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Loura D, Ferreira AM, Romeiro J, Charepe Z. Health-illness transition processes in children with complex chronic conditions and their parents: a scoping review. BMC Pediatr 2024; 24:446. [PMID: 38992610 PMCID: PMC11238377 DOI: 10.1186/s12887-024-04919-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/01/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND The prevalence of complex chronic conditions (CCC), which cause serious limitations and require specialized care, is increasing. The diagnosis of a CCC is a health-illness transition for children and their parents, representing a long-term change leading to greater vulnerability. Knowing the characteristics of these transitional processes is important for promoting safe transitions in this population. This scoping review aimed to map the available evidence on health-illness transition processes in children with complex chronic conditions and their parents in the context of healthcare. METHODS Six databases were searched for studies focusing on children aged 0-21 years with CCC and their parents experiencing health-illness transition processes, particularly concerning adaptation to illness and continuity of care, in the context of healthcare. Studies within this scope carried out between 2013 and 2023 and written in Portuguese or English were identified. The articles were selected using the PRISMA methodology. The data were extracted to an instrument and then presented with a synthesizing approach supporting the interpretation of the results. RESULTS Ninety-eight methodologically broad but predominantly qualitative articles were included in this review. Children with CCC have specific needs associated with complex and dynamic health-illness transitions with a multiple influence in their daily lives. Several facilitating factors (p.e. positive communication and a supportive therapeutic relationship with parents and professionals, as well as involvement in a collaborative approach to care), inhibiting factors (p.e. the complexity of the disease and therapeutic regime, as well as the inefficient organization and coordination of teams) and both positive (p.e. well-being and better quality of life) and negative response patterns (p.e. negative feelings about the chronic illness) were identified. Some interventions to support the transitional process also emerged from the literature. Pediatric palliative care is seen as a good practice and an integrative approach for these children and families. CONCLUSION Health professionals play a fundamental role in supporting the transitional process and promoting positive response patterns. More significant investment is needed at the clinical and academic levels regarding production and dissemination of knowledge in this area to ensure the awareness of children with CCC and that their needs are fully enhanced. REVIEW REGISTRATION https://doi.org/10.17605/OSF.IO/QRZC8 .
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Affiliation(s)
- David Loura
- Local Health Unit of São José, Dona Estefânia Hospital, St. Jacinta Marto, N. 8A, 1150-192, Lisbon, Portugal.
- Faculty of Health Sciences and Nursing, Catholic University of Portugal, Lisbon, Portugal.
| | - Ana Margarida Ferreira
- Faculty of Health Sciences and Nursing, Catholic University of Portugal, Lisbon, Portugal
- Local Health Unit of Arco Ribeirinho, Nossa Senhora Do Rosário Hospital, Setúbal, Portugal
| | - Joana Romeiro
- Faculty of Health Sciences and Nursing, Catholic University of Portugal, Lisbon, Portugal
- Center for Interdisciplinary Health Research (CIIS), Lisbon, Portugal
- Catholic University of Portugal, Postdoc-Fellowship Program in Integral Human Development (IHD), CADOS, Lisbon, Portugal
| | - Zaida Charepe
- Faculty of Health Sciences and Nursing, Catholic University of Portugal, Lisbon, Portugal
- Center for Interdisciplinary Health Research (CIIS), Lisbon, Portugal
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Foster CC, Blackwell CK, Kan K, Morales L, Cella D, Shaunfield S. Parental self-efficacy managing a child's medications and treatments: adaptation of a PROMIS measure. J Patient Rep Outcomes 2023; 7:10. [PMID: 36735145 PMCID: PMC9898482 DOI: 10.1186/s41687-023-00549-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Self-efficacy is important for managing chronic conditions; however, its measurement in pediatric healthcare settings remains rare. The goal of this project was to adapt an existing disease-agnostic adult self-efficacy patient reported outcome (PRO) measure to enhance suitability of items for measuring the self-efficacy of parents that manage their children's health conditions. METHODS We adapted the existing Patient-Reported Outcomes Measurement Information System® (PROMIS®) adult self-efficacy healthcare measure to parental voice. First, a targeted literature review informed rephrasing of the adult items and identification of new pediatric-specific content. The initial item pool was revised based on input from 12 multidisciplinary experts. Next cognitive interviews of adapted items were simultaneously conducted with English and Spanish-speaking parents of pediatric patients with a range of chronic and/or disabling conditions recruited from a Midwestern children's hospital to finalize the measure. RESULTS Findings resulted in an initial item pool of 33 pediatric-specific items which were narrowed to 31 draft items based on expert input. Parent cognitive interview findings (N = 26) informed further item reduction resulting in a final measure consisting of 30 items representing nine domains. Fourteen items are relevant to children regardless of condition severity (e.g., health care information/decision making; symptom identification/management) and 16 items are relevant to children with specific health care needs (e.g., medication usage, equipment). CONCLUSION We conducted a first step in developing a condition-agnostic, PRO measure of parental self-efficacy managing their children's chronic and/or disabling conditions that is acceptable and understandable to English and Spanish-speaking parents.
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Affiliation(s)
- Carolyn C Foster
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 162, Chicago, IL, 60611, USA.
| | - Courtney K Blackwell
- Depatment of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kristin Kan
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 162, Chicago, IL, 60611, USA
| | - Luis Morales
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 162, Chicago, IL, 60611, USA
| | - David Cella
- Depatment of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sara Shaunfield
- Depatment of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Transição do cuidado de crianças e satisfação com os cuidados de enfermagem. ACTA PAUL ENFERM 2023. [DOI: 10.37689/acta-ape/2023ao03241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Foster C, Kaat AJ, Shaunfield S, Lin E, Coleman C, Storey M, Morales L, Davis MM. PediHome: Development of a Family-Reported Measure of Pediatric Home Healthcare Quality. Acad Pediatr 2022; 22:1510-1519. [PMID: 35439604 DOI: 10.1016/j.acap.2022.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 03/11/2022] [Accepted: 04/08/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE No validated tools exist to measure pediatric home healthcare quality. The objective of this work was to develop a family-reported survey (PediHome) to measure the quality of home healthcare for children with medical complexity (CMC). METHODS A national multidisciplinary expert panel (N = 19) was convened to develop survey content domains. Panelist were joined by 3 additional experts to rank candidate survey items for importance and evaluate relevance and structure. Cognitive interviews were conducted with English-speaking (n = 12) and Spanish-speaking (n = 4) family caregivers of CMC to revise problematic items and clarify response options. A cross-sectional survey was then fielded (6/1/20-10/31/20) to parents whose children receive healthcare at 2 regional academic medical centers. RESULTS The final measure included N = 28 total items with 4 items quantifying access, 1 evaluating overall quality rating, and 21 items assessing provider tasks (11 home nursing only, 2 certified nursing assistant/home health aide only, and 1 dual). Out of 312 caregivers of CMC, 142 (46%) responded and one-half (n = 68, 48%) reported a child receiving home nursing. They received a weekly median of 58.4% (IQR ±31.2%) of approved nursing hours with 55% reporting a missed nursing shift within the last month. Median overall quality was 75-9 (0-10 scale) and median scores on specific quality items ranged from 31-4 to 43-4 (0-4 scale). CONCLUSIONS PediHome is a new content-valid family-reported measure of home healthcare quality for CMC that is useful for evaluating healthcare quality across several domains. Future work will involve assessing PediHome's construct and predictive validity.
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Affiliation(s)
- Carolyn Foster
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics (C Foster and MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill; Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center (C Foster and MM Davis), Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill.
| | - Aaron J Kaat
- Department of Medical Social Sciences (AJ Kaat, S Shaunfield, L Morales and MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Sara Shaunfield
- Department of Medical Social Sciences (AJ Kaat, S Shaunfield, L Morales and MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Elaine Lin
- Division of General Pediatrics, Department of Pediatrics (E Lin), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Cara Coleman
- Family Voices National (C Coleman), Lexington, Mass
| | - Margaret Storey
- Ann & Robert H. Lurie Children's Hospital of Chicago Family Advisory Board (M Storey), Chicago, Ill
| | - Luis Morales
- Department of Medical Social Sciences (AJ Kaat, S Shaunfield, L Morales and MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Matthew M Davis
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics (C Foster and MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill; Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center (C Foster and MM Davis), Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill; Department of Medical Social Sciences (AJ Kaat, S Shaunfield, L Morales and MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill; Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine (MM Davis), Chicago, Ill
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Lewis TR, Kielt MJ, Walker VP, Levin JC, Guaman MC, Panitch HB, Nelin LD, Abman SH. Association of Racial Disparities With In-Hospital Outcomes in Severe Bronchopulmonary Dysplasia. JAMA Pediatr 2022; 176:852-859. [PMID: 35913704 PMCID: PMC9344383 DOI: 10.1001/jamapediatrics.2022.2663] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/20/2022] [Indexed: 11/14/2022]
Abstract
Importance Bronchopulmonary dysplasia (BPD) is the most common serious morbidity of preterm birth. Short-term respiratory outcomes for infants with the most severe forms of BPD are highly variable. The mechanisms that explain this variability remain unknown and may be mediated by racial disparities. Objective To determine the association of maternal race with death and length of hospital stay in a multicenter cohort of infants with severe BPD. Design, Setting, and Participants This multicenter cohort study included preterm infants enrolled in the BPD Collaborative registry from January 1, 2015, to July 19, 2021, involving 8 BPD Collaborative centers located in the US. Included patients were born at less than 32 weeks' gestation, had a diagnosis of severe BPD as defined by the 2001 National Institutes of Health Consensus Criteria, and were born to Black or White mothers. Exposures Maternal race: Black vs White. Main Outcomes and Measures Death and length of hospital stay. Results Among 834 registry infants (median [IQR] gestational age, 25 [24-27] weeks; 492 male infants [59%]) meeting inclusion criteria, the majority were born to White mothers (558 [67%]). Death was observed infrequently in the study cohort (32 [4%]), but Black maternal race was associated with an increased odds of death (adjusted odds ratio, 2.1; 95% CI, 1.2-3.5) after adjusting for center. Black maternal race was also significantly associated with length of hospital stay (adjusted between-group difference, 10 days; 95% CI, 3-17 days). Conclusions and Relevance In a multicenter severe BPD cohort, study results suggest that infants born to Black mothers had increased likelihood of death and increased length of hospital stay compared with infants born to White mothers. Prospective studies are needed to define the sociodemographic mechanisms underlying disparate health outcomes for Black infants with severe BPD.
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Affiliation(s)
- Tamorah R Lewis
- Children's Mercy Hospital, The University of Missouri-Kansas City, Kansas City
| | - Matthew J Kielt
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus
| | - Valencia P Walker
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus
| | - Jonathan C Levin
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Howard B Panitch
- Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia
| | - Leif D Nelin
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus
| | - Steven H Abman
- Children's Hospital Colorado, The University of Colorado School of Medicine, Aurora
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Cechinel-Peiter C, Lanzoni GMDM, de Mello ALSF, Acosta AM, Pina JC, de Andrade SR, Oelke ND, dos Santos JLG. Quality of transitional care of children with chronic diseases: a cross-sectional study. Rev Esc Enferm USP 2022; 56:e20210535. [PMID: 35404992 PMCID: PMC10081595 DOI: 10.1590/1980-220x-reeusp-2021-0535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/17/2022] [Indexed: 04/16/2023] Open
Abstract
Abstract Objective: To analyze which factors may be associated with the quality-of-care transition of children with chronic diseases from the hospital to their home. Method: A cross-sectional, quantitative study, carried out in two hospitals in Southern Brazil, from February to September 2019. Participants included 167 family members of children with chronic disease. Data collection took place through a demographic questionnaire, and the use of the Brazilian version of the Care Transitions Measure (CTM-15). Results: The average score for the quality of care transition was 90.1 (sd = 19.5) (0–100). Factor 1, “Health management preparation”, was the one with the highest self-perceived average, 92.3 (sd = 11.6), while Factor 4, “Care plan”, had the lowest average, 86.3 (sd = 21.3). The quality of care transition was higher for patients living in municipalities belonging to health regions other than the hospital’s. Conclusion: The quality of care transition for children with chronic diseases, perceived by the children’s family members, in the discharge process from the hospital to home, was considered high. Living in a health region other than the hospital’s region was associated with better perception of the quality of care transition.
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Cechinel-Peiter C, Lanzoni GMDM, Neves ET, Baggio MA, Oelke ND, Santos JLGD. Continuity of care for children with chronic conditions after discharge: a constructivist grounded theory. Rev Bras Enferm 2022; 75:e20210783. [DOI: 10.1590/0034-7167-2021-0783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/02/2022] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objectives: to understand the meaning of continuity of care for children with chronic conditions through transitional care from hospital to home. Methods: this is a qualitative study, conducted from a Constructivist Grounded Theory perspective. Purposive and theoretical sampling were used to recruit 35 participants, including nurses, professionals from the interprofessional hospital team, and actors responsible for healthcare in the home context. The research was conducted at two large hospitals, between March and September 2019. Semi-structured interviews were conducted. Data analysis was carried out using initial and focused coding, according to constructivist grounded theory. Results: the substantive theory that emerged from this study was named “Postponing the next hospitalization”. Eight categories-concepts and 18 elements were derived from the data to support the substantive theory. Final Considerations: transitional care from hospital to home acts as a reminder for the resumption of continuity of care after discharge.
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Williams LJ, Waller K, Chenoweth RP, Ersig AL. Stakeholder perspectives: Communication, care coordination, and transitions in care for children with medical complexity. J SPEC PEDIATR NURS 2021; 26:e12314. [PMID: 33098752 PMCID: PMC8063923 DOI: 10.1111/jspn.12314] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/08/2020] [Accepted: 10/08/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to obtain feedback on communication, care coordination, and transitions in care for hospitalized children with medical complexity (CMC). DESIGN AND METHODS This descriptive, mixed-methods study used online surveys with forced-choice and open-ended questions to obtain stakeholder feedback. Stakeholders included parents, healthcare providers, and nurses. Participants over 18 years of age were recruited from a Midwest children's hospital inpatient unit dedicated to care of CMC. Quantitative data were analyzed using t-tests and one-way analysis of variance. Qualitative description was used to analyze responses to open-ended questions. RESULTS Parents' ratings of communication, care coordination, and transitions in care were generally high. Transitions from other facilities to the emergency department and unit received lower ratings. Providers and nurses gave high ratings to overall care, communication among providers and nurses on the patient unit, and experiences with discharge; however, between unit communication and unit-based coordination received lower ratings. Providers and nurses had higher ratings for discharge preparation than parents (p ≤ .001). Three themes were identified in responses to the open-ended questions: establishing balanced and collaborative relationships between the care team and families, taking a proactive approach to care coordination, and the importance of an inclusive, interdisciplinary, and centralized approach to care coordination and communication. PRACTICE IMPLICATIONS Collaboration among all stakeholders is needed to achieve coordinated care, inclusive communication, and transitions with positive outcomes during hospitalization. Parents identified a need for consistent communication from care teams, with the primary inpatient team taking a lead role. Including parents in care coordination and transitions in care is key, as they are the experts in their children's health and well-being.
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Affiliation(s)
- Lori J Williams
- American Family Children's Hospital, Madison, Wisconsin, USA
| | | | - Rachel P Chenoweth
- The University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, USA
| | - Anne L Ersig
- The University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, USA
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Nageswaran S, Sebesta MR, Golden SL. Transitioning Children With Medical Complexity From Hospital to Home Health Care: Implications for Hospital-Based Clinicians. Hosp Pediatr 2020; 10:657-662. [PMID: 32631842 DOI: 10.1542/hpeds.2020-0068] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES There is limited research about best practices for transitioning children with medical complexity (CMC) from hospital to home. Our objectives were to describe issues related to transitioning CMC from hospital to home health care and identify strategies to improve this transition. METHODS This qualitative study was conducted in western North Carolina between 2012 and 2014 and involved a focus group of 14 hospital- and community-based stakeholders and 4 focus groups of 18 home health nurses. Focus groups were audio-recorded and transcribed verbatim, and transcriptions were managed in ATLAS.ti software. By using content analysis, recurrent themes related to transitioning CMC from hospital to home were identified. RESULTS Themes in 4 domains emerged. (1) Home health orders: home health care providers desired hospital-based providers to write accurate and specific orders, notify them in advance about discharge to order specialized supplies, and avoid changing orders at the last minute. (2) Communication: participants found discharge summaries useful but did not always receive them. Communication between hospital-based clinicians, home health care providers, and the child's primary care physician about the hospitalization and home care was important. (3) Resources: home health care providers needed hospital-based clinicians to be a resource during the early period of transition home. (4) Caregiver preparation: participants emphasized caregiver preparation about medical care of CMC, home health nursing, and the differences between hospital and home care practices in the care of CMC. CONCLUSIONS There are gaps in the system of transitional care of CMC. Potential strategies to improve transitional care of CMC between the hospital and home health care services exist.
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Affiliation(s)
- Savithri Nageswaran
- Departments of Pediatrics and
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Shannon L Golden
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Ravid NL, Zamora K, Rehm R, Okumura M, Takayama J, Kaiser S. Implementation of a multidisciplinary discharge videoconference for children with medical complexity: a pilot study. Pilot Feasibility Stud 2020; 6:27. [PMID: 32099662 PMCID: PMC7027051 DOI: 10.1186/s40814-020-00572-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 02/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The hospital to home transition for children with medical complexity (CMC) poses many challenges, including suboptimal communication between the hospital and medical home. Our objective was to evaluate the implementation of a discharge videoconference incorporating the patient, caregiver, primary care provider (PCP), hospitalist physician, and case manager. METHODS We evaluated implementation of this pilot intervention at a freestanding tertiary care children's hospital using mixed methods. A discharge videoconference was conducted for hospitalized children (< 18 years old) meeting complex chronic disease (C-CD) criteria. We collected field notes and conducted surveys and semi-structured interviews. Outcomes included adoption, cost, acceptability, feasibility, and appropriateness. Adoption, cost, and acceptability were analyzed using descriptive statistics. Acceptability, feasibility, and appropriateness were summarized using thematic content analysis. RESULTS Adoption: A total of 4 CMC (9% of the 44 eligible children) had discharge videoconferences conducted. Cost (in provider time): On average, videoconferences took 5 min to schedule and lasted 21.5 min. Acceptability: All hospitalists involved (n = 4) were very likely to participate again. Interviews with caregivers (n = 4) and PCPs (n = 5) demonstrated that for those participating, videoconferences were acceptable and appropriate due to benefits including development of a shared understanding, remote physical assessment by the PCP, transparency, and humanization of the care handoff, and increased PCP comfort with care of CMC. Feasibility: Barriers included internet connection quality and scheduling constraints. CONCLUSIONS This novel, visual approach to discharge communication for CMC had low adoption, possibly related to recruitment strategy. The videoconference posed low time burdens, and participating physicians and caregivers found them acceptable due to a variety of benefits. We identified several feasibility barriers that could be targeted in future implementation efforts.
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Affiliation(s)
- Noga L. Ravid
- Department of Pediatrics, University of California, San Francisco, 550 16th St. 5th floor, Box 0110, San Francisco, CA 94143 USA
| | - Kayla Zamora
- San Francisco School of Medicine, University of California, 513 Parnassus Avenue, San Francisco, CA 94143 USA
| | - Roberta Rehm
- Department of Family Health Care Nursing, University of California at San Francisco, 2 Koret Way, San Francisco, CA 94143 USA
| | - Megumi Okumura
- Department of Pediatrics, University of California, San Francisco, 550 16th St. 5th floor, Box 0110, San Francisco, CA 94143 USA
| | - John Takayama
- Department of Pediatrics, University of California, San Francisco, 550 16th St. 5th floor, Box 0110, San Francisco, CA 94143 USA
| | - Sunitha Kaiser
- Department of Pediatrics, University of California, San Francisco, 550 16th St. 5th floor, Box 0110, San Francisco, CA 94143 USA
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Abstract
Health care disparities exist along the continuum of care for children admitted to the hospital; they start before admission, impact hospital course, and continue after discharge. During an acute illness, risk of admission, length of stay, hospital costs, communication during family-centered rounds, and risk of readmission have all been shown to vary by socioeconomic status, race, and ethnicity. Understanding factors beyond the acute illness that increase a child's risk of admission, increase hospital course complications, and lower discharge quality is imperative for the new generation of pediatric hospitalists focused on improving health for a population of children. In this article, we describe a framework to conceptualize socioeconomic, racial, and ethnic health disparities for the hospitalized child. Additionally, we offer actions pediatric hospitalists can take to address disparities within their practices.
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Affiliation(s)
- Shaunte McKay
- Department of Pediatrics, Duke University Hospital, Durhan, North Carolina
| | - Victoria Parente
- Department of Pediatrics, Duke University Hospital, Durhan, North Carolina
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