quality of Life Inventory (PedsQL) Diabetes Module and to compare the PedsQL general and diabetes-specific quality of life (QOL) measures regarding psychometric properties and relations to relevant outcomes. METHODS The instruments were completed by 447 children age 9 to 15.5 years with Type 1 diabetes > 1 year from four US paediatric diabetes clinics; parents completed the parallel parent-proxy measures. Principal components factor analysis was used to examine the factor structure of the PedsQL diabetes module. Analyses of the generic and diabetes QOL measures included psychometric properties, parent-child correlations and correlations with depression, adherence and glycated haemoglobin (HbA(1c)). RESULTS The factor structure of the PedsQL diabetes module did not support the original five subscales. Both one- and two-factor models were supported; however, parallel parent and child subscales did not emerge. While the generic and diabetes-specific measures of QOL were moderately to highly correlated with each other, the constructs were differentially associated with relevant diabetes outcomes. Generic QOL was more highly associated with depression than diabetes QOL. Conversely, diabetes QOL was more highly associated with adherence and HbA(1c), although this was seen to a greater extent for parent-proxy report than for child report. CONCLUSIONS Factor analysis of the PedsQL diabetes module supports the use of a total diabetes QOL score. Findings regarding the associations of the generic and diabetes modules with diabetes outcomes underscore the unique contribution provided by both generic and diabetes QOL.
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Affiliation(s)
- T R Nansel
- Prevention Research Branch, DESPR, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, DHHS, Bethesda, MD, USA.
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Modi AC, Guilfoyle SM, Zeller MH. Impaired health-related quality of life in caregivers of youth seeking obesity treatment. J Pediatr Psychol 2008; 34:147-55. [PMID: 18641083 DOI: 10.1093/jpepsy/jsn070] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To document and identify predictors of caregiver health-related quality of life (HRQOL) in a sample of youth seeking obesity treatment and examine whether it moderates the relation between parent proxy and youth self-report HRQOL. METHODS Youth (5-18 years) and their caregivers (N = 120) presenting to a pediatric medical weight management program completed the Pediatric Quality of Life Inventory and caregivers completed the Short-Form 36. RESULTS Caregivers were predominantly overweight/obese (90%) and half were African-American. Caregiver HRQOL was lower than "healthy" adults, similar to nontreatment-seeking adults with obesity, and better than treatment-seeking adults with obesity. Caregiver body mass index and socioeconomic status predicted caregiver physical HRQOL. Caregiver age predicted caregiver mental HRQOL. A moderation effect was not detected. CONCLUSIONS Given the significant degree of overweight and HRQOL impairment in caregivers of youth seeking obesity treatment, further examination of caregiver functioning in the context of pediatric obesity treatment outcomes is warranted.
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Affiliation(s)
- Avani C Modi
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Beaulieu R, Humphreys J. Evaluation of a telephone advice nurse in a nursing faculty managed pediatric community clinic. J Pediatr Health Care 2008; 22:175-81. [PMID: 18455066 DOI: 10.1016/j.pedhc.2007.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2006] [Revised: 05/25/2007] [Accepted: 05/25/2007] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Nurse-managed health centers face increasing obstacles to financial viability. Efficient use of clinic resources and timely and appropriate patient care are necessary for sustainability. A registered nurse with adequate education and support can provide high-quality triage and advice in community-based practice sites. The purpose of this program evaluation was to examine the effect of a telephone advice nurse service on parent/caregiver satisfaction and access to care. METHODS A quasi-experimental separate pre-post sample design study investigated parent/caregiver satisfaction with a telephone advice nurse in an urban pediatric nurse-managed health center. The clinic medical information system was used to retrieve client visit data prior to the service and in the first year of the program. RESULTS Statistically significant differences were found on two items from the satisfaction with the advice nurse survey: the reason for calling (P < .05), and the importance of being involved in decision making (P < .05). DISCUSSION A telephone advice nurse may increase both parent/caregiver and provider satisfaction and access to care.
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Affiliation(s)
- Richard Beaulieu
- Department of Family Health Care Nursing, University of California, San Francisco, USA.
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Viehweger E, Robitail S, Rohon MA, Jacquemier M, Jouve JL, Bollini G, Simeoni MC. Measuring quality of life in cerebral palsy children. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.annrmp.2007.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Viehweger E, Robitail S, Rohon MA, Jacquemier M, Jouve JL, Bollini G, Simeoni MC. Mesure de la qualité de vie chez l’enfant atteint de paralysie cérébrale. ACTA ACUST UNITED AC 2008; 51:119-37. [DOI: 10.1016/j.annrmp.2007.12.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Revised: 10/17/2007] [Accepted: 12/03/2007] [Indexed: 11/24/2022]
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Schmidt S, Thyen U, Chaplin J, Mueller-Godeffroy E. Cross-cultural development of a child health care questionnaire on satisfaction, utilization, and needs. ACTA ACUST UNITED AC 2007; 7:374-82. [PMID: 17870646 DOI: 10.1016/j.ambp.2007.04.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Revised: 04/18/2007] [Accepted: 04/23/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The instrument Child Health Care-Satisfaction, Utilization and Needs (CHC-SUN) has been developed cross-culturally to evaluate pediatric health care services for children with special health care needs (CSHCN) from the proxy perspective of parents. METHODS The children of the participating parents received treatment in pediatric specialty clinics in 7 European countries for asthma, cystic fibrosis, diabetes, epilepsy, cerebral palsy, rheumatoid arthritis, and atopic dermatitis. The instrument was developed through a process including literature review, expert consensus, and item generation through focus groups. The pilot instrument was extensively tested to assess psychometric properties, support item reduction, and evaluate clinical validity. The final field version was tested in a new sample of 795 parents in 7 countries. RESULTS Pilot testing and item reduction resulted in a practical 40-item instrument with 14 single items related to provision of services (module 1), and 26 items related to 6 scales on satisfaction with care (module 2), and 1 item on general satisfaction with care. Satisfaction with care scales showed very good psychometric properties, both initially and in the field version, with Cronbach's alpha ranging between .80 and .95 in the revised scales. Both modules discriminated well between functional status and diagnosis across countries. CONCLUSIONS A new instrument is available to measure provision of services and satisfaction with care for children with chronic conditions from the perspective of parents. Cross-cultural analysis reveals that the measure is useful in multinational studies evaluating health services against the background of different health systems.
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Affiliation(s)
- Silke Schmidt
- Department of Medical Psychology, Center of Psychosocial Medicine, University Hospital of Hamburg, Germany.
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Damiano PC, Tyler MC, Romitti PA, Momany ET, Jones MP, Canady JW, Karnell MP, Murray JC. Health-related quality of life among preadolescent children with oral clefts: the mother's perspective. Pediatrics 2007; 120:e283-90. [PMID: 17671039 DOI: 10.1542/peds.2006-2091] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the factors that affect the health-related quality of life of preadolescent children with nonsyndromic oral clefts using the Pediatric Quality of Life Inventory instrument and to evaluate whether there were any differences related to the type of cleft or other factors. METHODS Data for this study were derived from telephone interviews with the parents of a statewide population of children who were in the Iowa Registry for Congenital and Inherited Disorders, were aged 2 to 12 years, had nonsyndromic oral clefts, and were born in Iowa between January 1, 1990, and December 31, 2000. Twenty-minute interviews were conducted with mothers of 104 children in the spring and summer of 2003; respondents then completed and mailed back Pediatric Quality of Life Inventory surveys 2 to 3 weeks after the interviews (69% participation rate). RESULTS After controlling for demographic characteristics, children with less severe speech problems had higher total Pediatric Quality of Life Inventory scores as well as higher physical and psychosocial health domain scores. Age and cleft type interacted, with younger children (aged 2-7 years) with a cleft lip or cleft lip and palate having higher health-related quality of life scores than children with an isolated cleft palate; however, this pattern was reversed for older children (aged 8-12 years). CONCLUSIONS Speech and aesthetic concerns seem to have been important factors affecting the health-related quality of life for children with oral clefts. These factors seem to be more important as children get closer to adolescence (ages 8-12 years) when acceptance by peers becomes more critical.
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Affiliation(s)
- Peter C Damiano
- DDS, Health Policy Research Program, University of Iowa, Public Policy Center, 227 S Quadrangle, Iowa City, IA 52242, USA.
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Grange A, Bekker H, Noyes J, Langley P. Adequacy of health-related quality of life measures in children under 5 years old: systematic review. J Adv Nurs 2007; 59:197-220. [PMID: 17627625 DOI: 10.1111/j.1365-2648.2007.04333.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This paper is a report of a systematic review to assess the adequacy of measures evaluating generic health-related quality of life outcomes in children less than 5 years old. BACKGROUND Evaluating generic health-related quality of life outcomes in children is important to assess the effectiveness of interventions, nursing care and services. METHODS A methodological systematic review was carried out for the period 1980-2005 in accord with the UK Centre of Reviews and Dissemination guidelines on systematic reviews. We searched multiple electronic databases, hand-searched key texts, and contacted investigators. We included all English language publications describing primary empirical research of generic health-related quality of life, health status, functional status or wellbeing measures, with published psychometric evidence. All measures (proxy and/or self-complete) for use in children under 5 years were included; single dimension measures were excluded. RESULTS Seventy-six papers (70 studies) referring to 16 generic health-related quality of life measures met our inclusion criteria. None of the 16 measures were adequate in terms of their conceptual content or psychometric criteria; quality scores were poor (0-8). No current, generic health-related quality of life measure is both psychometrically and conceptually robust, although the Health Utilities Index has the most comprehensive psychometric data published. However, not all dimensions of health are assessed, with little evidence of reliability in children under 5 years of age. CONCLUSION There is a need to develop empirically robust and conceptually comprehensive health-related quality of life measures, particularly in the context of proxy-completion measures for very young children.
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Affiliation(s)
- Angela Grange
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford Royal Infirmary, Bradford, UK. [corrected]
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Abstract
This prospective research study evaluated the parent's perception of their child's quality of life at 1 and 6 months following injury, using the Child Health Questionnaire to measure outcomes. At both 1 and 6 months postinjury, the physical summary and psychosocial summary scores were significantly lower than US norms for all levels of injury severity. Predictors of lower physical and psychosocial scores, such as the Injury Severity Score and specific location of injury, were determined. This study demonstrates the long-term impact of injury and validates the need for earlier intervention and anticipatory guidance for the child and family.
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Affiliation(s)
- Lynn H Schweer
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
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Youssef NN, Langseder AL, Verga BJ, Mones RL, Rosh JR. Chronic childhood constipation is associated with impaired quality of life: a case-controlled study. J Pediatr Gastroenterol Nutr 2005; 41:56-60. [PMID: 15990631 DOI: 10.1097/01.mpg.0000167500.34236.6a] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the effect of chronic constipation on children's quality of life. METHODS From October 2002 to November 2003, 224 children (140 male, 84 female, aged 10.6 +/- 2.9 years) and 224 parents were evaluated by a health related quality of life tool during initial outpatient consultation. Children with constipation (n = 80) were compared with controls with inflammatory bowel disease (n = 42), controls with gastroesophageal reflux disease (n = 56), and with healthy children (n = 46). RESULTS Children with constipation had lower quality of life scores than did those with inflammatory bowel disease (70 versus 84; P < 0.05), gastroesophageal reflux disease (70 versus 80; P < 0.05), and healthy children (70 versus 88; P < 0.05). Children with constipation reported lower physical scores than did inflammatory bowel disease patients (75 versus 85; P < 0.02), gastroesophageal reflux disease patients (75 versus 85; P < 0.05), or healthy children (75 versus 87; P < 0.05). Parents of children with constipation reported lower scores than did their children (61 versus 70; P < 0.05). Children with constipation had longer duration of symptoms than did the controls with inflammatory bowel disease and gastroesophageal reflux disease (43.8 months versus 14.2 months; P < 0.001). Prolonged duration of symptoms for children with constipation correlated with lower parent-reported scores (P < 0.002). CONCLUSIONS At initial evaluation, children with constipation have a lower quality of life than do children with inflammatory bowel disease or gastroesophageal reflux disease. Self-reported lower scores may be a reflection of impaired physical ability. Parental perceptions of low quality of life are probably impacted by the duration of their child's symptoms and by family members with similar complaints. Practitioners should be aware of the high level of parental concern and the relatively low self-reported and parent-reported quality of life in children with chronic constipation as they plan therapy.
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Affiliation(s)
- Nader N Youssef
- Center for Pediatric Functional Gastrointestinal and Motility Disorders, Goryeb Children's Hospital, Atlantic Health System Morristown, New Jersey 07962, USA.
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Laffel LMB, Connell A, Vangsness L, Goebel-Fabbri A, Mansfield A, Anderson BJ. General quality of life in youth with type 1 diabetes: relationship to patient management and diabetes-specific family conflict. Diabetes Care 2003; 26:3067-73. [PMID: 14578241 DOI: 10.2337/diacare.26.11.3067] [Citation(s) in RCA: 148] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate self-report and parent proxy report of child/teen general quality of life in youth with type 1 diabetes, compare their responses with those of a general pediatric population, and identify relationships between diabetes management, diabetes-related family behavior, and diabetes-specific family conflict with quality of life in youth with type 1 diabetes. RESEARCH DESIGN AND METHODS Study participants included 100 children, 8-17 years of age (12.1 +/- 2.3), with type 1 diabetes for 0.5-6 years (2.7 +/- 1.6). Each child and a parent completed the Pediatric Quality of Life Inventory (PedsQL), completed the Diabetes Family Conflict Scale, and provided data on parent involvement in diabetes management. An independent measure of adherence to treatment assessed by the patient's clinician and a measure of glycemic control (HbA(1c)) were also collected. RESULTS PedsQL responses from youth with type 1 diabetes were stable over 1 year and similar to norms from a healthy standardization sample for all three scales of the PedsQL: total, physical, and psychosocial quality of life. After controlling for age, duration of diabetes, sex, HbA(1c), and family involvement, child report of diabetes-specific family conflict (P < 0.01) was the only significant predictor of child report of quality of life (model R(2) = 0.21, P < 0.02). CONCLUSIONS Youth with type 1 diabetes report remarkably similar quality of life to a nondiabetic youth population. Greater endorsement of diabetes-specific family conflict predicted diminished quality of life for the child. As treatment programs focus on intensifying glycemic control in youth with type 1 diabetes, interventions should include efforts to reduce diabetes-specific family conflict in order to preserve the child's overall quality of life.
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Affiliation(s)
- Lori M B Laffel
- Pediatric and Adolescent Unit, Behavioral Research and Mental Health Section, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
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McDougall J, Miller LT. Measuring chronic health condition and disability as distinct concepts in national surveys of school-aged children in Canada: a comprehensive review with recommendations based on the ICD-10 and ICF. Disabil Rehabil 2003; 25:922-39. [PMID: 12857580 DOI: 10.1080/0963828031000122249] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE With the aim of improving the measurement of child health and disability in survey research, this paper reviews the coverage of chronic health conditions and the domains of disability and related environmental factors as they are laid out in the ICD-10 and ICF, respectively, in national surveys of school-aged children conducted in Canada since 1980. Recommendations are made for future survey use and construction. METHODS Two reviewers independently examined each of the surveys. Coverage of chronic health conditions, the domains of disability, and environmental factors in survey questions was identified by mapping question content onto ICD-10 and ICF codes. The reviewers then compared their findings and came to a final consensus. RESULTS Surveys vary in the range and depth of coverage of the ICD-10 and ICF chapters. Disability surveys and health surveys for persons aged 12 and over contain the most comprehensive lists of chronic conditions. Coverage of impairments is limited. Coverage of activity limitations and participation restrictions is most limited in the domains of personal care and domestic life. Environmental factors not covered include natural environmental changes, attitudes, and policies. CONCLUSIONS Development of a comprehensive standard list of chronic health conditions based on the ICD-10 and development of standard survey measures of the domains of disability and environmental factors based on the ICF for use in surveys of school-aged children would facilitate an understanding of children's health and disability in the context of the current international health framework provided by the World Health Organization.
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Affiliation(s)
- Janette McDougall
- Research Program, Thames Valley Children's Centre, London, Ontario, Canada.
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Mansour ME, Kotagal U, Rose B, Ho M, Brewer D, Roy-Chaudhury A, Hornung RW, Wade TJ, DeWitt TG. Health-related quality of life in urban elementary schoolchildren. Pediatrics 2003; 111:1372-81. [PMID: 12777555 DOI: 10.1542/peds.111.6.1372] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Health disparities between children from urban minority backgrounds and children from more affluent backgrounds are well-recognized. Few studies specifically address urban children's perceptions of their health-related quality of life (HRQOL) or the factors that contribute to these perceptions. Since schools are pivotal to children's intellectual, social, and emotional development, school connectedness may be a factor that contributes to their perception of HRQOL. OBJECTIVE To examine children's perceptions of HRQOL in an elementary school-based population of urban children. METHODS The study population consisted of 2nd, 3rd, and 5th graders from 6 urban kindergarten to 8th grade schools and their parents. Children completed a survey that included questions on HRQOL and school connectedness. Parents completed a telephone survey that assessed demographics, the child's health, health care usage, and parental health status. Data on school absences and mobility from the computerized school database were linked to survey data. Bivariate analyses were used to evaluate the association between child report of HRQOL and collected variables, including school connectedness. Multivariable linear regression was conducted to identify the factors best predicting HRQOL in these urban children. RESULTS Of the 1150 eligible students, parent and child survey data were available for 525 (45.6%). Fifty-one percent of students were male and 89% were black. Ninety-four percent of parents were female, 29% were married, and 62% had family incomes below 20,000 dollars per year. The mean total score for HRQOL was 67.2, with a possible range of 0 to 100 (higher scores reflecting better HRQOL). In the multivariable analysis, child grade, the relationship of the " parent" to the child, employment, family income, type/presence of insurance, and school connectedness were significantly associated with the HRQOL total score. CONCLUSIONS Young urban children self-report low HRQOL scores and do so as early as the 2nd grade. These low scores, which reflect children's own perceptions of impaired psychological and physical health, have potential implications for the success of urban children in their learning environments. The association between HRQOL and school connectedness might suggest that health and educational programs that improve a child's attachment to school could result in improved perceptions of health by urban children.
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Affiliation(s)
- Mona E Mansour
- Division of General and Community Pediatrics, Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.
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Furth SL, Gerson AC, Neu AM, Fivush BA. The impact of dialysis and transplantation on children. ADVANCES IN RENAL REPLACEMENT THERAPY 2001; 8:206-13. [PMID: 11533921 DOI: 10.1053/jarr.2001.26350] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Effective methods to treat end stage renal disease (ESRD) in children have become available in the United States during the last 3 decades. Since the United States Congress created the Medicare ESRD Program in 1972, most children with ESRD have the option of Medicare insurance. Medicare expenditures for children with ESRD range from $14,000 for transplant recipients to $43,000 for dialysis patients per year. The tremendous expense of ESRD treatment has led to research to determine which treatment options are associated with the best health outcomes and the best value (quality/cost) for the money spent treating ESRD. The National Kidney Foundation's Dialysis Outcomes Quality Initiative recommends the use of quality of life and health status measures to gauge the impact of renal replacement therapy on quality of life in the ESRD population. In adult patients with renal failure, several generic and disease-specific quality of life measures have been validated and tested for reliability. In contrast, little research using validated and reliable health status measures has been performed in pediatric patients to measure the impact of ESRD. This article summarizes existing literature on how we currently measure the impact of dialysis and transplantation on children, discusses existing health status measures for children and adolescents, and describes how these measures might be used to improve our care of patients and long-term outcomes for children with kidney failure.
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Affiliation(s)
- S L Furth
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287-2535, USA.
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