1
|
Stephens MM, Casola AR, Cooper ET, Rea O, Roseman K. Development and implementation of a continuing care program for patients with intellectual and developmental disabilities in family medicine. Fam Pract 2024; 41:378-381. [PMID: 37656895 DOI: 10.1093/fampra/cmad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/03/2023] Open
Abstract
In the United States, individuals with intellectual and developmental disabilities (IDD) consistently experience health disparities. One factor is limited access to quality healthcare services equipped to meet the needs of those with IDD, particularly as they transition to adulthood. The purpose of this work is to describe the development and implementation of Jefferson's Continuing Care Program (JCCP), which was designed to address this care gap. We share how the idea, logistics, and support for the clinic were developed; how JCCP was designed to be uniquely accessible both via physical space and clinic flow; and how those challenges encountered have been crucial for fine-tuning optimal patient care. Since its inception in 2019, JCCP has made large strides towards educating the next generation of medical providers to care for patients with IDD. Looking to the future, JCCP plans to broaden its impact by serving more patients, continuing our advocacy and education work, and continuing to adapt to the needs of our community.
Collapse
Affiliation(s)
- Mary M Stephens
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Allison R Casola
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Emma T Cooper
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Olivia Rea
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Karin Roseman
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| |
Collapse
|
2
|
Bilhartz JL, Lopez MJ, Eder SJ, Magee JC, Rea K, Sturza J, Fredericks EM. Changes over time in self-efficacy and the allocation of responsibility for health management tasks in pediatric liver transplant recipients: Targets to improve the transition process. Pediatr Transplant 2024; 28:e14673. [PMID: 38059409 DOI: 10.1111/petr.14673] [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: 06/14/2023] [Revised: 11/03/2023] [Accepted: 11/24/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND The process of transition to adult-based care encompasses a critical period in the life of an adolescent and young adult living with a chronic illness and one that comes with an increase in the risk of poor health outcomes. As yet, there is a dearth of empirical data to help optimize this process to ensure the best long-term outcome. METHODS This study used a principal components analysis to determine specific constructs measured by a revised version of the transition readiness survey used in our clinic. We investigated changes in these constructs over time. We further investigated the relationship between the change in these constructs over time spent in a focused transition program with adherence. RESULTS The primary component underlying our transition readiness survey for patients and parents represented self-efficacy. Time spent in the transition program was an independent predictor of change in self-efficacy (rho 0.299, p = .015); however, the magnitude of that change had no relationship to adherence. Change in parent-proxy self-efficacy was found to have a statistically significant relationship with tacrolimus standard deviation (rho -0.301, p = .026). There was disagreement identified between patient and parent responses on the survey. Neither change in patient nor parent reports of self-efficacy was found to have a relationship with post-transfer adherence. CONCLUSIONS This study reaches the novel conclusion that self-efficacy and parent-proxy self-efficacy are dynamic concepts that change over time spent in a focused transition program. The patient-parent disagreement and the relationship between parent-proxy self-efficacy and adherence stress the importance of involving parents/guardians in the transition process as well.
Collapse
Affiliation(s)
- Jacob L Bilhartz
- Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA
- University of Michigan Transplant Center, Michigan Medicine, Ann Arbor, Michigan, USA
| | - M James Lopez
- Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA
- University of Michigan Transplant Center, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Sally J Eder
- Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA
| | - John C Magee
- University of Michigan Transplant Center, Michigan Medicine, Ann Arbor, Michigan, USA
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Kelly Rea
- Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Julie Sturza
- Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Emily M Fredericks
- Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA
- University of Michigan Transplant Center, Michigan Medicine, Ann Arbor, Michigan, USA
| |
Collapse
|
3
|
Splane J, Doucet S, Luke A. Transitioning from paediatric to adult healthcare: Exploring the practices and experiences of care providers. J Child Health Care 2023:13674935231202870. [PMID: 37728067 DOI: 10.1177/13674935231202870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Complex paediatric health conditions are increasingly associated with survival into adulthood resulting in more youth with complex care needs (CCN) transitioning from paediatric to adult healthcare. Current transition practices, when present, are disorganized, resulting in health status deterioration and complications due to unmet needs. The aim of this qualitative descriptive study is to develop a broader understanding of the current transition practices and experiences, as well as recommendations of care providers who support youth with CCN in the transition from paediatric to adult healthcare. Fifteen care providers from two Eastern Canadian provinces were interviewed using a semi-structured interview guide. The data collected were analyzed using inductive thematic analysis following the six phases outlined by Braun and Clarke (2006). The findings from this research demonstrate (1) a shortage of care providers, (2) inconsistent timing for transition initiation, and (3) lack of available community resources and services. Participant recommendations include (1) a designated transition coordinator; (2) transition policy implementation; (3) improved collaboration between and across care teams; and (4) the integration of virtual care to facilitate the transition process. The results of this study can potentially improve transition practices and policies and guide future research in this area.
Collapse
Affiliation(s)
- Jennifer Splane
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Shelley Doucet
- Department of Nursing & Health Sciences, University of New Brunswick Saint John, Saint John, NB, Canada
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, NB, Canada
| | - Alison Luke
- Department of Nursing & Health Sciences, University of New Brunswick Saint John, Saint John, NB, Canada
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, NB, Canada
| |
Collapse
|
4
|
Casado E, Gómez-Alonso C, Pintos-Morell G, Bou-Torrent R, Barreda-Bonis AC, Torregrosa JV, Broseta-Monzó JJ, Arango-Sancho P, Chocrón-de-Benzaquen S, Olmedilla-Ishishi Y, Soler-López B. Transition of patients with metabolic bone disease from paediatric to adult healthcare services: current situation and proposals for improvement. Orphanet J Rare Dis 2023; 18:245. [PMID: 37644568 PMCID: PMC10463506 DOI: 10.1186/s13023-023-02856-6] [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] [Received: 07/15/2022] [Accepted: 08/20/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND There are currently no models for the transition of patients with metabolic bone diseases (MBDs) from paediatric to adult care. The aim of this project was to analyse information on the experience of physicians in the transition of these patients in Spain, and to draw up consensus recommendations with the specialists involved in their treatment and follow-up. METHODS The project was carried out by a group of experts in MBDs and included a systematic review of the literature for the identification of critical points in the transition process. This was used to develop a questionnaire with a total of 48 questions that would determine the degree of consensus on: (a) the rationale for a transition programme and the optimal time for the patient to start the transition process; (b) transition models and plans; (c) the information that should be specified in the transition plan; and (d) the documentation to be created and the training required. Recommendations and a practical algorithm were developed using the findings. The project was endorsed by eight scientific societies. RESULTS A total of 86 physicians from 53 Spanish hospitals participated. Consensus was reached on 45 of the 48 statements. There was no agreement that the age of 12 years was an appropriate and feasible point at which to initiate the transition in patients with MBD, nor that a gradual transition model could reasonably be implemented in their own hospital. According to the participants, the main barriers for successful transition in Spain today are lack of resources and lack of coordination between paediatric and adult units. CONCLUSIONS The TEAM Project gives an overview of the transition of paediatric MBD patients to adult care in Spain and provides practical recommendations for its implementation.
Collapse
Affiliation(s)
- Enrique Casado
- Rheumatology Department, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain
| | - Carlos Gómez-Alonso
- Bone and Mineral Metabolism Clinical Management Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Guillem Pintos-Morell
- Hereditary Metabolic Diseases, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Rosa Bou-Torrent
- Paediatric Rheumatology Unit, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | - José Vicente Torregrosa
- Department of Nephrology and Renal Transplant, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Pedro Arango-Sancho
- Department of Paediatric Nephrology, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | | | - Begoña Soler-López
- Medical Department, E-C-BIO, S.L., c/Rosa de Lima, 1, Edificio ALBA, Office 016, 28230, Las Rozas, Madrid, Spain.
| |
Collapse
|
5
|
Osako M, Yamaoka Y, Takeuchi C, Mochizuki Y, Fujiwara T. Health care transition for cerebral palsy with intellectual disabilities: A systematic review. Rev Neurol (Paris) 2023:S0035-3787(23)00820-2. [PMID: 36870883 DOI: 10.1016/j.neurol.2022.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 10/05/2022] [Accepted: 11/12/2022] [Indexed: 03/06/2023]
Abstract
OBJECTIVE Today, most individuals with cerebral palsy are adults who need a paediatric-to-adult health care transition. However, many remain in paediatric care for treatment of adult-onset health issues. Therefore, a systematic review based on the 'Triple Aim' framework was performed to determine the status of paediatric-to-adult health care transition for people with cerebral palsy. A comprehensive evaluation of transitional care was proposed for using this framework. It consists of 'experience of care', meaning satisfaction with the care, 'population health', meaning the well-being of patients, and 'cost', meaning cost-effectiveness. METHOD Electronic database (PubMed) searches were performed. The inclusion criteria were original articles published between 1990 and 2020. The search terms used in this study were ('cerebral palsy' AND 'transition to adult health care') OR ('cerebral palsy' AND 'transition'). The study type had to be epidemiological, case report, case-control, and cross-sectional, but not qualitative. The outcomes of the studies were categorised into 'care experience', 'population health', and 'cost', according to the Triple Aim framework. RESULTS Thirteen articles met the abovementioned inclusion criteria. Few studies have examined the effect of the intervention of transition for young adults with cerebral palsy. Participants in some studies had no intellectual disability. Young adults were dissatisfied with the 'care experience', 'population health', and 'cost' and had unmet health needs and inadequate social participation. INTERPRETATION Further transition intervention studies with a comprehensive assessment and proactive involvement of individuals are warranted. The presence of an intellectual disability should be considered.
Collapse
Affiliation(s)
- M Osako
- Department of Neurology, Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled, 1-2-3 Jujodai, Kita-ku, Tokyo 114-0033, Japan.
| | - Y Yamaoka
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - C Takeuchi
- Department of Neurology, Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled, 1-2-3 Jujodai, Kita-ku, Tokyo 114-0033, Japan
| | - Y Mochizuki
- Department of Neurology, Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled, 1-2-3 Jujodai, Kita-ku, Tokyo 114-0033, Japan
| | - T Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
6
|
Fleischer M, Coskun B, Stolte B, Della-Marina A, Kölbel H, Lax H, Nonnemacher M, Kleinschnitz C, Schara-Schmidt U, Hagenacker T. [Essen transition model for neuromuscular diseases]. DER NERVENARZT 2023; 94:129-135. [PMID: 35254466 PMCID: PMC9898325 DOI: 10.1007/s00115-022-01274-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Advances in healthcare systems with new therapeutic options improve the life expectancy of patients with neuromuscular diseases. With this, a shift in the phenotype of the diseases from the neuromuscular system towards other organs is more frequently observed, requiring closer interdisciplinary cooperation in caring for these young adults. Therefore, the transition to the adult caring system is nowadays a multilayered transfer with the need for complex care of these patients. OBJECTIVE How can the transitional process be efficiently structured to combine the therapeutic effort of each specialist discipline involved and improve the healthcare process and quality of life in young adults with neuromuscular diseases? MATERIAL AND METHOD The Departments of Neuropediatrics and Neurology of the University Medicine Essen established the Essen transition model for a structured transitional process. A concept of care was developed for the late onset Pompe's disease, Duchenne muscular dystrophy and juvenile myasthenia gravis representatively for neuromuscular diseases. It consists of four components: 1) In a standardized operational procedure (SOP), general processes, clinical diagnostic steps and guidance of treatment between the two departments are harmonized and specified. 2) The young adults and their relatives are seen in a joint consultation of both disciplines allowing a comprehensive handover for healthcare professionals. 3) In a quarterly meeting, transition conference representatives from the different specialized disciplines from pediatric and adult medicine get together for a case-related interdisciplinary exchange. 4) An interdepartmental transitional database was created to integrate all diagnostic results and parameters as a common information platform and data basis. CONCLUSION The Essen transition model aims to close a gap in the transition of patients with neuromuscular diseases and improve healthcare in these patients with their complex needs.
Collapse
Affiliation(s)
- Michael Fleischer
- Klinik für Neurologie und Center for Translational Neuro- and Behavioral Science, Universitätsmedizin Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - Bayram Coskun
- Klinik für Neurologie und Center for Translational Neuro- and Behavioral Science, Universitätsmedizin Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - Benjamin Stolte
- Klinik für Neurologie und Center for Translational Neuro- and Behavioral Science, Universitätsmedizin Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - Adela Della-Marina
- Klinik für Kinderheilkunde 1, Abteilung für Neuropädiatrie, Universitätsmedizin Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - Heike Kölbel
- Klinik für Kinderheilkunde 1, Abteilung für Neuropädiatrie, Universitätsmedizin Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - Hildegard Lax
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Hufelandstraße 55, 45122, Essen, Deutschland
| | - Michael Nonnemacher
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Hufelandstraße 55, 45122, Essen, Deutschland
| | - Christoph Kleinschnitz
- Klinik für Neurologie und Center for Translational Neuro- and Behavioral Science, Universitätsmedizin Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - Ulrike Schara-Schmidt
- Klinik für Kinderheilkunde 1, Abteilung für Neuropädiatrie, Universitätsmedizin Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - Tim Hagenacker
- Klinik für Neurologie und Center for Translational Neuro- and Behavioral Science, Universitätsmedizin Essen, Hufelandstraße 55, 45147, Essen, Deutschland.
| |
Collapse
|
7
|
Hriberšek M, Eibensteiner F, Kapral L, Teufel A, Nawaz FA, Cenanovic M, Sai CS, Devkota HP, De R, Singla RK, Parvanov ED, Tsagkaris C, Atanasov AG, Schaden E. "Loved ones are not 'visitors' in a patient's life"-The importance of including loved ones in the patient's hospital stay: An international Twitter study of #HospitalsTalkToLovedOnes in times of COVID-19. Front Public Health 2023; 11:1100280. [PMID: 36778575 PMCID: PMC9909431 DOI: 10.3389/fpubh.2023.1100280] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023] Open
Abstract
Background Hospitals are institutions whose primary task is to treat patients. Family-centered care, which considers loved ones as equal partners in patient care, has been gaining recognition in the adult care setting. Our aim was to record experiences of and opinions on communication between hospital-based healthcare providers and patients' loved ones, related but not limited to the rigorous mitigation measures implemented during the COVID-19 pandemic. Methods The Twitter profile @HospitalsTalkTo and hashtag #HospitalsTalkToLovedOnes were created to interact with the Twitter public between 7 June 2021 and 7 February 2022. Conversations surrounding #HospitalsTalkToLovedOnes were extracted and subjected to natural language processing analysis using term frequency and Markov chain analysis. Qualitative thematic analysis was performed on the 10% most interacted tweets and of tweets mentioning "COVID" from a personal experience-based subset. Results We collected 4412 unique tweets made or interacted by 7040 Twitter users from 142 different countries. The most frequent words were patient, hospital, care, family, loved and communication. Thematic analysis revealed the importance of communication between patients, patients' loved ones and hospitals; showed that patients and their loved ones need support during a patient's hospital journey; and that pediatric care should be the gold standard for adult care. Visitation restrictions due to COVID-19 are just one barrier to communication, others are a lack of phone signal, no space or time for asking questions, and a complex medical system. We formulate 3 recommendations to improve the inclusion of loved ones into the patient's hospital stay. Conclusions "Loved ones are not 'visitors' in a patient's life". Irrespective of COVID-19, patient's loved ones need to be included during the patient's hospital journey. Transparent communication and patient empowerment increase patient safety and improve the hospital experience for both the patients and their loved ones. Our findings underline the need for the concept of family-centered care to finally be implemented in adult nursing clinical practice.
Collapse
Affiliation(s)
- Mojca Hriberšek
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Fabian Eibensteiner
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria,Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Lorenz Kapral
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Anna Teufel
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Faisal A. Nawaz
- Department of Psychiatry, Al Amal Psychiatric Hospital, Dubai, United Arab Emirates
| | | | | | - Hari Prasad Devkota
- Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan,Pharmacy Program, Gandaki University, Pokhara, Nepal
| | - Ronita De
- Department of ICMR-NICED Virus Lab, Indian Council of Medical Research-National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Rajeev K. Singla
- Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China,School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
| | - Emil D. Parvanov
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria,Department of Translational Stem Cell Biology, Research Institute of the Medical University of Varna, Varna, Bulgaria
| | | | - Atanas G. Atanasov
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria,Department of Biotechnology and Nutrigenomics, Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Magdalenka, Poland
| | - Eva Schaden
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria,Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria,*Correspondence: Eva Schaden ✉
| |
Collapse
|
8
|
Sathe M, Werzen AS, Davis N, Millstein LS. Implementing a Longitudinal Adolescent Transition of Care Curriculum: Identifying Comfort and Barriers Among Residents. Cureus 2022; 14:e29394. [DOI: 10.7759/cureus.29394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/20/2022] [Indexed: 11/05/2022] Open
|
9
|
Fleischer M, Coskun B, Stolte B, Della-Marina A, Kölbel H, Lax H, Nonnemacher M, Kleinschnitz C, Schara-Schmidt U, Hagenacker T. Essen transition model for neuromuscular diseases. Neurol Res Pract 2022; 4:41. [PMID: 36058951 PMCID: PMC9442978 DOI: 10.1186/s42466-022-00206-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the optimization of medical care structures and the rapid progress in the development of new therapeutic methods, an increase in life expectancy is observed in patients with neuromuscular diseases. This leads to an expansion of the phenotypic spectrum, whereby new or previously less relevant disease manifestations in different organ systems gain more importance. The care of adolescents and young adults with neuromuscular diseases, therefore, requires increasingly close interdisciplinary collaboration within neuromuscular centers. RESEARCH QUESTION How can the transition process from pediatric to adult care be structured so that the individual disciplines are efficiently integrated into the complex treatment and care process, and the patients' quality of life is improved? MATERIAL AND METHODS A structured transition process was established at the University Hospital in Essen, Germany. Exemplarily, a comparable care concept was developed based on Pompe disease, Duchenne muscular dystrophy, and juvenile myasthenia gravis comprising four elements: (1) With the introduction of cross-department standard operating procedures, the logistical processes, as well as the diagnostic and therapeutic measures, are uniformly coordinated, and the transition process is bindingly defined. (2) To ensure a seamless transition, young patients are seen with their parents during joint consultations before they reach their 17th birthday. This creates an opportunity for patients to get to know the subsequent department structure and build a lasting relationship of trust. (3) A quarterly "transition board" regularly brings together the participating disciplines from pediatric and adult care systems for a case-related interdisciplinary exchange and continuous optimization of the transition process. (4) A cross-department "Transition Database", in which medical findings and parameters are recorded, was implemented as a common information platform and database. CONCLUSION The Essen Transition Model aims to close the gap in care for young patients with neuromuscular diseases during the critical transition from pediatric to adult medicine and to create a successful continuation of treatment in adulthood.
Collapse
Affiliation(s)
- Michael Fleischer
- Department of Neurology and Center for Translational Neuro- and Behavioral Science, University Medicine Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Bayram Coskun
- Department of Neurology and Center for Translational Neuro- and Behavioral Science, University Medicine Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Benjamin Stolte
- Department of Neurology and Center for Translational Neuro- and Behavioral Science, University Medicine Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Adela Della-Marina
- Division of Neuropediatrics, Department of Pediatrics 1, University Medicine Essen, Essen, Germany
| | - Heike Kölbel
- Division of Neuropediatrics, Department of Pediatrics 1, University Medicine Essen, Essen, Germany
| | - Hildegard Lax
- Institute of Medical Informatics, Biometrics, and Epidemiology, University Hospital Essen, Essen, Germany
- Center for Clinical Trials, University Medicine Essen, Essen, Germany
| | - Michael Nonnemacher
- Institute of Medical Informatics, Biometrics, and Epidemiology, University Hospital Essen, Essen, Germany
- Center for Clinical Trials, University Medicine Essen, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology and Center for Translational Neuro- and Behavioral Science, University Medicine Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Ulrike Schara-Schmidt
- Division of Neuropediatrics, Department of Pediatrics 1, University Medicine Essen, Essen, Germany
| | - Tim Hagenacker
- Department of Neurology and Center for Translational Neuro- and Behavioral Science, University Medicine Essen, Hufelandstraße 55, 45147, Essen, Germany.
| |
Collapse
|
10
|
Fergus KB, Zambeli-Ljepović A, Hampson LA, Copp HL, Nagata JM. Health care utilization in young adults with childhood physical disabilities: a nationally representative prospective cohort study. BMC Pediatr 2022; 22:505. [PMID: 36008822 PMCID: PMC9413894 DOI: 10.1186/s12887-022-03563-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/19/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Young people with physical disabilities face barriers to accessing health care; however, few studies have followed adolescents with physical disabilities longitudinally through the transition of care into adulthood. The objective of this study was to investigate differences in health care utilization between adolescents with physical disabilities and those without during the transition period from adolescent to adult care. METHODS We utilized the National Longitudinal Study of Adolescent to Adult Health, a prospective cohort study following adolescents ages 11-18 at baseline (1994-1995) through adulthood. Baseline physical disability status was defined as difficulty using limbs, using assistive devices or braces, or having an artificial limb; controls met none of these criteria. Health care utilization outcomes were measured seven years after baseline (ages 18-26). These included yearly physical check-ups, unmet health care needs, and utilization of last-resort medical care, such as emergency departments, inpatient hospital wards, and inpatient mental health facilities. Multiple logistic regression models were used to predict health care utilization, controlling for age, sex, race/ethnicity, insurance status, and history of depression. RESULTS Thirteen thousand four hundred thirty-six participants met inclusion criteria, including 4.2% with a physical disability and 95.8% without. Half (50%) of the sample were women, and the average age at baseline was 15.9 years (SE = 0.12). In logistic regression models, those with a disability had higher odds of unmet health care needs in the past year (Odds Ratio (OR) 1.41 95% CI 1.07-1.87), two or more emergency department visits in the past five years (OR 1.34 95% CI 1.06-1.70), and any hospitalizations in the past five years (OR 1.36 95% CI 1.07-1.72). No statistically significant differences in preventive yearly check-ups or admission to mental health facilities were noted. CONCLUSIONS Young adults with physical disabilities are at higher risk of having unmet health care needs and using last-resort health care services compared to their non-disabled peers.
Collapse
Affiliation(s)
- Kirkpatrick B Fergus
- Department of Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Alan Zambeli-Ljepović
- Department of Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Lindsay A Hampson
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Hillary L Copp
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California-San Francisco, 550 16th Street, 4th Floor, Box 0530, San Francisco, CA, 94143, USA.
| |
Collapse
|
11
|
Transition of Chronic Pediatric Nephrological Patients to Adult Care Excluding Patients on Renal Replacement Therapy with Literature Review. CHILDREN 2022; 9:children9070959. [PMID: 35883943 PMCID: PMC9317370 DOI: 10.3390/children9070959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022]
Abstract
(1) Background: The transition of children with chronic kidney disease to adult care has become a well-handled issue. However, other patients with normal or mildly decreased renal function also requiring further management and transition are neglected. (2) Methods: A questionnaire was sent to patients with kidney pathology, aged 17 years and older.(3) Results: The patients were mostly high-school (55%) or college students (39%), living with their parents (94%). One third did not know how their disease affected their choice of profession and reproductive health. Furthermore, 46% of the respondents did not know who would continue with their care, and 44% still had a primary pediatrician. (4) Conclusions: A review of the literature on the topic was performed and summarized here. Regular education is the key for successful transfer, not only in chronic kidney and transplant patients, but also in others in whom a decline in renal function can be expected in the future.
Collapse
|
12
|
Prüfe J, Pape L, Kreuzer M. Barriers to the Successful Health Care Transition of Patients with Kidney Disease: A Mixed-Methods Study on the Perspectives of Adult Nephrologists. CHILDREN 2022; 9:children9060803. [PMID: 35740740 PMCID: PMC9221888 DOI: 10.3390/children9060803] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/22/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022]
Abstract
The transition from paediatric to adult-based health care is a challenging period bearing a high risk of medication nonadherence and transplant loss in adolescents and young adults after kidney transplantation. Successful transition asks for the cooperation of many, not least the adult physicians. Yet little is known about their thoughts and attitudes on the transition. We conducted a cross-sectional mixed-methods study, inviting all nephrologists registered with the German Society of Nephrology. A total of 119/1984 nephrologists answered an online survey, and 9 nephrologists participated in expert interviews on transition experiences and perceived barriers. Interviews were thematically analysed. Based on the results, 30 key statements were listed and returned to participants for a ranking of their relevance. The main themes extracted are (1) available resources, (2) patient-related factors, (3) qualification and (4) preparation of and cooperation with the paediatric setting. In conclusion, it became evident that successful transition faces multiple obstacles. At the least, it asks for time, staff, and money. Rigid structures in health care leave little room for addressing the specific needs of this small group of patients. Transition becomes a topic one wants to and is able to afford.
Collapse
Affiliation(s)
- Jenny Prüfe
- Department of Pediatrics II, University Children’s Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany; (L.P.); (M.K.)
- Psychosocial Service, University Children’s Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
- Correspondence:
| | - Lars Pape
- Department of Pediatrics II, University Children’s Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany; (L.P.); (M.K.)
| | - Martin Kreuzer
- Department of Pediatrics II, University Children’s Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany; (L.P.); (M.K.)
| |
Collapse
|
13
|
Cheng HWB, Li CHR, Yeung KY, Lee T, Chan KP, Chung WKV, Hsu D, Chan OMI, Chui R, Man CW, Cheung KW, Wong C, Wu MP, Chan CHR. Transition to adult services for young people suffering from life-limiting neurodevelopmental disabilities: A case series. PROGRESS IN PALLIATIVE CARE 2022. [DOI: 10.1080/09699260.2022.2066270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Chak Ho Rever Li
- Department of Pediatrics & Adolescent Medicine, Tuen Mun Hospital, New Territories, Hong Kong
| | - K. Y. Yeung
- Department of Pediatrics & Adolescent Medicine, Tuen Mun Hospital, New Territories, Hong Kong
| | - Tracy Lee
- Department of Pediatrics & Adolescent Medicine, Tuen Mun Hospital, New Territories, Hong Kong
| | - Ka Po Chan
- Department of Medicine & Geriatrics, Tuen Mun Hospital, New Territories, Hong Kong
| | - Wai Kei Vicky Chung
- Department of Medicine & Geriatrics, Tuen Mun Hospital, New Territories, Hong Kong
| | - Dany Hsu
- Department of Medicine & Geriatrics, Tuen Mun Hospital, New Territories, Hong Kong
| | - Oi Man Iman Chan
- Department of Medicine & Geriatrics, Tuen Mun Hospital, New Territories, Hong Kong
| | - Ruby Chui
- Department of Medicine & Geriatrics, Tuen Mun Hospital, New Territories, Hong Kong
| | - Ching Wah Man
- Department of Medicine & Geriatrics, Tuen Mun Hospital, New Territories, Hong Kong
| | - Ka Wai Cheung
- Palliative Home Care Team, Tuen Mun Hospital, New Territories, Hong Kong
| | - Cherry Wong
- Palliative Home Care Team, Tuen Mun Hospital, New Territories, Hong Kong
| | - M. P. Wu
- Palliative Home Care Team, Tuen Mun Hospital, New Territories, Hong Kong
| | - Chun Hung Red Chan
- Palliative Home Care Team, Tuen Mun Hospital, New Territories, Hong Kong
| |
Collapse
|
14
|
Riedl Khursigara M, Matsuda-Abedini M, Radhakrishnan S, Hladunewich MA, Lemaire M, Teoh CW, Noone D, Licht C. A Guide for Adult Nephrologists and Hematologists to Managing Atypical Hemolytic Uremic Syndrome and C3 Glomerulopathy in Teens Transitioning to Young Adults. Adv Chronic Kidney Dis 2022; 29:231-242. [PMID: 36084970 DOI: 10.1053/j.ackd.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 04/11/2022] [Indexed: 11/11/2022]
Abstract
Atypical hemolytic uremic syndrome and C3 glomerulopathy/immune complex membranoproliferative glomerulonephritis are ultra-rare chronic, complement-mediated diseases with childhood manifestation in a majority of cases. Transition of clinical care of patients from pediatric to adult nephrologists-typically with controlled disease in native or transplant kidneys in case of atypical hemolytic uremic syndrome and often with chronic progressive disease despite treatment efforts in case of C3 glomerulopathy/immune complex membranoproliferative glomerulonephritis-identifies a challenging juncture in the journey of these patients. Raising awareness for the vulnerability of this patient cohort; providing education on disease pathophysiology and management including the use of new, high-precision complement antagonists; and establishing an ongoing dialog of patients, families, and all members of the health care team involved on either side of the age divide will be inevitable to ensure optimal patient outcomes and a safe transition of these patients to adulthood.
Collapse
Affiliation(s)
| | - Mina Matsuda-Abedini
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Seetha Radhakrishnan
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michelle A Hladunewich
- Division of Nephrology and Obstetric Medicine, Department of Medicine, Sunnybrook Health Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mathieu Lemaire
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Cell Biology Program, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Chia Wei Teoh
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Damien Noone
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christoph Licht
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Cell Biology Program, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.
| |
Collapse
|
15
|
Tsang VWL, Fletcher S, Jassemi S, Smith S. Youth, Caregiver, and Provider Perception of the Transition from Pediatric to Adult Care for Youth with Chronic Diseases. J Dev Behav Pediatr 2022; 43:197-205. [PMID: 34698703 DOI: 10.1097/dbp.0000000000001024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/02/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Youth with chronic diseases are required to transition from pediatric to adult care across the world at variable ages in their adolescent years. The aim of this study is to examine perspectives of young patients, caregivers, and physicians in the transition process. METHODS This 3-phase mixed methods research study gathered data using an iterative approach with the collaboration of youth coresearchers. Physician opinions were gathered through a survey. Further data were collected through 15 semistructured, standardized interviews of adolescent medicine physicians. Perspectives of adolescents and young adult (AYA) patients and their caregivers were gathered independently using a 20-item survey. Quantitative data were analyzed with descriptive statistics and sorted by theme. RESULTS In phase 1, respondents rated current transition processes as an average 5.19/10 on a 10-point Likert scale (1 = poor and 10 = excellent) with no participants rating 9 or 10 of 10. The top barrier identified was a lack of communication between pediatric and adult doctors (71.0%). The top ranked strategy for improvement was to provide formal transition guidelines (69.8%). In phase 2, specific concerns include lack of insurance coverage, lack of physicians available to take on youth transitioning to adult care who are also knowledgeable regarding pediatric conditions, and lack of funding or staff support for transition clinics. In phase 3, most of the youth surveyed (52%) reported that their physicians have not involved them in conversations about transitioning. AYA patients prefer the point of transfer to occur with other life transitions such as graduation, and caregivers prefer transfer to happen during times of stability where their children can dedicate adequate time to their health. CONCLUSION Fulfilling youth desire for increased patient autonomy and ownership can help overcome their poor perception of the transition process. Increased physician training in adolescent health and improvements in post-transition community plans may be beneficial to prevent loss to follow-up among young patients across medical disciplines. Successful transition into adult care requires a unique process for each youth and requires adequate preparation from the pediatric front, empowerment of young patients and their families, and continuity of care by adult providers.
Collapse
Affiliation(s)
- Vivian W L Tsang
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sarah Fletcher
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sara Jassemi
- Division of Adolescent Health and Medicine, Department of Pediatrics, BC Children's Hospital Vancouver, BC, Canada ; and
| | - Sharon Smith
- Department of Emergency Medicine, Connecticut Children's Medical Centre, Hartford, CT
| |
Collapse
|
16
|
Pruette CS, Ranch D, Shih WV, Ferris MDG. Health Care Transition in Adolescents and Young Adults With Chronic Kidney Disease: Focus on the Individual and Family Support Systems. Adv Chronic Kidney Dis 2022; 29:318-326. [PMID: 36084978 DOI: 10.1053/j.ackd.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 02/03/2022] [Accepted: 02/15/2022] [Indexed: 11/11/2022]
Abstract
Health care transition (HCT) from pediatric to adult-focused services is a longitudinal process driven by the collaboration and interactions of adolescent/young adult patients, their families, providers, health care agencies, and environment. Health care providers in both pediatric and adult-focused settings must collaborate, as patients' health self-management skills are acquired in the mid-20s, after they have transferred to adult-focused care. Our manuscript discusses the individual and family support systems as they relate to adolescents and young adults with chronic or end-stage kidney disease. In the individual domain, we discuss demographic/socioeconomic characteristics, disease complexity/course, cognitive capabilities, and self-management/self-advocacy. In the family domain, we discuss family composition/culture factors, family function, parenting style, and family unit factors. We provide a section dedicated to patients with cognitive and developmental disability. Furthermore, we discuss barriers for HCT preparation and offer solutions as well as activities for HCT preparation.
Collapse
Affiliation(s)
| | - Daniel Ranch
- Department of Pediatrics, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health at San Antonio, San Antonio, TX
| | | | | |
Collapse
|
17
|
Cassidy CE, Kontak JC, Pidduck J, Higgins A, Anderson S, Best S, Grant A, Jeffers E, MacDonald S, MacKinnon L, Mireault A, Rowe L, Walls R, Curran J. Provider perspectives of barriers and facilitators to the transition from pediatric to adult care: a qualitative descriptive study using the COM-B model of behaviour. JOURNAL OF TRANSITION MEDICINE 2022. [DOI: 10.1515/jtm-2022-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
Transition of care can be a complex process that involves multiple providers working together across the pediatric and adult health care system to support youth. The shift from a primarily family-centred approach to a patient-centred approach that emphasizes more personal responsibility for health care management can be challenging for youth, caregivers and providers to navigate. Despite the importance of transition, there is a lack of evidence about the best practices and types of interventions that support the transition of care process from the perspective of both pediatric and adult health care providers. An exploration of barriers and facilitators is a critical first step to identifying important behavioural determinants for designing and implementing evidence-based interventions. As such, the purpose of this study was to identify the barriers and facilitators to the transition of care from the perspective of pediatric and adult health care providers.
Methods
A qualitative descriptive design was used to conduct semi-structured interviews guided by the COM-B Model of Behaviour – a theoretical model that suggests that for any behaviour to occur there must be a change in one or more of the following domains: capability, opportunity and/or motivation. The study took place in the province of Nova Scotia, Canada and focused on three common conditions: Inflammatory Bowel Disease, Diabetes, and Juvenile Idiopathic Arthritis. Participants were recruited through stratified purposeful and convenience sampling and all interviews were conducted virtually on Zoom. Interviews were audio-recorded, transcribed verbatim and imported into NVivo Qualitative Data Software for analysis. Data were first analyzed using directed content analysis, guided by the COM-B model, then further examined using inductive thematic analysis to identify barriers and facilitators within the three domains.
Results
In total, 26 health care providers participated in this study (pediatric, n=13, adult n=13) including a mix of adult and pediatric physicians, nurses, and allied health care professionals. The participants identified primarily as female (n=19.73%) and had a range of years of experience (3–39, mean = 14.84). We identified a range of interconnected barriers and facilitators across each of the COM-B Model of Behaviour domains such as, degree of formalized training (capability), facilitation and coordination responsibilities (opportunity), collaboration across providers (opportunities), securing attachment to adult care system (motivation) and time (opportunity). Findings were categorized by three overarching themes: (1) Knowledge and Skills to Support Transition of Care; (2) Navigation Role for Youth and Caregivers; and (3) System Coordination.
Conclusions
By using the COM-B Model of Behaviour, we identified key barriers and facilitators that intersect to influence the transition of care process. These findings will be used to inform and adapt initiatives and interventions in Nova Scotia to improve the transition experience, as well as may be transferrable to other jurisdictions.
Collapse
Affiliation(s)
- Christine E. Cassidy
- School of Nursing , Dalhousie University and IWK Health Centre , Halifax , NS , Canada
| | - Julia C. Kontak
- Maritime SPOR SUPPORT Unit, Nova Scotia Health and Faculty of Health, Dalhousie University , Halifax , NS , Canada
| | | | | | - Scott Anderson
- Maritime SPOR SUPPORT Unit , Nova Scotia Health , Halifax , NS , Canada
| | | | - Amy Grant
- Maritime SPOR SUPPORT Unit , Nova Scotia Health , Halifax , NS , Canada
| | - Elizabeth Jeffers
- Maritime SPOR SUPPORT Unit , Nova Scotia Health , Halifax , NS , Canada
| | | | | | - Amy Mireault
- Maritime SPOR SUPPORT Unit , Nova Scotia Health , Halifax , NS , Canada
| | - Liam Rowe
- Maritime SPOR SUPPORT Unit , Nova Scotia Health , Halifax , NS , Canada
| | - Rose Walls
- Mental Health and Addictions, Nova Scotia Health , Halifax , NS , Canada
| | - Janet Curran
- School of Nursing , Dalhousie University and IWK Health Centre , Halifax , NS , Canada
| |
Collapse
|
18
|
Jefferies M, Peart T, Perrier L, Lauzon A, Munce S. Psychological Interventions for Individuals With Acquired Brain Injury, Cerebral Palsy, and Spina Bifida: A Scoping Review. Front Pediatr 2022; 10:782104. [PMID: 35386256 PMCID: PMC8978581 DOI: 10.3389/fped.2022.782104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/10/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND With current medical advancements, more adolescents with neurodevelopmental disorders are transitioning from child- to adult-centred health care services. Therefore, there is an increasing demand for transitional services to help navigate this transition. Health care transitions can be further complicated by mental health challenges prevalent among individuals with cerebral palsy (CP), spina bifida (SB), and childhood onset acquired brain injury (ABI). Offering evidence-based psychological interventions for these populations may improve overall outcomes during transition period(s) and beyond. The objective of this scoping review is to identify key characteristics of psychological interventions being used to treat the mental health challenges of adolescents and adults with CP, SB, and childhood onset ABI. METHODS Methodological frameworks by Arksey and O'Malley, and Levac and colleagues were used to explore studies published between 2009 and 2019. Included studies were required to be written in English and report on a psychological intervention(s) administered to individuals at least 12 years of age with a diagnosis of CP, SB, or childhood onset ABI. All study designs were included. RESULTS A total of 11 studies were identified. Of these, eight reported psychological interventions for childhood onset ABI, while three reported on CP. No studies reporting on SB were identified. Commonly used interventions included acceptance and commitment therapy (ACT), psychotherapy, and cognitive behavioral therapy (CBT). CONCLUSIONS There are a limited number of studies investigating psychological interventions for individuals with childhood onset ABI and CP, and none for individuals with SB. Further research into effective psychological interventions for these populations will improve mental health outcomes and transitional services.
Collapse
Affiliation(s)
- Morgan Jefferies
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Taylor Peart
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Laure Perrier
- University of Toronto Libraries, University of Toronto, Toronto, ON, Canada
| | - Andrea Lauzon
- LIFESpan Service, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,LIFESpan Service, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Sarah Munce
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.,LIFESpan Service, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| |
Collapse
|
19
|
Yun Z, Jing L, Junfei C, Wenjing Z, Jinxiang W, Tong Y, Aijun Z. Entrustable Professional Activities for Chinese Standardized Residency Training in Pediatric Intensive Care Medicine. Front Pediatr 2022; 10:919481. [PMID: 35859946 PMCID: PMC9289143 DOI: 10.3389/fped.2022.919481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/10/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Entrustable professional activities (EPAs) were first introduced by Olle ten Cate in 2005. Since then, hundreds of applications in medical research have been reported worldwide. However, few studies discuss the use of EPAs for residency training in pediatric intensive care medicine. We conducted a pilot study of EPA for pediatric intensive care medicine to evaluate the use of EPAs in this subspecialty. MATERIALS AND METHODS A cross-sectional study was implemented in pediatric intensive care medicine standardized residency training at the Qilu Hospital of Shandong University. An electronic survey assessing EPA performance using eight scales composed of 15 categories were distributed among residents and directors. RESULTS A total of 217 director-assessment and 44 residents' self-assessment questionnaires were collected, both demonstrating a rising trend in scores across postgraduate years. There were significant differences in PGY1-vs.-PGY2 and PGY1-vs.-PGY3 director-assessment scores, while there were no differences in PGY2-vs.-PGY3 scores. PGY had a significant effect on the score of each EPA, while position significantly affected the scores of all EPAs except for EPA1 (Admit a patient) and EPA2 (Select and interpret auxiliary examinations). Gender only significantly affected the scores of EPA6 (Report a case), EPA12 (Perform health education), and EPA13 (Inform bad news). CONCLUSION This study indicates that EPA assessments have a certain discriminating capability among different PGYs in Chinese standardized residency training in pediatric intensive care medicine. Postgraduate year, gender, and resident position affected EPA scores to a certain extent. Given the inconsistency between resident-assessed and director-assessed scores, an improved feedback program is needed in the future.
Collapse
Affiliation(s)
- Zhang Yun
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Liu Jing
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chen Junfei
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Zhang Wenjing
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Wu Jinxiang
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Yue Tong
- Medical Training Office, Qilu Hospital of Shandong University, Jinan, China
| | - Zhang Aijun
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
| |
Collapse
|
20
|
Roy S, Valdez AMD, Trejo B, Bakewell T, Gallarde-Kim S, Martin AJ. "All circuits ended": Family experiences of transitioning from pediatric to adult healthcare for young adults with medical complexity in Oregon. J Pediatr Nurs 2022; 62:171-176. [PMID: 34158213 DOI: 10.1016/j.pedn.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Transition to adult health care for young adults with medical complexity (YAMC) is challenging and much work needs to be done in this area. The Oregon Center for Children and Youth with Special Health Needs participates in a federally-funded Collaborative Improvement and Innovation Network (CoIIN) to improve the quality of care for children with medical complexity. AIMS This study aimed to explore the experiences of Oregon families of YAMC who had recently transitioned to adult health care providers, and obtain recommendations for transition from family members, to inform the development of the CoIIN quality improvement project. METHODS We recruited caregivers of YAMC, ages 18 through 22 years, using a purposive sampling approach and conducted semi-structured interviews with 12 parents and grandparents. We analyzed the interview data to generate themes and sub-themes. RESULTS Families described having little to no notice about transitioning out of pediatric care and reported that their providers did not communicate with them about the steps needed to ensure a continuation of care into adulthood. Poor transition processes contributed to gaps in needed care, decline in health status of the young adults and psychological burden on the family. Families had to take on the responsibility of meeting the transition needs of YAMC and faced challenges in finding adult providers. CONCLUSIONS The results of this study suggest that YAMC and their families cared for by Oregon health care settings are not adequately prepared for, or supported in, the transition from pediatric to adult health care.
Collapse
Affiliation(s)
- Shreya Roy
- Oregon Center for Children and Youth With Special Health Needs, Institute on Development and Disability, Oregon Health & Science University, Portland, USA.
| | - Ana M D Valdez
- Oregon Center for Children and Youth With Special Health Needs, Institute on Development and Disability, Oregon Health & Science University, Portland, USA.
| | - BranDee Trejo
- Oregon Center for Children and Youth With Special Health Needs, Institute on Development and Disability, Oregon Health & Science University, Portland, USA.
| | - Tamara Bakewell
- Oregon Center for Children and Youth With Special Health Needs, Institute on Development and Disability, Oregon Health & Science University, Portland, USA.
| | - Sheryl Gallarde-Kim
- Oregon Center for Children and Youth With Special Health Needs, Institute on Development and Disability, Oregon Health & Science University, Portland, USA.
| | - Alison J Martin
- Oregon Center for Children and Youth With Special Health Needs, Institute on Development and Disability, Oregon Health & Science University, Portland, USA; Oregon Health & Science University-Portland State University School of Public Health, Portland, USA.
| |
Collapse
|
21
|
Toy J, Gregory A, Rehmus W. Barriers to healthcare access in pediatric dermatology: A systematic review. Pediatr Dermatol 2021; 38 Suppl 2:13-19. [PMID: 34338358 DOI: 10.1111/pde.14748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Barriers to healthcare access are healthcare inequities that have been widely studied across different medical specialties. No studies have previously evaluated the state of barriers to healthcare access research in pediatric dermatology. A systematic review was conducted to examine the types of barriers identified within pediatric dermatology literature. Relevant information was extracted and categorized into the themes of systemic, sociocultural, or individual barriers. The systemic barriers we found include finances, wait times, and geography. The sociocultural barriers included culture beliefs and communication. Patient beliefs and health knowledge were found as individual barriers. The small number and limited scope of studies we identified suggest that barriers to healthcare access in pediatric dermatology remain an understudied topic. Additional research is needed to further characterize these barriers to dermatologic care, as well as the impact of any interventions designed to overcome them.
Collapse
Affiliation(s)
- Jeffrey Toy
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Allison Gregory
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Wingfield Rehmus
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
22
|
Van Speybroeck A, Beierwaltes P, Hopson B, McKee S, Raman L, Rao R, Sherlock R. Care coordination guidelines for the care of people with spina bifida. J Pediatr Rehabil Med 2021; 13:499-511. [PMID: 33285645 PMCID: PMC7838978 DOI: 10.3233/prm-200738] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Care coordination is the deliberate organization of patient care activities between two or more participants (including the patient) involved in a person's care to facilitate the appropriate delivery of health care services. Organizing care involves the marshalling of personnel and other resources needed to carry out all required patient care activities. It is often managed by the exchange of information among participants responsible for different aspects of care [1]. With an estimated 85% of individuals with Spina Bifida (SB) surviving to adulthood, SB specific care coordination guidelines are warranted. Care coordination (also described as case management services) is a process that links them to services and resources in a coordinated effort to maximize their potential by providing optimal health care. However, care can be complicated due to the medical complexities of the condition and the need for multidisciplinary care, as well as economic and sociocultural barriers. It is often a shared responsibility by the multidisciplinary Spina Bifida team [2]. For this reason, the Spina Bifida Care Coordinator has the primary responsibility for overseeing the overall treatment plan for the individual with Spina Bifida[3]. Care coordination includes communication with the primary care provider in a patient's medical home. This article discusses the Spina Bifida Care Coordination Guideline from the 2018 Spina Bifida Association's Fourth Edition of the Guidelines for the Care of People with Spina Bifida and explores care coordination goals for different age groups as well as further research topics in SB care coordination.
Collapse
Affiliation(s)
| | | | - Betsy Hopson
- Children’s Hospital of Alabama, Birmingham, AL, USA
| | - Suzanne McKee
- Orlando Health Arnold Palmer Hospital for Children, Orlando, FL, USA
| | - Lisa Raman
- Nursing Committee and Educational Initiatives, Worldwide Syringomyelia and Chiari Task Force, Lawrenceville, GA, USA
- Spina Bifida Association, Patient and Clinical Services, Lawrenceville, GA, USA
| | - Ravindra Rao
- Loma Linda University Medical Center, Loma Linda, CA, USA
| | | |
Collapse
|
23
|
Abstract
Industry 4.0 has transformed manufacturing industry into a new paradigm. In a manner similar to manufacturing, health care delivery is at the dawn of a foundational change into the new era of smart and connected health care, referred to as Health Care 4.0. In this paper, we discuss the historical evolution of Health Care 1.0 to 4.0, describe the characteristics of smart and connected care in Health Care 4.0, identify multiple research challenges and opportunities of Health Care 4.0 in terms of data, model, dynamics, and integration, and outline the implications of people, process, system and health outcomes. Finally, conclusions and recommendations are presented in the areas of (1) involvement of multiple disciplines and perspectives, (2) development of technologies and methodologies with combination of quantitative and qualitative approaches, (3) closed-loop integration of sociotechnical system, and (4) design of person-centered system with specific attention to human needs and health equity.
Collapse
Affiliation(s)
- Jingshan Li
- Wisconsin Institute for Healthcare Systems Engineering, Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Pascale Carayon
- Wisconsin Institute for Healthcare Systems Engineering, Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
| |
Collapse
|
24
|
Bratches RWR, Scudder PN, Barr PJ. Supporting communication of visit information to informal caregivers: A systematic review. PLoS One 2021; 16:e0254896. [PMID: 34293002 PMCID: PMC8297802 DOI: 10.1371/journal.pone.0254896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 07/06/2021] [Indexed: 12/12/2022] Open
Abstract
Importance When caregivers cannot attend the clinic visit for the person they provide care for, patients are the predominant source of clinic visit information; however, poor patient recall inhibits the quality of information shared, resulting in poor caregiver preparedness and contributing to caregiver morbidity. Technological solutions exist to sharing clinic visit information, but their effectiveness is unclear. Objectives To assess if and how technology is being used to connect informal caregivers to patient clinic visit information when they cannot otherwise attend, and its impact on caregiver and patient outcomes. Evidence review MEDLINE, Cochrane, Scopus, and CINAHL were searched through 5/3/2020 with no language restrictions or limits. ClinicalTrials.gov and other reference lists were included in the search. Randomized controlled trials (RCTs) and nonrandomized trials that involved using a technological medium e.g., video or the electronic health record, to communicate visit information to a non-attending caregiver were included. Data were collected and screened using a standardized data collection form. Cochrane’s Risk of Bias 2.0 and the Newcastle-Ottawa Scale were used for RCTs and nonrandomized trials, respectively. All data were abstracted by two independent reviewers, with disagreements resolved by a third reviewer. Findings Of 2115 studies identified in the search, four met criteria for inclusion. Two studies were randomized controlled trials and two were nonrandomized trials. All four studies found positive effects of their intervention on caregiver outcomes of interest, and three out of four studies found statistically significant improvements in key outcomes for caregivers receiving visit information. Improved outcomes included caregiver happiness, caregiver activation, caregiver preparedness, and caregiver confidence in managing patient health. Conclusions and relevance Our review suggests that using technology to give a caregiver access to clinical visit information could be beneficial to various caregiver outcomes. There is an urgent need to address the lack of research in this area.
Collapse
Affiliation(s)
- Reed W. R. Bratches
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, United States of America
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, United States of America
- * E-mail:
| | - Paige N. Scudder
- Biomedical Libraries, Dartmouth College, Hanover, New Hampshire, United States of America
| | - Paul J. Barr
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, United States of America
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, United States of America
| |
Collapse
|
25
|
Gray W, Dorriz P, Kim H, Partain L, Benekos E, Carpinelli A, Zupanc M, Grant K, Weiss M. Adult Provider Perspectives on Transition and Transfer to Adult Care: A Multi-Specialty, Multi-Institutional Exploration. J Pediatr Nurs 2021; 59:173-180. [PMID: 33932647 DOI: 10.1016/j.pedn.2021.04.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/20/2021] [Accepted: 04/20/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To identify barriers that transcend multiple adult care specialties and identify potential solutions. DESIGN AND METHODS Twenty-one adult care providers practicing in the specialty areas of internal medicine, family medicine, gastroenterology, endocrinology, and neurology participated in one of six semi-structured focus group interviews. Data were coded and analyzed according to the Socio-ecological Model of Adolescent/Young Adult Readiness for Transition (SMART). RESULTS Three themes and one subtheme emerged from the data. These fell within the beliefs/expectations, knowledge, access/insurance, and relationships (subtheme) domains of the SMART model. Family beliefs/expectations regarding the provider role, difficulty accessing reliable information, and limited access to mental health and behavioral providers reportedly affect providers' ability to provide optimal health care. CONCLUSIONS Adult providers identified several barriers affecting their ability to care for newly transferred patients. Increased education of families and improved methods of communication between providers were recommended. Barriers related to access and insurance are common and require larger systems-level collaborations between health care systems and payor sources. PRACTICAL IMPLICATIONS Some recommendations (e.g., educating families on the distinct roles of the PCP vs. specialist, highlighting new treatment opportunities in adult care, conveying trust and endorsing the new provider), represent concrete steps pediatric providers can immediately take to improve transfer. Other steps will require forging bridges across the pediatric and adult care world to expand patient access to medical, mental health, and behavioral services.
Collapse
Affiliation(s)
- Wendy Gray
- Children's Health of Orange County, Orange, CA, United States of America.
| | - Parasto Dorriz
- Children's Health of Orange County, Orange, CA, United States of America
| | - Hanae Kim
- Children's Health of Orange County, Orange, CA, United States of America
| | - Lauren Partain
- Children's Health of Orange County, Orange, CA, United States of America
| | - Erin Benekos
- Children's Health of Orange County, Orange, CA, United States of America
| | - Anne Carpinelli
- Children's Health of Orange County, Orange, CA, United States of America
| | - Mary Zupanc
- Children's Health of Orange County, Orange, CA, United States of America
| | - Kenneth Grant
- Children's Health of Orange County, Orange, CA, United States of America
| | - Michael Weiss
- Children's Health of Orange County, Orange, CA, United States of America
| |
Collapse
|
26
|
Kosola S, Culnane E, Loftus H, Tornivuori A, Kallio M, Telfer M, Miettinen PJ, Kolho KL, Aalto K, Raivio T, Sawyer S. Bridge study protocol: an international, observational cohort study on the transition of healthcare for adolescents with chronic conditions. BMJ Open 2021; 11:e048340. [PMID: 34155079 PMCID: PMC8217914 DOI: 10.1136/bmjopen-2020-048340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/18/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION More than 10% of adolescents live with a chronic disease or disability that requires regular medical follow-up as they mature into adulthood. During the first 2 years after adolescents with chronic conditions are transferred to adult hospitals, non-adherence rates approach 70% and emergency visits and hospitalisation rates significantly increase. The purpose of the Bridge study is to prospectively examine associations of transition readiness and care experiences with transition success: young patients' health, health-related quality of life (HRQoL) and adherence to medical appointments as well as costs of care. In addition, we will track patients' growing independence and educational and employment pathways during the transition process. METHODS AND ANALYSIS Bridge is an international, prospective, observational cohort study. Study participants are adolescents with a chronic health condition or disability and their parents/guardians who attended the New Children's Hospital in Helsinki, Finland, or the Royal Children's Hospital (RCH) in Melbourne, Australia. Baseline assessment took place approximately 6 months prior to the transfer of care and follow-up data will be collected 1 year and 2 years after the transfer of care. Data will be collected from patients' hospital records and from questionnaires completed by the patient and their parent/guardian at each time point. The primary outcomes of this study are adherence to medical appointments, clinical health status and HRQoL and costs of care. Secondary outcome measures are educational and employment outcomes. ETHICS AND DISSEMINATION The Ethics Committee for Women's and Children's Health and Psychiatry at the Helsinki University Hospital (HUS/1547/2017) and the RCH Human Research Ethics Committee (38035) have approved the Bridge study protocol. Results will be published in international peer-reviewed journals and summaries will be provided to the funders of the study as well as patients and their parents/guardians. TRIAL REGISTRATION NUMBER NCT04631965.
Collapse
Affiliation(s)
- Silja Kosola
- Pediatric Research Center, New Children's Hospital, Helsinki, Finland
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Evelyn Culnane
- Transition Support Service, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Hayley Loftus
- Transition Support Service, Royal Children's Hospital, Parkville, Victoria, Australia
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Mira Kallio
- Pediatric Research Center, New Children's Hospital, Helsinki, Finland
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Clinical Research, University of Helsinki, Helsinki, Finland
| | - Michelle Telfer
- Department of Adolescent Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Päivi J Miettinen
- Pediatric Research Center, New Children's Hospital, Helsinki, Finland
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kaija-Leena Kolho
- Pediatric Research Center, New Children's Hospital, Helsinki, Finland
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Faculty of Medicine and Medical Technology, Tampere University, Tampere, Finland
| | - Kristiina Aalto
- Pediatric Research Center, New Children's Hospital, Helsinki, Finland
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Taneli Raivio
- Pediatric Research Center, New Children's Hospital, Helsinki, Finland
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Susan Sawyer
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Adolescent Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute and the Royal Children's Hospital, Parkville, Victoria, Australia
| |
Collapse
|
27
|
Boggs EF, Foster C, Shah P, Goodman DM, Hall M, Garfield CF. Trends in Technology Assistance Among Patients With Childhood Onset Chronic Conditions. Hosp Pediatr 2021; 11:711-719. [PMID: 34078644 DOI: 10.1542/hpeds.2020-004739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To describe the prevalence, types, and trends over time of medical technology assistance (TA) in patients at the age of transition to adult care with childhood onset chronic conditions (COCCs) cared for at children's hospitals. PATIENTS AND METHODS In this retrospective repeated annual cross-sectional cohort study of the Pediatric Health Information Systems inpatient data, patients with at least 1 hospitalization from January 1, 2008, to December 31, 2018 with a selected COCC were included. The COCCs investigated were brain and spinal cord malformation, cerebral palsy, heart and great vessel malformation, cystic fibrosis, sickle cell anemia, and chronic renal failure. TA was defined as requiring an indwelling medical device to maintain health status. Trends over time in TA were analyzed with the Cochran-Armitage test and generalized linear models. RESULTS During the study, 381 289 unique patients accounted for 940 816 hospitalizations. Transition-aged patients (19-21 years old) represented 2.4% of all included hospitalizations over the 11-year period, whereas patients ages 21 and above represented 2.7%. The annual proportion of patients with TA increased significantly from 31.3% in 2008 to 36.9% in 2018, a 17.9% increase (P < .001). CONCLUSIONS In this cohort of patients with select COCCs hospitalized at children's hospitals, a substantial and growing number of patients at the age of transition to adult care required TA. Identifying adult providers with resources to manage COCCs and maintain medical devices placed in childhood is challenging. These trends warrant special attention to support the timely and successful transition of medically complex patients from pediatric to adult care.
Collapse
Affiliation(s)
- Elizabeth F Boggs
- Divisions of Hospital Based Medicine and .,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Carolyn Foster
- Mary Ann & J. Milburn Smith Child Health Research, Outreach and Advocacy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; and.,Academic General Pediatrics and Primary Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Parag Shah
- Divisions of Hospital Based Medicine and.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Denise M Goodman
- Divisions of Hospital Based Medicine and.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Craig F Garfield
- Divisions of Hospital Based Medicine and.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Mary Ann & J. Milburn Smith Child Health Research, Outreach and Advocacy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; and
| |
Collapse
|
28
|
McMaughan DJ, Lin S, Ozmetin J, Beverly JG, Brog J, Naiser E. A Provider-Facing eHealth Tool for Transitioning Youth With Special Health Care Needs From Pediatric to Adult Care: Mixed Methods, User-Engaged Usability Study. JMIR Form Res 2021; 5:e22915. [PMID: 34032579 PMCID: PMC8188313 DOI: 10.2196/22915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 03/27/2021] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is a need for medical education on health care transitions for youth with special health care needs. The Texas Transition Toolkit (the tool) supports providers through a one-stop shop for researching literature on care transitions, a catalog of care transition tools, and guides for developing care transition programs. OBJECTIVE This study aims to assess the functionality and usability of the tool with providers working with transition-aged children and youth with special health care needs (representative users). METHODS The tool was evaluated using a triangulated mixed methods case study approach consisting of a concurrent think-aloud phase, a satisfaction survey, and a survey of problem relevance and task performance to operationalize and capture functionality and usability. Our mixed methods deep dive into the functionality and usability of the tool focused on 10 representative users from one medical home in Texas and 5 website design experts. RESULTS Representative users found the tool to be highly relevant, as demonstrated by the satisfaction score for relevance (138/150, 92%). According to the users, the tool provided comprehensive information related to health care transitions for youth with special health care needs, with a satisfaction score of 87.3% (131/150) for comprehensive. Overall satisfaction with the tool was high at 81.92% (1065/1300) with a cutoff score of 73.33% (953.4/1300) indicating high satisfaction, but users reported relatively lower satisfaction with search (114/150, 76%) and navigation (ease of use: 114/150, 76%; hyperlinks: 163/200, 81.5%; structure: 159/200, 79.5%). They experienced search- and navigation-related problems (total problems detected: 21/31, 68%) and, based on quality checks, had a relatively low task completion rate for tasks involving finding information (60/80, 75%), which required searching and navigation. The problems identified around search and navigation functionality were relevant (relevance scores ranging from 14.5 to 22, with a cutoff score of 11.7 indicating relevance). CONCLUSIONS The tool may help bridge the gaps in training on health care transitions for youth with special health care needs in US medical education. The tool can be used to create structured protocols to help improve provider knowledge, collaboration across pediatric and adult care providers, and the continuity of care as youth with special health care needs transition from pediatric to adult care. The results provided a road map for optimizing the tool and highlighted the importance of evaluating eHealth technologies with representative users.
Collapse
Affiliation(s)
- Darcy Jones McMaughan
- Department of Health Policy and Managment, School of Public Health, Texas A&M University, College Station, TX, United States.,Oklahoma State University, Stillwater, OK, United States
| | - Sherry Lin
- Department of Health Policy and Managment, School of Public Health, Texas A&M University, College Station, TX, United States
| | - Jennifer Ozmetin
- Department of Health Policy and Managment, School of Public Health, Texas A&M University, College Station, TX, United States
| | - Judith Gayle Beverly
- Department of Health Policy and Managment, School of Public Health, Texas A&M University, College Station, TX, United States
| | - Joshua Brog
- Department of Health Policy and Managment, School of Public Health, Texas A&M University, College Station, TX, United States
| | - Emily Naiser
- Public Policy Research Institute, Texas A&M University, College Station, TX, United States
| |
Collapse
|
29
|
Schumacher DJ, Martini A, Kinnear B, Kelleher M, Balmer DF, Wurster-Ovalle V, Carraccio C. Facilitators and Inhibitors to Assessing Entrustable Professional Activities in Pediatric Residency. Acad Pediatr 2021; 21:735-741. [PMID: 33221495 DOI: 10.1016/j.acap.2020.11.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 11/12/2020] [Accepted: 11/14/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Research on entrustable professional activities (EPAs) has focused on EPA development with little attention paid to implementation experiences. This constructivist grounded theory study sought to begin filling this gap by exploring the experiences of pediatric residency programs with implementing EPA-based assessment. METHODS Interviews with 19 program leader and clinical competency committee participants from 13 sites were held between January and July 2019. Participants were asked about their experiences with implementing EPA-based assessment. Data collection and analysis were iterative. RESULTS Participants described a range of facilitators and inhibitors that influenced their efforts to implement EPA-based assessment. These fell into 4 thematic areas: 1) alignment of EPA construct with local views of performance and assessment, 2) assessing EPAs illuminates holes in the residency curriculum, 3) clinical competency committee structure and process impacts EPA-based assessment, and 4) faculty engagement and development drives ability to assess EPAs. Areas described as facilitators by some participants were noted to be inhibitors for others. The sum of a program's facilitators and inhibitors led to more or less ability to assess EPAs on the whole. Finally, the first area functions differently from the others; it can shift the entire balance toward or away from the ability to assess EPAs overall. CONCLUSION This study helps fill a void in implementation evidence for EPA-based assessment through better understanding of facilitators and inhibitors to such efforts.
Collapse
Affiliation(s)
- Daniel J Schumacher
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine (DJ Schumacher, A Martini, and V Wurster-Ovalle), Cincinnati, Ohio.
| | - Abigail Martini
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine (DJ Schumacher, A Martini, and V Wurster-Ovalle), Cincinnati, Ohio
| | - Benjamin Kinnear
- Departments of Pediatrics and Medicine, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine (B Kinnear and M Kelleher), Cincinnati, Ohio
| | - Matthew Kelleher
- Departments of Pediatrics and Medicine, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine (B Kinnear and M Kelleher), Cincinnati, Ohio
| | - Dorene F Balmer
- Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine (DF Balmer), Philadelphia, Pa
| | - Victoria Wurster-Ovalle
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine (DJ Schumacher, A Martini, and V Wurster-Ovalle), Cincinnati, Ohio
| | | |
Collapse
|
30
|
Pham T, García A, Tsai M, Lau M, Kuper LE. Transition from Pediatric to Adult Care for Transgender Youth: A Qualitative Study of Patient, Parent, and Provider Perspectives. LGBT Health 2021; 8:281-289. [PMID: 33835876 DOI: 10.1089/lgbt.2020.0487] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: No information exists on the needs of transgender youth transitioning their gender-affirming health care from pediatric to adult settings. We obtained perspectives of transgender youth, their parents, and providers, and aimed to identify barriers and unmet needs during the transition of care. Methods: Five online focus groups were conducted between February and March 2019 with separate groups for transgender youth 13-17 and 18-21 years old; parents of transgender youth 13-17 and 18-21 years old; and gender-affirming health care providers. Thematic analysis of transcripts was conducted by two researchers. Pooled Cohen's κ was 0.83, indicating excellent inter-rater reliability. Results: Sixty-six participants (29 youth, 27 parents, and 10 providers) identified 10 themes. Themes related to barriers to transition included access and insurance challenges, patient readiness and hesitancy to transfer care, and multidisciplinary-system inefficiencies. Themes related to improving transition focused on prioritizing referrals from trusted sources, establishing gradual patient independence, aligning gender transition goals, and setting impetus for transferring care. Conclusion: Successful health care transition for transgender youth must consider the intricacies of a complex medical system and challenges that they pose to adolescents' perceived abilities to independently manage health care and willingness to prepare transfer of care. Given that patients, parents, and providers assume important roles during the process, each can uniquely contribute toward ensuring a smooth transition. Efforts to improve this process should focus on enhancing collaboration between clinics and families through crowdsourcing resources, continued verification of health goals, supporting greater patient autonomy, and delineating an explicit timeline for transition.
Collapse
Affiliation(s)
- Tri Pham
- University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Antonio García
- University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Michelle Tsai
- University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - May Lau
- Children's Health System of Texas, Dallas, Texas, USA.,Department of Pediatrics and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Laura E Kuper
- Children's Health System of Texas, Dallas, Texas, USA.,Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
31
|
Oguni H, Ito S, Nishikawa A, Otani Y, Nagata S. Transition from pediatric to adult care in a Japanese cohort of childhood-onset epilepsy: prevalence of epileptic syndromes and complexity in the transition. Seizure 2021; 88:1-6. [PMID: 33773226 DOI: 10.1016/j.seizure.2021.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/11/2021] [Accepted: 03/17/2021] [Indexed: 10/21/2022] Open
Abstract
AIM We retrospectively examined patients with childhood-onset epilepsy who transitioned from pediatric to adult care to reveal the clinical characteristics and evaluate the complexity of transitioning. METHODS The subjects were 220 patients (89 males, 131 females) who had been treated at our pediatric epilepsy clinic and had transferred to adult care between 2014 and 2018 without attending a transition clinic or program. The demographic data of the patients were retrospectively analyzed. RESULTS The ages at transition ranged from 15 to 54 years (median: 27 years old). There were 91 patients with focal epilepsies (FEs) and 129 patients with generalized epilepsies [genetic generalized epilepsy (GGE) n = 30, generalized epilepsy of various etiologies (GEv) n = 99]. A most frequent epileptic syndrome was temporal lobe epilepsy followed by frontal lobe epilepsy in FEs, GTCS only followed by juvenile myoclonic epilepsy in GGE and Lennox-Gastaut syndrome followed by Dravet syndrome in GEv. At the age of transition, a total of 77 of the 96 patients with developmental and epileptic encephalopathies (DEE) had pharmacoresistant seizures, which was positively correlated with a late transition age (P≤0.05). More than monthly seizures and greater than moderate disabilities were noted in 45% and 55% of the patients, respectively. CONCLUSION The patients with childhood-onset epilepsy transitioned to adult care from the hospital-based pediatric epilepsy clinic were characterized by generalized>focal epilepsy, a frequent complication of DEE, more than monthly seizures, and worse than moderate intellectual disabilities. The complication of DEE made a smooth transition difficult and delayed the transition age.
Collapse
Affiliation(s)
- Hirokazu Oguni
- Department of Pediatrics, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan; Epilepsy Center, TMG Asaka Medical Center, 1340-1 Mizonuma, Asaka-city, Saitama, 351-0023, Japan.
| | - Susumu Ito
- Department of Pediatrics, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Aiko Nishikawa
- Department of Pediatrics, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Yui Otani
- Department of Pediatrics, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Satoru Nagata
- Department of Pediatrics, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| |
Collapse
|
32
|
Abstract
OBJECTIVE To appraise the current training of Neurology (N), Pediatric (P), and Med-Peds (MP) residents at MedStar Georgetown University Hospital (MGUH) in providing care to patients with epilepsy who are transitioning from pediatric to adult care. METHODS Through an online questionnaire, we surveyed Neurology, Pediatric, and Med-Peds residents to assess their knowledge, confidence, and experience at transitioning youth with epilepsy to adult-oriented health care. RESULTS N, P, and MP residents generally rated their knowledge and confidence at providing transition care to youth with epilepsy to be poor; however, P and MP residents rated higher in limited measures of knowledge and experience. CONCLUSION Our appraisal of resident training in transitions care for youth with epilepsy has highlighted training elements in our institution that require attention for both adult and pediatric providers, leading to the formulation of an educational intervention that will promote experiential and multimodal approaches in this area.
Collapse
Affiliation(s)
- Francis G Tirol
- 71541MedStar Georgetown University Hospital, Washington, DC, USA
| | - Anagha Kumar
- 121577MedStar Health Research Institute, Hyattsville, MD, USA
| |
Collapse
|
33
|
Jacobsen RM. Outcomes in Adult Congenital Heart Disease: Neurocognitive Issues and Transition of Care. Pediatr Clin North Am 2020; 67:963-971. [PMID: 32888692 DOI: 10.1016/j.pcl.2020.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There is a growing population of patients living with congenital heart disease (CHD), now with more adults living with CHD than children. Adults with CHD have unique health care needs, requiring a thoughtful approach to cardiac, neurocognitive, mental, and physical health issues. They have increased risk of anxiety, depression, pragmatic language impairment, limited social cognition, worse educational attainment and unemployment, and delayed progression into independent adulthood. As a result, it is important to establish an individualized approach to obtain successful transition and transfer of care from the pediatric to adult health care world in this patient population.
Collapse
Affiliation(s)
- Roni M Jacobsen
- Pediatric and Adult Congenital Cardiology, University of Colorado School of Medicine, Children's Hospital Colorado, University of Colorado Hospital, Aurora, CO, USA.
| |
Collapse
|
34
|
Coller RJ, Ahrens S, Ehlenbach ML, Shadman KA, Mathur M, Caldera K, Chung PJ, LaRocque A, Peto H, Binger K, Smith W, Sheehy A. Priorities and Outcomes for Youth-Adult Transitions in Hospital Care: Perspectives of Inpatient Clinical Leaders at US Children's Hospitals. Hosp Pediatr 2020; 10:774-782. [PMID: 32759291 PMCID: PMC7446547 DOI: 10.1542/hpeds.2020-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Adults with chronic conditions originating in childhood experience ongoing hospitalizations; however, efforts to guide youth-adult transitions rarely address transitioning to adult-oriented inpatient care. Our objectives were to identify perceptions of clinical leaders on important and feasible inpatient transition activities and outcomes, including when, how, and for whom inpatient transition processes are needed. METHODS Clinical leaders at US children's hospitals were surveyed between January and July 2016. Questionnaires were used to assess 21 inpatient transition activities and 13 outcomes. Perceptions about feasible and important outcome measures and appropriate patients and settings for activities were summarized. Each transition activity was categorized into one of the Six Core Elements (policy, tracking, readiness, planning, transfer, or completion). Associations between perceived transition activity importance or feasibility, hospital characteristics, and transition activity performance were evaluated. RESULTS In total, 96 of 195 (49.2%) children's hospital leaders responded. The most important and feasible activities were identifying patients needing or overdue for transition, discussing transition timing with youth and/or families, and informing youth and/or families that future stays would be at an adult facility. Feasibility, but not importance, ratings were associated with current performance of transition activities. Inpatient transition activities were perceived to be important for children with medical and/or social complexity or high hospital use. Emergency department visits and patient experience during transition were top outcome measurement priorities. CONCLUSIONS Children's hospital clinical leaders rated inpatient youth-adult transition activities and outcome measures as important and feasible; however, feasibility may ultimately drive implementation. This work should be used to inform initial research and quality improvement priorities, although additional stakeholder perspectives are needed.
Collapse
Affiliation(s)
| | | | | | | | | | - Kristin Caldera
- Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Paul J Chung
- Department of Pediatrics, David Geffen School of Medicine and
- RAND Health Care, RAND Corporation, Santa Monica, California
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
- Children's Discovery and Innovation Institute, Mattel Children's Hospital, Los Angeles, California; and
| | | | | | | | - Windy Smith
- American Family Children's Hospital, Madison, Wisconsin
| | | |
Collapse
|
35
|
Kirschner KL, Ushkow S, Mukherjee S, Martinez MG, Hickey E, Cotts KG, Mukherjee D. People with Pediatric‐Onset Complex Disabilities: Good News, Bad News. PM R 2020; 12:602-609. [DOI: 10.1002/pmrj.12372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Shubhra Mukherjee
- Specialty RehabilitationShriners Hospitals for Children – Chicago Chicago IL USA
- Department of PM&RNorthwestern University Feinberg School of Medicine Chicago IL USA
| | | | - Erin Hickey
- MacLean Center for Clinical Medical EthicsThe University of Chicago Chicago IL USA
| | - Kamala Gullapalli Cotts
- Adult Developmental Disability Clinic Chicago IL USA
- MacLean Center for Clinical Medical EthicsThe University of Chicago Chicago IL USA
| | - Debjani Mukherjee
- Division of Medical EthicsWeill Cornell Medical College New York NY USA
| |
Collapse
|
36
|
Berkowitz S, Lang P. Transitioning Patients With Complex Health Care Needs to Adult Practices: Theory Versus Reality. Pediatrics 2020; 145:peds.2019-3943. [PMID: 32358070 DOI: 10.1542/peds.2019-3943] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Pat Lang
- Children's Minnesota, Minneapolis, Minnesota
| |
Collapse
|
37
|
Cassady SJ, Lasso-Pirot A, Deepak J. Phenotypes of Bronchopulmonary Dysplasia in Adults. Chest 2020; 158:2074-2081. [PMID: 32473946 DOI: 10.1016/j.chest.2020.05.553] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/06/2020] [Accepted: 05/24/2020] [Indexed: 11/30/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD), first described by Northway in 1967, is a process of neonatal lung injury that is most strongly associated with prematurity. The "old" form of the disease associated with the oxidative damage and volutrauma from perinatal mechanical ventilation has been increasingly supplanted by a "new" form resulting from interrupted growth of the lung at earlier stages of fetal development. Given the significant improvement in the survival of children with BPD since the 1980s, many more of these patients are living into adulthood and are being seen in adult pulmonary practices. In this review, we present three brief vignettes of patients from our practice to introduce three of the major patterns of disease seen in adult survivors of BPD, namely, asthma-like disease, obstructive lung disease, and pulmonary hypertension. Additional factors shown to affect the lives of adult BPD survivors are also discussed. Finally, we discuss insights into the process of transitioning these complex patients from pediatric to adult pulmonary practices. As survivors of BPD enter adulthood and continue to require specialty pulmonary care, awareness of the disease's varied manifestations and responses to treatment will become increasingly important.
Collapse
Affiliation(s)
- Steven J Cassady
- Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD.
| | - Anayansi Lasso-Pirot
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
| | - Janaki Deepak
- Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD
| |
Collapse
|
38
|
Ho J, Fong CK, Iskander A, Towns S, Steinbeck K. Digital psychosocial assessment: An efficient and effective screening tool. J Paediatr Child Health 2020; 56:521-531. [PMID: 31883286 DOI: 10.1111/jpc.14675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 06/11/2019] [Accepted: 10/14/2019] [Indexed: 11/30/2022]
Abstract
AIM A large proportion of young people with chronic health conditions are surviving into adulthood. They face the same challenges as their healthy peers and are at increased risk of mental health problems. Psychosocial assessment is a crucial aspect of clinical care. Interviews using the internationally used and accepted HEEADSSS (home environment, education/employment, eating, peer-related activities, drugs, sexuality, suicide/depression, and safety) framework require trained clinicians, rapid interpersonal engagement, time and manual documentation. HEEADSSS-derived digital self-report surveys can be initiated by non-trained staff. This study compares the utility and information recorded using both methods. METHODS A retrospective analysis comparing documentation from HEEADSSS guided face-to-face interview and a digital survey tool was conducted using 146 records collected by the Trapeze transition service across the two locations of the Sydney Children's Hospital Network (NSW, Australia) between 2013 and 2016. A panel of four experts used an iterative process to identify 29 data verification points, falling into seven categories. Wilcoxon signed-rank tests were used to compare category scores. RESULTS The digital survey took an average of 15 min and showed a significantly higher rate of disclosure across all psychosocial categories, particularly in the sensitive areas of emotions, drug use, sex and safety, compared to electronic medical record documentation of interview. CONCLUSIONS Digital survey provided a time-efficient psychosocial screening tool that was self-administered, able to be introduced by non-trained staff, had a consistent record of responses, and elicited a substantially higher disclosure rate for important areas of strength and risk that may otherwise be avoided or not recorded.
Collapse
Affiliation(s)
- Jane Ho
- Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Trapeze, Centre for Adolescent and Young Adult Health, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Cameron K Fong
- Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Trapeze, Centre for Adolescent and Young Adult Health, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Andrew Iskander
- Trapeze, Centre for Adolescent and Young Adult Health, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Susan Towns
- Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Adolescent Medicine, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
| | - Katharine Steinbeck
- Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
39
|
Chougui K, Addab S, Palomo T, Morin SN, Veilleux LN, Bernstein M, Thorstad K, Hamdy R, Tsimicalis A. Clinical manifestations of osteogenesis imperfecta in adulthood: An integrative review of quantitative studies and case reports. Am J Med Genet A 2020; 182:842-865. [PMID: 32091187 DOI: 10.1002/ajmg.a.61497] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 12/03/2019] [Accepted: 01/03/2020] [Indexed: 12/16/2022]
Abstract
Osteogenesis imperfecta (OI) is a rare genetic disorder of the bones caused by a mutation in Type I collagen genes. As adults with OI are aging, medical concerns secondary to OI may arise. This integrative review sought to review, appraise, and synthesize the clinical manifestations faced by adults with OI. Four electronic bibliographic databases were searched. Published quantitative, qualitative, and mixed-methods studies, as well as case reports from 2000 to March 2019, addressing a clinical manifestation in adulthood, were reviewed. Eligible studies and case reports were subsequently appraised using the Mixed Methods Appraisal Tool and Case Report Checklist, respectively. Twenty quantitative studies and 88 case reports were included for review regardless of the varying methodological quality score. These studies collectively included 2,510 adults with different OI types. Several clinical manifestations were studied, and included: hearing loss, cardiac diseases, pregnancy complications, cerebrovascular manifestations, musculoskeletal manifestations, respiratory manifestations, vision impairment, and other clinical manifestations. Increased awareness may optimize prevention, treatment, and follow-up. Opportunities to enhance the methodological quality of research including better design and methodology, multisite collaborations, and larger and diverse sampling will optimize the generalizability and transferability of findings.
Collapse
Affiliation(s)
- Khadidja Chougui
- Nursing Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.,Psychology, Universite de Montreal, Montreal, Quebec, Canada
| | - Sofia Addab
- Nursing Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.,Experimental Surgery, McGill University, Montreal, Quebec, Canada
| | - Telma Palomo
- Bone Densitometry, Fleury Medicina e Saúde, São Paulo, Brazil
| | - Suzanne N Morin
- Department of Medicine, McGill University, Montreal, Quebec, Canada.,General Internal Medicine and Bone Metabolism Center, Montreal General Hospital, Montreal, Quebec, Canada
| | - Louis-Nicolas Veilleux
- Experimental Surgery, McGill University, Montreal, Quebec, Canada.,Motion Analysis Center, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada
| | - Mitchell Bernstein
- Orthopedic Surgery, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.,Department of Pediatric Surgery, McGill University, Montreal, Quebec, Canada
| | - Kelly Thorstad
- Nursing and Patient Services, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada
| | - Reggie Hamdy
- Orthopedic Surgery, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.,Department of Pediatric Surgery, McGill University, Montreal, Quebec, Canada
| | - Argerie Tsimicalis
- Nursing Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.,Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
40
|
Hobart CB, Phan H. Pediatric-to-adult healthcare transitions: Current challenges and recommended practices. Am J Health Syst Pharm 2020; 76:1544-1554. [PMID: 31532501 DOI: 10.1093/ajhp/zxz165] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE An overview of the pediatric-to-adult healthcare transition (HCT) process, including stakeholders, challenges, and fundamental components that present opportunities for pharmacists and pharmacy technicians, is provided. SUMMARY Pediatric-to-adult HCT programs should be longitudinal in nature, be patient focused, and be coproduced by patients, caregivers, and care team members. Educational components of HCT programs should include knowledge and skills in disease state management and self-care; safe and effective use of medications, as well as other treatment modalities; and healthcare system navigation, including insurance issues. Interprofessional involvement in HCT is encouraged; however, roles for each discipline involved are not clearly delineated in current guidelines or literature. Possible influencing elements in achieving successful pediatric-to-adult HCT outcomes include those that are related to patient and/or caregiver factors, clinician awareness, availability of resources, and ability to achieve financial sustainability. CONCLUSION The use of structured pediatric-to-adult HCT programs is currently recommended to optimize patient and health-system outcomes. Given the importance of medication-related knowledge and healthcare system navigation skills to successful care transitions, there are opportunities for pharmacists and pharmacy technicians to contribute to HCT programs.
Collapse
Affiliation(s)
- Catherine B Hobart
- Department of Clinical and Administrative Sciences, College of Pharmacy, Larkin University, Miami, FL
| | - Hanna Phan
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, and Department of Pediatrics, College of Medicine, University of Arizona, Tucson, AZ
| |
Collapse
|
41
|
Lu M, Yee BJ, Fitzgerald DA. Transition to adult care in sleep medicine. Paediatr Respir Rev 2020; 33:9-15. [PMID: 31806562 DOI: 10.1016/j.prrv.2019.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 09/25/2019] [Indexed: 11/15/2022]
Abstract
More children with chronic and complex care needs are transitioned to adulthood due to advancements in medical technology including the use of non-invasive ventilation [NIV] at home and innovative medical therapies. Sleep medicine is becoming a common and at times vital component of the management plan. Various challenges are experienced in transitioning sleep patients depending on the underlying condition. These include the direct conflict between the desires of a young person for independence and their declining ability to provide self-care in neuromuscular patients, the behavioural challenges inherent in the management of children with various syndromes and the funding of equipment, care needs and multidisciplinary team input in an already resource limited adult setting. These patients should be transitioned in an early and coordinated approach following core principles of transition. Ongoing advocacy is required to raise awareness of the increased trend for technology supported young people being transitioned. Further research is required to track and assess the transition process in patients with various sleep conditions.
Collapse
Affiliation(s)
- Mimi Lu
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| | - Brendon J Yee
- Centre for Sleep and Chronobiology (CIRUS), Woolcock Institute of Medical Research, University of Sydney, New South Wales, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
42
|
|
43
|
Schumacher DJ, West DC, Schwartz A, Li ST, Millstein L, Griego EC, Turner T, Herman BE, Englander R, Hemond J, Hudson V, Newhall L, McNeal Trice K, Baughn J, Giudice E, Famiglietti H, Tolentino J, Gifford K, Carraccio C. Longitudinal Assessment of Resident Performance Using Entrustable Professional Activities. JAMA Netw Open 2020; 3:e1919316. [PMID: 31940042 PMCID: PMC6991321 DOI: 10.1001/jamanetworkopen.2019.19316] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Entrustable professional activities (EPAs) are an emerging workplace-based, patient-oriented assessment approach with limited empirical evidence. OBJECTIVE To measure the development of pediatric trainees' clinical skills over time using EPA-based assessment data. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of categorical pediatric residents over 3 academic years (2015-2016, 2016-2017, and 2017-2018) assessed on 17 American Board of Pediatrics EPAs. Residents in training at 23 pediatric residency programs in the Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network were included. Assessment was conducted by clinical competency committee members, who made summative assessment decisions regarding levels of supervision required for each resident and each EPA. Data were collected from May 2016 to November 2018 and analyzed from November to December 2018. INTERVENTIONS Longitudinal, prospective assessment using EPAs. MAIN OUTCOMES AND MEASURES Trajectories of supervision levels by EPA during residency training and how often graduating residents were deemed ready for unsupervised practice in each EPA. RESULTS Across the 5 data collection cycles, 1987 residents from all 3 postgraduate years in 23 residency programs were assigned 25 503 supervision level reports for the 17 general pediatrics EPAs. The 4 EPAs that required the most supervision across training were EPA 14 (quality improvement) on the 5-level scale (estimated mean level at graduation, 3.7; 95% CI, 3.6-3.7) and EPAs 8 (transition to adult care; mean, 7.0; 95% CI, 7.0-7.1), 9 (behavioral and mental health; mean, 6.6; 95% CI, 6.5-6.6), and 10 (resuscitate and stabilize; mean, 6.9; 95% CI, 6.8-7.0) on the expanded 5-level scale. At the time of graduation (36 months), the percentage of trainees who were rated at a supervision level corresponding to "unsupervised practice" varied by EPA from 53% to 98%. If performance standards were set to align with 90% of trainees achieving the level of unsupervised practice, this standard would be met for only 8 of the 17 EPAs (although 89% met this standard for EPA 17, performing the common procedures of the general pediatrician). CONCLUSIONS AND RELEVANCE This study presents initial evidence for empirically derived practice readiness and sets the stage for identifying curricular gaps that contribute to discrepancy between observed practice readiness and standards needed to produce physicians able to meet the health needs of the patient populations they serve. Future work should compare these findings with postgraduation outcomes data as a means of seeking validity evidence.
Collapse
Affiliation(s)
- Daniel J. Schumacher
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Daniel C. West
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, University of Pennsylvania, Philadelphia
| | - Alan Schwartz
- Department of Medical Education, University of Illinois at Chicago
- Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network, McLean, Virginia
- Department of Pediatrics, University of Illinois at Chicago
| | - Su-Ting Li
- Department of Pediatrics at the University of California Davis Health, Sacramento
| | - Leah Millstein
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore
| | - Elena C. Griego
- Department of Pediatrics, Seattle Children’s Hospital, Seattle, Washington
| | - Teri Turner
- Department of Pediatrics, Texas Children’s Hospital/Baylor College of Medicine, Houston
| | - Bruce E. Herman
- Department of Pediatrics, University of Utah, Salt Lake City
| | - Robert Englander
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis
| | - Joni Hemond
- Department of Pediatrics, University of Utah, Salt Lake City
| | - Valera Hudson
- Department of Pediatrics, Children’s Hospital of Georgia/Augusta University, Augusta
| | - Lauren Newhall
- Department of Pediatrics, Children’s Hospital of Georgia/Augusta University, Augusta
| | | | - Julie Baughn
- Department of Pediatrics, Mayo Medical School, Rochester, Minnesota
| | - Erin Giudice
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore
| | | | - Jonathan Tolentino
- Department of Pediatrics, Stony Brook University, Stony Brook, New York
- Department of Internal Medicine, Stony Brook University, Stony Brook, New York
| | - Kimberly Gifford
- Department of Pediatrics, Dartmouth University, Lebanon, New Hampshire
| | | |
Collapse
|
44
|
Erspamer KJ, Jacob H, Hasan R. Practices, attitudes and barriers faced by internists and pediatricians in transitioning young adult patients to adult medicine. Int J Adolesc Med Health 2019; 34:/j/ijamh.ahead-of-print/ijamh-2019-0129/ijamh-2019-0129.xml. [PMID: 31883368 DOI: 10.1515/ijamh-2019-0129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/04/2019] [Indexed: 11/15/2022]
Abstract
Purpose To assess perspectives of clinicians at an academic medical center regarding current practices, barriers and possible interventions in transitioning young adult patients to adult care. Methods Electronic survey results from licensed independent providers in the Departments of Internal Medicine (n = 87) and Pediatrics (n = 49) were analyzed. Results The majority of providers at our institution are unaware of and do not follow national transition guidelines. Seventy-seven percent of pediatricians provide the majority of preparation and support in transition care of young adults with complex medical conditions without involvement of other interprofessional team members. Ninety-six percent of internists report not receiving formal training related to transition care and only 44% are comfortable caring for young adults with medical complexity. Eighty-eight percent of pediatricians and internists support a standard transition process, yet significant gaps in this process exist. Conclusion Despite the existence of national society-supported recommendations for transitions of care processes, lack of awareness among providers regarding national transition guidelines has led to uncertainty when it comes to managing the transition of young adult patients. There is lack of communication between pediatricians and internists, and internists are not as confident in caring for young adult patients. The scope of work of the interprofessional team is not utilized adequately. Providers agree on the importance of developing a standardized pediatric to adult transition process. These results help inform possible future interventions to improve care for this population.
Collapse
Affiliation(s)
- Kayla J Erspamer
- School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Hannah Jacob
- School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Reem Hasan
- Division of General Pediatrics in Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA.,Division of General Internal Medicine and Geriatrics in Department of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Dr, Portland, OR 97239, USA, Phone: +503-494-8562
| |
Collapse
|
45
|
Brandon E, Ballantyne M, Penner M, Lauzon A, McCarvill E. Accessing primary health care services for transition-aged young adults with cerebral palsy; perspectives of young adults, parents, and physicians. JOURNAL OF TRANSITION MEDICINE 2019. [DOI: 10.1515/jtm-2019-0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractBackgroundYoung adults with childhood-onset disabilities experience challenges with accessing age appropriate primary health care services as they transition from pediatric to adult health care services. They often experience a negative impact on their health with associated long-term health and social concerns, disease complications and increased use of emergency services once transitioned to adult services. This is particularly challenging for youth with cerebral palsy (CP) due the complexity of their medical needs. The aim of this study was to explore experiences with accessing or providing primary care services for transitioned-aged young adults with CP from young adult, parent, pediatrician and primary care physician perspectives.MethodsA qualitative descriptive design was conducted to identify the challenges and facilitators for transitioned aged young adults with accessing primary, adult care services. Semi-structured interviews were conducted with 16 participants within the circle of care (4 adults with CP, 4 parents, 4 pediatricians and 4 primary healthcare physicians) for individuals with CP in Toronto, Canada. Interviews were audio-recorded and transcribed verbatim. Qualitative analysis guided both the data collection and the data analysis processes.ResultsData analysis revealed that all participant groups reported transition challenges with respect to accessibility, the suitability of some primary care environments for caring for individuals with complex care needs, gaps in seamless care, and limited time and funding when receiving or providing primary care services to young adults with CP.DiscussionThere is a greater demand for adult healthcare providers now to deliver services for adults with childhood onset disabilities. Transition-aged young adults with CP and complex medical needs have increased challenges with accessing primary care services. Considering the following would improve primary care services transition for this population with complex medical needs: ongoing partnering between pediatric and adult health care streams to promote seamless care; connection to team-based primary care services where family physicians, subspecialties and interprofessional practitioners work together to provide joint care planning; salary compensation for increased service needs due to medical complexity; accessible sites; and development of guidelines for transitioning youth/young adults with complex care needs.
Collapse
Affiliation(s)
- Erin Brandon
- Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON, M4G 1R8, Canada
- Lawrence S. Bloomberg Faculty of Nursing – University of Toronto, Toronto, ON, M5T 1P8, Canada
| | - Marilyn Ballantyne
- Lawrence S. Bloomberg Faculty of Nursing – University of Toronto, Toronto, ON, M5T 1P8, Canada
- Chief Nurse Executive and Clinician Investigator, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON, M4G 1R8, Canada
| | - Melanie Penner
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON, M4G 1R8, Canada
| | - Andrea Lauzon
- Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON, M4G 1R8, Canada
- University Health Network-Toronto Rehab, Toronto, ON, Canada
| | - Erin McCarvill
- Bridgepoint Family Health Team, Toronto, ON, M4K 2N1, Canada
| |
Collapse
|
46
|
Sadun RE, Chung RJ, Pollock MD, Maslow GR. Lost in transition: resident and fellow training and experience caring for young adults with chronic conditions in a large United States' academic medical center. MEDICAL EDUCATION ONLINE 2019; 24:1605783. [PMID: 31107191 PMCID: PMC6534234 DOI: 10.1080/10872981.2019.1605783] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/08/2019] [Accepted: 04/08/2019] [Indexed: 05/21/2023]
Abstract
BACKGROUND The transition from pediatric to adult healthcare is a vulnerable time for adolescents and young adults (AYA), especially those with chronic conditions. Successful transition requires communication and coordination amongst providers, patients, and families. Unfortunately, multiple studies have demonstrated that the majority of practicing providers do not feel prepared to help AYA patients through health care transition, but little is known about the transition/transfer aptitudes of physician trainees. OBJECTIVES The purpose of this study was to establish the transition/transfer training that residents and fellows from different fields receive - and determine what training factors are associated with increased confidence in core transition/transfer skills. DESIGN A 20-item electronic survey regarding experiences caring for AYA patients was sent to all 2014-2015 graduate medical education (GME) trainees at our institution. RESULTS Forty-nine percent (479/985) of trainees responded: 60 pediatric, 387 non-pediatric, and 32 'combined' (e.g., Medicine/Pediatrics or Family Medicine). Trainees from all three categories of programs reported similar exposure to AYA patients with chronic conditions, with a median of 1-3 encounters per month. A quarter of trainees rated themselves as 'not at all prepared' to speak with a counterpart provider about a transferring patient, while nearly half of trainees considered themselves 'not at all prepared' to speak with a patient and family about transition. Trainee confidence in performing these two skills was strongly predicted by three factors: increased exposure to AYA with chronic conditions, education (training or role modeling) in transition skills, and experience practicing transition skills. Of these, the strongest association with trainee confidence was experience practicing the skills of communicating with other providers (OR = 13.0) or with patients/families (OR = 14.5). CONCLUSION Despite at least monthly encounters with AYA with chronic conditions, most residents and fellows have very little experience communicating across the pediatric-to-adult healthcare divide, highlighting training opportunities in graduate medical education.
Collapse
Affiliation(s)
- Rebecca E. Sadun
- Department of Medicine, Duke University, Durham, NC, USA
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - Richard J. Chung
- Department of Medicine, Duke University, Durham, NC, USA
- Department of Pediatrics, Duke University, Durham, NC, USA
| | | | - Gary R. Maslow
- Department of Pediatrics, Duke University, Durham, NC, USA
- Department of Psychiatry, Duke University, Durham, NC, USA
| |
Collapse
|
47
|
Lampe C, McNelly B, Gevorkian AK, Hendriksz CJ, Lobzhanidze TV, Pérez-López J, Stepien KM, Vashakmadze ND, Del Toro M. Transition of patients with mucopolysaccharidosis from paediatric to adult care. Mol Genet Metab Rep 2019; 21:100508. [PMID: 31687335 PMCID: PMC6819742 DOI: 10.1016/j.ymgmr.2019.100508] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/21/2019] [Indexed: 12/16/2022] Open
Abstract
Mucopolysaccharidoses (MPS) are rare disorders associated with enzyme deficiencies, resulting in glycosaminoglycan (GAG) accumulation in multiple organ systems. As patients increasingly survive to adulthood, the need for a smooth transition into adult care is essential. Using case studies, we outline strategies and highlight the challenges of transition, illustrating practical solutions that may be used to optimise the transition process for patients with MPS disorders. Seven MPS case studies were provided by four European inherited metabolic disease centres; six of these patients transferred to an adult care setting and the final patient remained under paediatric care. Of the patients who transferred, age at the start of transition ranged between 14 and 18 years (age at transfer ranged from 16 to 19 years). While there were some shared features of transition strategies, they varied in duration, the healthcare professionals involved and the management of adult patients with MPS. Challenges included complex symptoms, patients' unwillingness to attend appointments with unfamiliar team members and attachment to paediatricians. Challenges were resolved by starting transition at an early age, educating patients and families, and providing regular communication with and reassurance to the patient and family. Sufficient time should be provided to allow patients to understand their responsibilities in the adult care setting while feeling assured of continued support from healthcare professionals. The involvement of a coordinated multidisciplinary team with expertise in MPS is also key. Overall, transition strategies must be comprehensive and individualised to patients' needs.
Collapse
Affiliation(s)
- C Lampe
- HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | - B McNelly
- Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - A K Gevorkian
- Research Center for Children's Health, Moscow, Russia
| | | | | | | | - K M Stepien
- Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | | | - M Del Toro
- Vall d'Hebron University Hospital, Barcelona, Spain
| |
Collapse
|
48
|
Developing a Hospital-Wide Transition Program for Young Adults With Medical Complexity. J Adolesc Health 2019; 65:476-482. [PMID: 31277993 DOI: 10.1016/j.jadohealth.2019.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/12/2019] [Accepted: 04/15/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Transitional age adults (18-24 years) are the fastest growing cohort of patients in children's hospitals across the nation. The purpose of the study was to standardize pediatric to adult healthcare transfers of complex adult patients through a tiered and multimodal population-based intervention. METHODS The Multidisciplinary Intervention Navigation Team (MINT) was developed to decrease variations in pediatric to adult medical transitions. System-level goals were to (1) increase provider and leadership engagement, (2) increase transition tools, (3) increase use of electronic medical record-based clinical decision supports, (4) improve transition practices through development of transition policies and clinical pathways; (5) increase transition education for patients and caregivers; (6) increase the adult provider referral network; and (7) implement an adult transition consult service for complex patients (MINT Consult). RESULTS Between July 2015 and March 2017, MINT identified 11 transition champions, increased the number of divisions with drafted transition policies from 0 to 7, increased utilization of electronic medical record-based transition support tools from 0 to 7 divisions, held seven psychoeducational events, and developed a clinical pathway. MINT has received more than 70 patient referrals. Of patients referred, median age is 21 years (range, 17-43); 70% (n = 42) have an intellectual disability. Referring pediatric providers (n = 25) reported that MINT helped identify adult providers and coordinate care with other Children's Hospital of Philadelphia specialists (78%); and that MINT saved greater than 2 hours of time (48%). CONCLUSIONS MINT improved the availability, knowledge, and use of transition-related resources; saved significant time among care team members; and increased provider comfort around transition-related conversations.
Collapse
|
49
|
Hart LC, Mouw MS, Teal R, Jonas DE. What Care Models Have Generalists Implemented to Address Transition from Pediatric to Adult Care?: a Qualitative Study. J Gen Intern Med 2019; 34:2083-2090. [PMID: 31410810 PMCID: PMC6816717 DOI: 10.1007/s11606-019-05226-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 03/26/2019] [Accepted: 06/13/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND The transition from pediatric to adult care is a critical period for young adults with childhood-onset conditions. General internists are tasked with participating in the care of this vulnerable population. Existing guidelines regarding transition do not fully address structural or organizational characteristics of practices that facilitate transition. Moreover, literature regarding transition has focused on pediatric subspecialty settings, leaving internists with little guidance after transfer. OBJECTIVES To better understand post-transfer transitional care by describing care models that primary care providers have implemented, and examining common features of generalist physicians' experiences providing transitional care. DESIGN Qualitative methods, semi-structured interviews. PARTICIPANTS Nineteen generalist-trained physicians from across the USA, engaged in transition-focused and/or ongoing care of adolescents and young adults with childhood-onset conditions. APPROACH Content and grounded theory analyses. KEY RESULTS Participants included nineteen physicians from seventeen institutions. Most (89%) were from academic medical centers. About 80% had completed a combined internal medicine-pediatrics residency. About 70% worked with clinic staff who were dedicated to transition. Practice structures fell into four main care models: (1) primary care in adult settings; (2) transition support and primary care in pediatric settings; (3) a blend of pediatric and adult care elements forming a bridge during transition; and (4) a transition consultative service. Most provided primary care for adults with childhood-onset conditions within larger adult-oriented primary care practices. Common features across interviews included taking extra time with patients both during and between visits and an interdisciplinary team-based approach. Shared practice strategies and philosophies emphasized care coordination, focus on the whole patient beyond immediate health concerns, and willingness to learn from practice and from families. CONCLUSIONS Participants used disparate care models. Common features and strategies among interviews highlight key functions and attributes of transitional care across settings, suggest important elements of care post-transfer, and clarify the role of generalists.
Collapse
Affiliation(s)
- Laura C Hart
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Mary S Mouw
- Division of Geriatrics, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Randall Teal
- Connected Health Applications and Interventions (CHAI-Core), University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel E Jonas
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
50
|
Wiemann CM, Graham SC, Garland BH, Hergenroeder AC, Raphael JL, Sanchez-Fournier BE, Benavides JM, Warren LJ. Development of a Group-Based, Peer-Mentor Intervention to Promote Disease Self-Management Skills Among Youth With Chronic Medical Conditions. J Pediatr Nurs 2019; 48:1-9. [PMID: 31195183 DOI: 10.1016/j.pedn.2019.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/19/2019] [Accepted: 05/19/2019] [Indexed: 01/17/2023]
Abstract
STUDY PURPOSE The purpose of this paper is to describe the development of a group-based peer-mentor intervention to enhance knowledge/skills of transition-age youth (TAY) from three clinical services (gastroenterology, renal or rheumatology) at a large children's hospital in order to facilitate transition from pediatric to adult healthcare. DESIGN AND METHODS Using a multi-modal, iterative approach, the structure/content of the intervention was based on peer-reviewed literature; surveys/interviews conducted with TAY, families, and adult and pediatric providers; principles of Self-Determination Theory and motivational interviewing; and guided by a logic model. A TAY community advisory board helped interpret the information and develop the intervention. RESULTS The resulting intervention has eight sessions led by peer mentors (young adults who have successfully transitioned to adult healthcare, who are trained to use a motivational interviewing approach) covering topics such as goal setting; understanding my diagnosis; organizing personal, health & insurance information; characteristics of a good provider; filling/refilling prescriptions; and mental well-being. The TAY community advisory board recommended holding two sessions on each of four Saturdays, using interactive group activities to make it fun, and creating a written complimentary manual for caregivers. CONCLUSIONS A TAY community advisory board was instrumental in developing an innovative peer-mentor intervention to promote the development of specific skills TAY require to manage their disease within adult healthcare. PRACTICE IMPLICATIONS Although the intervention was developed with extensive stakeholder input, a next step is to evaluate the intervention with respect to how well it fits the broader membership in the target population.
Collapse
Affiliation(s)
- Constance M Wiemann
- Section of Adolescent Medicine & Sports Medicine, Department of Pediatrics, Baylor College of Medicine, TX, USA.
| | - Sarah C Graham
- Section of Adolescent Medicine & Sports Medicine, Department of Pediatrics, Baylor College of Medicine, TX, USA
| | - Beth H Garland
- Section of Adolescent Medicine & Sports Medicine, Department of Pediatrics, Baylor College of Medicine, TX, USA.
| | - Albert C Hergenroeder
- Section of Adolescent Medicine & Sports Medicine, Department of Pediatrics, Baylor College of Medicine, TX, USA.
| | - Jean L Raphael
- Center for Child Health Policy and Advocacy, Department of Pediatrics, Baylor College of Medicine, TX, USA.
| | - Blanca E Sanchez-Fournier
- Section of Adolescent Medicine & Sports Medicine, Department of Pediatrics, Baylor College of Medicine, TX, USA.
| | - Jacqueline M Benavides
- Section of Adolescent Medicine & Sports Medicine, Department of Pediatrics, Baylor College of Medicine, TX, USA.
| | | |
Collapse
|