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Weitzman ER, Minegishi M, Cox R, Wisk LE. Associations Between Patient-Reported Outcome Measures of Physical and Psychological Functioning and Willingness to Share Social Media Data for Research Among Adolescents With a Chronic Rheumatic Disease: Cross-Sectional Survey. JMIR Pediatr Parent 2023; 6:e46555. [PMID: 38059571 PMCID: PMC10721135 DOI: 10.2196/46555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/27/2023] [Accepted: 08/15/2023] [Indexed: 12/08/2023] Open
Abstract
Background Social media data may augment understanding of the disease and treatment experiences and quality of life of youth with chronic medical conditions. Little is known about the willingness to share social media data for health research among youth with chronic medical conditions and the differences in health status between sharing and nonsharing youth with chronic medical conditions. Objective We aimed to evaluate the associations between patient-reported measures of disease symptoms and functioning and the willingness to share social media data. Methods Between February 2018 and August 2019, during routine clinic visits, survey data about social media use and the willingness to share social media data (dependent variable) were collected from adolescents in a national rheumatic disease registry. Survey data were analyzed with patient-reported measures of disease symptoms and functioning and a clinical measure of disease activity, which were collected through a parent study. We used descriptive statistics and multivariate logistic regression to compare patient-reported outcomes between youth with chronic medical conditions who opted to share social media data and those who did not opt to share such data. Results Among 112 youths, (age: mean 16.1, SD 1.6 y; female: n=72, 64.3%), 83 (74.1%) agreed to share social media data. Female participants were more likely to share (P=.04). In all, 49 (43.8%) and 28 (25%) participants viewed and posted about rheumatic disease, respectively. Compared to nonsharers, sharers reported lower mobility (T-score: mean 49.0, SD 9.4 vs mean 53.9, SD 8.9; P=.02) and more pain interference (T-score: mean 45.7, SD 8.8 vs mean 40.4, SD 8.0; P=.005), fatigue (T-score: mean 49.1, SD 11.0 vs mean 39.7, SD 9.7; P<.001), depression (T-score: mean 48.1, SD 8.9 vs mean 42.2, SD 8.4; P=.003), and anxiety (T-score: mean 45.2, SD 9.3 vs mean 38.5, SD 7.0; P<.001). In regression analyses adjusted for age, sex, study site, and Physician Global Assessment score, each 1-unit increase in symptoms was associated with greater odds of willingness to share social media data, for measures of pain interference (Adjusted Odds Ratio [AOR] 1.07, 95% CI 1.001-1.14), fatigue (AOR 1.08, 95% CI 1.03-1.13), depression (AOR 1.07, 95% CI 1.01-1.13), and anxiety (AOR 1.10, 95% CI 1.03-1.18). Conclusions High percentages of youth with rheumatic diseases used and were willing to share their social media data for research. Sharers reported worse symptoms and functioning compared to those of nonsharers. Social media may offer a potent information source and engagement pathway for youth with rheumatic diseases, but differences between sharing and nonsharing youth merit consideration when designing studies and evaluating social media-derived findings.
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Affiliation(s)
- Elissa R Weitzman
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, BostonMA, United States
- Department of Pediatrics, Harvard Medical School, BostonMA, United States
- Division of Addiction Medicine, Boston Children’s Hospital, BostonMA, United States
| | - Machiko Minegishi
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, BostonMA, United States
- Division of Addiction Medicine, Boston Children’s Hospital, BostonMA, United States
| | - Rachele Cox
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, BostonMA, United States
- Division of Addiction Medicine, Boston Children’s Hospital, BostonMA, United States
| | - Lauren E Wisk
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los AngelesCA, United States
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Improvement of Electronic Health Record Integrated Transition Planning Tools in Primary Care. Pediatr Qual Saf 2020; 5:e282. [PMID: 32656460 PMCID: PMC7297398 DOI: 10.1097/pq9.0000000000000282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 03/14/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The transition from pediatric to adult care is under-studied in primary care. Electronic health record-integrated transition planning tools (ETPTs) can facilitate the transition. We tested whether ETPTs and clinician reminders increase the frequency of transition discussions during adolescent well-visits. METHODS In an academic adolescent medicine primary care practice serving a predominantly African American, Medicaid-insured population, we developed 4 ETPTs-readiness assessment, plan template, information handout, and diagnosis code. We used Plan-Do-Study-Act quality improvement cycles to implement ETPTs and measure outcomes. Each cycle added a new layer of clinician support: (1) ETPT training, (2) visual reminders, (3) incentives, and (4) daily reminders. The primary outcome was the proportion of well-visits in which "any ETPT use" occurred. We collected data via chart review and used run charts and regression analyses with multiple comparisons to detect differences between cycles. Clinicians-provided feedback was elicited. RESULTS Any ETPT use increased from 0% to 45% between baseline and cycle 4. The odds of any ETPT use was ten times larger in cycle 4 compared to cycle 1 (odds ratio 10.09, 95% confidence interval 2.29-44.44, P = 0.002) and 22 times larger in cycle 4 than cycle 2 (odds ratio 21.99, 95% confidence interval 3.96-122.00, P < 0.001). Clinicians identified time constraints and lack of sociocultural relevance as barriers to uptake. CONCLUSIONS Daily reminders combined with training and visual reminders were effective in increasing the use of ETPTs in primary care. Future interventions should adapt existing transition tools to the needs of target populations and create regular reminders to facilitate uptake.
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Marsh KK, Bush RA, Connelly CD. Exploring perceptions and use of the patient portal by young adults with type 1 diabetes: A qualitative study. Health Informatics J 2020; 26:2586-2596. [PMID: 32301370 DOI: 10.1177/1460458220911780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Emerging adults have been raised in the digital age and are therefore prime candidates for using a patient portal to manage chronic conditions. The limited body of research both identifies the underutilization of the patient portal and suggests increased use of the portal for the chronically ill as a tool to alleviate caregiver stress, as well as a potential modality to assist emerging adults to manage their chronic illnesses. This qualitative study was completed to obtain an understanding of emerging adults familiarity with the electronic patient portal and to elicit the perception of the usefulness of the portal to support self-management of type I diabetes. Findings provide a preliminary understanding of how a sampling of emerging adults with type I diabetes uses, perceives the benefits of, and wants to improve technology for diabetes self-management.
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Affiliation(s)
| | - Ruth A Bush
- University of San Diego, USA; Rady Children's Hospital-San Diego, USA
| | - Cynthia D Connelly
- University of San Diego, USA; Child and Adolescent Services Research Center, USA
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Davis S, MacKay L. Moving Beyond the Rhetoric of Shared Decision-Making: Designing Personal Health Record Technology With Young Adults With Type 1 Diabetes. Can J Diabetes 2020; 44:434-441. [PMID: 32616277 DOI: 10.1016/j.jcjd.2020.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Engaging young adults with type 1 diabetes (T1D) in the self-management of daily tasks and decision-making provides opportunities for positive health outcomes. However, emerging adulthood and care transitions are associated with decreased clinic attendance and diabetes complications. Shared decision-making (SDM) is an optimal approach for health decisions; however, it has been difficult to implement in practice. Personal health record (PHR) technology is a promising approach for overcoming such barriers. Still, today, PHRs have yet to root themselves into care and present an opportunity for improvement in SDM and engagement in self-management decision-making. The objective of this study was to confirm a functional model of an integrated shared decision-making-personal health record system (e-PHR) by young adults with T1D and care providers. METHODS User-centred design approach whereby young adults with T1D, 18 to 24 years of age, and care providers matched PHR functions for the SDM process to confirm an e-PHR functional model. RESULTS An e-PHR functional model justified by young adults (n=7) and providers (n=15) was confirmed. The conceptual design was architected within an interconnected digital health ecosystem and integrated 23 PHR functionalities for SDM with a moderate level of agreement between patients and providers (Cohen kappa 0.60 to 0.74). CONCLUSIONS The establishment of an e-PHR functional model is a precursor to system design requirements. Results highlight the conceivable value of integrating SDM into PHRs for engagement of young adults with T1D in self-management decision-making. Design implications highlight key challenges for future research and system development, including information exchange across disparate systems, usability considerations and system intelligence for information personalization and decision-support tools.
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Affiliation(s)
- Selena Davis
- School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada.
| | - Lee MacKay
- Kootenay Lake Hospital Diabetes Clinic and Kootenay Boundary Division of Family Practice, Nelson, British Columbia, Canada
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Tulu B, Trudel J, Strong DM, Johnson SA, Sundaresan D, Garber L. Patient Portals: An Underused Resource for Improving Patient Engagement. Chest 2016; 149:272-7. [PMID: 26066707 DOI: 10.1378/chest.14-2559] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The potential of patient portals to improve patient engagement and health outcomes has been discussed for more than a decade. The slow growth in patient portal adoption rates among patients and providers in the United States, despite external incentives, indicates that this is a complex issue. We examined evidence of patient portal use and effects with a focus on the pulmonary domain. We found a paucity of studies of patient portal use in pulmonary practice, and highlight gaps for future research. We also report on the experience of a pulmonary department using a patient portal to highlight the potential of these systems.
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Affiliation(s)
- Bengisu Tulu
- Robert A. Foisie School of Business, Worcester Polytechnic Institute, Worcester, MA
| | | | - Diane M Strong
- Robert A. Foisie School of Business, Worcester Polytechnic Institute, Worcester, MA
| | - Sharon A Johnson
- Robert A. Foisie School of Business, Worcester Polytechnic Institute, Worcester, MA
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Gaskin GL, Bruce J, Anoshiravani A. Understanding Parent Perspectives Concerning Adolescents' Online Access to Personal Health Information. J Particip Med 2016; 8:e3. [PMID: 27595043 PMCID: PMC5006948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Although today's youth are interested in using the internet to access and manage information related to their health, little information exists about parental attitudes towards the release of health information to adolescents. METHODS Structured interviews were conducted with the parents of 83 adolescents detained at a large Northern California juvenile detention facility to examine parental perceptions toward allowing their children online access to their own health information. RESULTS The majority of parents interviewed (70%) wanted their children to have online access to their own health information. Seventy-nine percent of these parents were also comfortable allowing their children to choose with whom they would share this information. CONCLUSIONS This study is one of the first to examine parental attitudes towards providing adolescents access to their own health information, and the first among parents of underserved youth. This study demonstrates that parents may be quite supportive of allowing their adolescent children to have secure online access to their own health information.
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Affiliation(s)
- Gregory L. Gaskin
- Department of Pediatrics, Stanford University School of Medicine,
Stanford, CA
| | - Janine Bruce
- Department of Pediatrics, Stanford University School of Medicine,
Stanford, CA
| | - Arash Anoshiravani
- Department of Pediatrics, Stanford University School of Medicine,
Stanford, CA
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8
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Davis AM, Brown RF, Taylor JL, Epstein RA, McPheeters ML. Transition care for children with special health care needs. Pediatrics 2014; 134:900-8. [PMID: 25287460 PMCID: PMC4533283 DOI: 10.1542/peds.2014-1909] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Approximately 750,000 children in the United States with special health care needs will transition from pediatric to adult care annually. Fewer than half receive adequate transition care. METHODS We had conversations with key informants representing clinicians who provide transition care, pediatric and adult providers of services for individuals with special health care needs, policy experts, and researchers; searched online sources for information about currently available programs and resources; and conducted a literature search to identify research on the effectiveness of transition programs. RESULTS We identified 25 studies evaluating transition care programs. Most (n = 8) were conducted in populations with diabetes, with a smaller literature (n = 5) on transplant patients. We identified an additional 12 studies on a range of conditions, with no more than 2 studies on the same condition. Common components of care included use of a transition coordinator, a special clinic for young adults in transition, and provision of educational materials. CONCLUSIONS The issue of how to provide transition care for children with special health care needs warrants further attention. Research needs are wide ranging, including both substantive and methodologic concerns. Although there is widespread agreement on the need for adequate transition programs, there is no accepted way to measure transition success. It will be essential to establish consistent goals to build an adequate body of literature to affect practice.
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Affiliation(s)
- Alaina M. Davis
- Division of General Pediatrics, and,Evidence-Based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - Rebekah F. Brown
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics;,Evidence-Based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - Julie Lounds Taylor
- Division of General Pediatrics, and,Evidence-Based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; and,Vanderbilt University Kennedy Center for Research on Education and Human Development, Nashville, Tennessee
| | - Richard A. Epstein
- Division of Child and Adolescent Psychiatry, Department of Psychiatry; and,Evidence-Based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - Melissa L. McPheeters
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee;,Evidence-Based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; and
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Sawicki GS, Kelemen S, Weitzman ER. Ready, set, stop: mismatch between self-care beliefs, transition readiness skills, and transition planning among adolescents, young adults, and parents. Clin Pediatr (Phila) 2014; 53:1062-8. [PMID: 25006112 PMCID: PMC4443439 DOI: 10.1177/0009922814541169] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Health care transition (HCT) from pediatric to adult-focused systems is a key milestone for youth. Developing self-care skills and HCT planning are key elements. In a survey at 4 pediatric specialty clinics to 79 youth aged 16 to 25 years and 52 parents, skill-based HCT readiness was assessed using the Transition Readiness Assessment Questionnaire (TRAQ). Multivariable logistic regression evaluated the association between TRAQ scores and self-care beliefs. In all, 70% of youth and 67% of parents believed that they/their child could manage their care. Only 38% of youth and 53% of parents reported thinking about HCT; only 18% of youth and 27% of parents reported having a HCT plan. Youth with higher TRAQ scores were more likely to believe they could manage their care, controlling for age and gender (adjusted odds ratio = 4.0, 95% confidence interval = 1.7-9.5). Transition readiness skills are associated with self-care beliefs. However, a mismatch exists between high reported self-care beliefs and low levels of transition planning.
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Affiliation(s)
- Gregory S. Sawicki
- Boston Children's Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | | | - Elissa R. Weitzman
- Boston Children's Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
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10
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Van Gorp P, Comuzzi M, Jahnen A, Kaymak U, Middleton B. An open platform for personal health record apps with platform-level privacy protection. Comput Biol Med 2014; 51:14-23. [PMID: 24859286 DOI: 10.1016/j.compbiomed.2014.04.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 04/23/2014] [Accepted: 04/28/2014] [Indexed: 10/25/2022]
Abstract
One of the main barriers to the adoption of Personal Health Records (PHR) systems is their closed nature. It has been argued in the literature that this barrier can be overcome by introducing an open market of substitutable PHR apps. The requirements introduced by such an open market on the underlying platform have also been derived. In this paper, we argue that MyPHRMachines, a cloud-based PHR platform recently developed by the authors, satisfies these requirements better than its alternatives. The MyPHRMachines platform leverages Virtual Machines as flexible and secure execution sandboxes for health apps. MyPHRMachines does not prevent pushing hospital- or patient-generated data to one of its instances, nor does it prevent patients from sharing data with their trusted caregivers. External software developers have minimal barriers to contribute innovative apps to the platform, since apps are only required to avoid pushing patient data outside a MyPHRMachines cloud. We demonstrate the potential of MyPHRMachines by presenting two externally contributed apps. Both apps provide functionality going beyond the state-of-the-art in their application domain, while they did not require any specific MyPHRMachines platform extension.
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Affiliation(s)
- P Van Gorp
- Eindhoven University of Technology, The Netherlands.
| | - M Comuzzi
- City University London, United Kingdom
| | - A Jahnen
- Public Research Center Henri Tudor, Luxembourg
| | - U Kaymak
- Eindhoven University of Technology, The Netherlands
| | - B Middleton
- Partners HealthCare and Harvard Medical School, MA, USA
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Sharma N, O’Hare K, Antonelli RC, Sawicki GS. Transition care: future directions in education, health policy, and outcomes research. Acad Pediatr 2014; 14:120-7. [PMID: 24602574 PMCID: PMC4098714 DOI: 10.1016/j.acap.2013.11.007] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 11/08/2013] [Accepted: 11/12/2013] [Indexed: 12/19/2022]
Abstract
All youth must transition from pediatric to adult-centered medical care. This process is especially difficult for youth with special health care needs. Many youth do not receive the age-appropriate medical care they need and are at risk during this vulnerable time. Previous research has identified barriers that may prevent effective transition, and protocols have been developed to improve the process. Health outcomes related to successful transition have yet to be fully defined. Health care transition can also be influenced by education of providers, but there are gaps in medical education at the undergraduate, graduate, and postgraduate levels. Current changes in federal health policy allow improved health care coverage, provide some new financial incentives, and test new structures for transitional care, including the evolution of accountable care organizations (ACO). Future work must test how these systems changes will affect quality of care. Finally, transition protocols exist in various medical subspecialties; however, national survey results show no improvement in transition readiness, and there are no consistent measures of what constitutes transition success. In order to advance the field of transition, research must be done to integrate transition curricula at the undergraduate, graduate, and postgraduate levels; to provide advance financial incentives and pilot the ACO model in centers providing care to youth during transition; to define outcome measures of importance to transition; and to study the effectiveness of current transition tools on improving these outcomes.
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Affiliation(s)
- Niraj Sharma
- Division of General Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass; Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass.
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Jan S, Slap G, Smith-Whitley K, Dai D, Keren R, Rubin DM. Association of hospital and provider types on sickle cell disease outcomes. Pediatrics 2013; 132:854-61. [PMID: 24167173 DOI: 10.1542/peds.2013-0089] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Adolescents and young adults (A/YA) with sickle cell disease (SCD) are hospitalized in both children's and general hospitals. We determined the effect of hospital type and provider specialty on outcomes of hospitalized A/YA with SCD and acute chest syndrome (ACS). METHODS This retrospective cohort study used the 2007-2009 Premier Database, a large multi-institutional database, to identify 1476 patients ages 16 to 25 years with 2299 admissions with SCD and ACS discharged from 256 US hospitals from 2007 to 2009. Multilevel logistic regression and zero-truncated negative binomial regression were performed after adjustment for patient demographic, clinical, and hospital characteristics to test the association of hospital type and provider specialty on death, endotracheal intubation, simple or exchange transfusion, length of stay (LOS), and 30-day readmission. RESULTS Of all admissions, 14 died and 45% were intubated. General hospitals had 13 deaths and were associated with higher intubation rates (predicted probability [PP], 48% [95% confidence interval (CI), 43%-52%]) and longer LOS (predicted mean LOS, 7.6 days [95% CI, 7.2-7.9]) compared with children's hospitals (PP of intubation, 24% [95% CI, 5%-42%]; and predicted mean LOS, 6.8 days [95% CI, 5.6-5.8]). There was no difference by hospital type or provider specialty in PP of simple or exchange transfusion, or 30-day readmission. CONCLUSIONS General hospitals carry higher intubation risks for A/YA with SCD and ACS compared with children's hospitals. We need to better understand the drivers of these differences, including the role of staff expertise, hospital volume, and quality of ongoing SCD care.
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Affiliation(s)
- Sophia Jan
- MSHP, CHOP PolicyLab, 3535 Market St, 15th Floor, Philadelphia, PA 19104.
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Advancing healthcare transitions in the medical home: tools for providers, families and adolescents with special healthcare needs. Curr Opin Pediatr 2013; 25:439-46. [PMID: 23770924 DOI: 10.1097/mop.0b013e3283623d2f] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of the present article is to review recent national guidelines regarding healthcare transition (HCT) planning for adolescents with special healthcare needs (SHCN) and to describe practical tools for use by the primary care pediatrician to implement these guidelines. RECENT FINDINGS Approximately one in five adolescents in the United States has SHCN. Achieving successful transitions from child-oriented to adult-oriented healthcare for these patients can be difficult. Despite numerous barriers to HCT, innovations in healthcare delivery, including the patient-centered medical home and accountable care payment structures, may help overcome challenges. The American Academy of Pediatrics, American Academy of Family Physicians, and the American College of Physicians have provided explicit practice-level guidance for supporting HCT. The National Healthcare Transition Center developed the Six Core Elements of Healthcare Transition, recommending six detailed action steps for transitions from pediatric settings. Steps reflect guidelines and, along with novel patient-centered information technologies, may help support individuals and families navigating complex transitions. SUMMARY It is time to integrate transition planning into the medical home. Further evidence is needed to identify transition strategies that improve outcomes. Although innovations in care delivery, payment structures, and information technologies may support HCT, pediatricians can and should implement already available and recommended transition steps.
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Gordon P, Camhi E, Hesse R, Odlum M, Schnall R, Rodriguez M, Valdez E, Bakken S. Processes and outcomes of developing a continuity of care document for use as a personal health record by people living with HIV/AIDS in New York City. Int J Med Inform 2012; 81:e63-73. [PMID: 22841825 DOI: 10.1016/j.ijmedinf.2012.06.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 06/18/2012] [Accepted: 06/27/2012] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe the processes and outcomes of developing and implementing a Continuity of Care Document (CCD), My Health Profile, as a personal health record for persons living with HIV (PLWH) in an HIV/AIDS Special Needs Plan in New York City. METHODS Multiple qualitative and quantitative data sources were used to describe the processes and outcomes of implementing My Health Profile including focus groups, Audio Computer Assisted Self Interview (ACASI) surveys, administrative databases, chart abstraction, usage logs, and project management records. Qualitative data were thematically analyzed. Quantitative data analytic methods included descriptive and multivariate statistics. Data were triangulated and synthesized using the Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Framework. RESULTS Reach - SNP members are predominantly African American or Hispanic/Latino and about one-third are female. A larger proportion of African Americans and smaller proportions of Hispanics/Latinos and Whites were trained to use My Health Profile.Efficacy/Effectiveness - CCDs were produced for 8249 unique members and updated on a monthly basis, 509 members were trained to use My Health Profile. Total number of member logins for 112 active users was 1808 and the longest duration of use was 1008 days. There were no significant differences between users and non-users of My Health Profile in clinical outcomes, perceptions of the quality of medical care, or health service utilization. Adoption -My Health Profile was well-matched to organizational mission, values, and priorities related to coordination of care for a high-risk population of PLWH. Implementation - Pre-implementation focus group participants identified potential barriers to use of My Health Profile including functional and computer literacy, privacy and confidentiality concerns, potential reluctance to use technology, and cognitive challenges. Key strategies for addressing barriers included a dedicated bilingual coach for recruitment, training, and support; basic computer and My Health Profile training; transparent audit trail revealing clinician and case manager access of My Health Profile, time-limited passwords for sharing My Health Profile with others at the point of need, and emergency access mechanism. Maintenance -My Health Profile was integrated into routine operational activities and its sustainability is facilitated by its foundation on standards for Health Information Exchange (HIE). CONCLUSIONS Although potential barriers exist to the use of personal health records (PHRs) such as My Health Profile, PLWH with complex medical needs, low socioeconomic status, and limited computer experience will use such tools when a sufficient level of user support is provided and privacy and confidentiality concerns are addressed.
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Affiliation(s)
- Peter Gordon
- Columbia University Department of Medicine, Division of Infectious Diseases and NewYork Presbyterian Hospital, New York, NY, United States.
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