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Olsson M, Bajpai R, Yew YW, Koh MJA, Thng S, Car J, Järbrink K. Associations between health-related quality of life and health care costs among children with atopic dermatitis and their caregivers: A cross-sectional study. Pediatr Dermatol 2020; 37:284-293. [PMID: 31863524 DOI: 10.1111/pde.14071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Atopic dermatitis is associated with a decreased health-related quality of life and contributes to substantial health care costs. It is important to understand what accelerates health care costs to inform various stakeholders, so they can effectively meet health care needs. This cross-sectional study aims to explore associations between health-related quality of life, health care costs, and cost-accelerating variables. METHODS Information on health-related quality of life (HRQoL) was collected through generic and disease-specific instruments from caregivers and children <16 years of age with a physician-confirmed diagnosis of atopic dermatitis. The economic impact of atopic dermatitis was evaluated by analyzing information on health service utilization and other health care costs related to managing the condition. RESULTS Children with high impact on health-related quality of life presented an annual health care cost of US$ 3787 compared with US$ 2548 for moderately impacted and US$ 2258 among children for which the condition had low impact. The severity of atopic dermatitis, disease duration, and a lower health-related quality of life was associated with greater health care costs. Analyses of subdomains of health-related quality of life revealed correlations between "mood" and "personal relationships" on one hand and caregivers' physical health and health care costs on the other hand. CONCLUSIONS Highly affected HRQoL is associated with increased health care costs and could be a valuable complement to traditional severity assessments. By using HRQoL instruments, burdens and symptoms beyond severity can be identified and addressed with interventions to increase HRQoL and subsequently reduce health care costs.
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Affiliation(s)
- Maja Olsson
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Queensland University of Technology, Brisbane, QLD, Australia
| | - Ram Bajpai
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | | | - Mark Jean Aan Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Steven Thng
- National Skin Centre, Singapore, Singapore.,Skin Research Institute of Singapore, A*STAR. 8A Biomedical Grove, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Krister Järbrink
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Marrie RA, O'Mahony J, Maxwell C, Ling V, Till C, Barlow-Krelina E, Yeh EA, Arnold DL, Bar-Or A, Banwell B. Factors associated with health care utilization in pediatric multiple sclerosis. Mult Scler Relat Disord 2019; 38:101511. [PMID: 31722282 DOI: 10.1016/j.msard.2019.101511] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 11/02/2019] [Accepted: 11/05/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND We assessed whether clinical characteristics and health-related quality of life (HRQOL) are independently associated with subsequent hospitalizations and physician visits among children with multiple sclerosis (MS); and whether differences in HRQOL account for differences in physician visits between children with MS, monophasic acquired demyelinating syndromes (ADS) and healthy children. METHODS We used linked administrative (health) data from Ontario, Canada and data from a prospective cohort study including HRQOL (measured using the PedsQL), age, sex, cognitive function (accuracy and response time as assessed by Penn Neurocognitive Battery), number of relapses, and neurologic abnormalities on examination. We used generalized linear models with generalized estimating equations to examine factors associated with hospitalizations and ambulatory physician visit rates following each HRQOL assessment, adjusting for age, sex, and socioeconomic status. RESULTS We included 36 children with MS, 43 with monophasic ADS and 43 healthy controls. Among children with MS, more relapses were associated with increased odds of hospitalization (odds ratio 1.59; 1.18-2.14); better cognitive accuracy scores were associated with fewer physician visits (rate ratio [RR] 0.68; 0.47-0.98). Children with MS had higher rates of physician visits than healthy children (RR 1.44; 1.00-2.08), unlike children with a monophasic ADS, but HRQOL scores did not account for these differences. CONCLUSION Within the MS population, more relapses are associated with increased odds of hospitalization while better cognitive performance is associated with reduced rates of physician visits. Differences in HRQOL do not account for differences in physician visits by children with MS as compared to healthy children.
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Affiliation(s)
- Ruth Ann Marrie
- Departments of Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Julia O'Mahony
- Institute of Health Policy, Management and Evaluation, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Colleen Maxwell
- Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada; ICES, Toronto, Ontario, Canada.
| | | | - Christine Till
- Department of Psychology, York University, Toronto, Ontario, Canada.
| | | | - E Ann Yeh
- Department of Pediatrics, University of Toronto; Division of Neurology, The Hospital for Sick Children, Neurosciences and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada.
| | - Douglas L Arnold
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
| | - Amit Bar-Or
- Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Brenda Banwell
- Division of Child Neurology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Abstract
THEORETICAL PRINCIPLES Pragmatic Children's Nursing Theory draws on the theory principles of North American Pragmatist including the work of William James, Richard Rorty, and John Dewy and incorporates Margaret Urban Walkers' work on expressive collaborative feminism. PHENOMENA ADDRESSED In this discussion paper I explore how the role of parents is framed in Pragmatic Children's Nursing Theory. In setting out Pragmatic Children's Nursing Theory I detailed a rebuttal of Family Centred care. However, working with the theory I have come to realise how the arguments against Family Centred care do not exclude involving parents in children's care. Indeed, Pragmatic Children's Nursing recognises the vital role parents and other carers play in children's access and experience of childhood. Using Walkers expressive collaborative feminism who accepts and who rejects the parenting role for children living with illness is discussed. RESEARCH LINKAGES This is an emergent theoretical approach to children's nursing with challenging research evidence. However, I draw on existing children's nursing studies to explore the potential of Pragmatic Children's Nursing Theory to assist children, parents and nurses in negotiating care. Concluding that as childhoods and parenting are continually evolving, in time, in certain physical, cultural and political contexts, that pragmatic theory will evolve to meet these intergenerational contextual challenges.
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Apples and Oranges: Serious Chronic Illness in Adults and Children. J Pediatr 2016; 179:256-258. [PMID: 27671116 DOI: 10.1016/j.jpeds.2016.08.098] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/17/2016] [Accepted: 08/30/2016] [Indexed: 11/21/2022]
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Howell CR, Gross HE, Reeve BB, DeWalt DA, Huang IC. Known-groups validity of the Patient-Reported Outcomes Measurement Information System (PROMIS(®)) in adolescents and young adults with special healthcare needs. Qual Life Res 2016; 25:1815-23. [PMID: 26872912 PMCID: PMC4893933 DOI: 10.1007/s11136-016-1237-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE To examine known-groups validity of the Patient-Reported Outcomes Measurement Information System (PROMIS(®)) Short Forms (SFs) for adolescents and young adults with special healthcare needs (SHCN) using data collected from the PROMIS Linking Study. METHODS In total, 292 adolescents aged 14-17.9 years and 300 young adults aged 18-20 years with SHCN from the PROMIS Linking Study were used for analyses. Presence of SHCN was classified into three categories (medication use, service use, and functional limitations). HRQoL was measured with the PROMIS Pediatric and Adult SFs. Differences in health-related quality of life (HRQoL) domain scores between SHCN sample and the norms of the PROMIS pediatric and adult calibration samples, respectively, were compared using t tests. Associations of HRQoL scores with the presence of individual SHCN categories were tested using linear regression. RESULTS All HRQoL domain scores for the SHCN samples were significantly worse than the respective calibration samples. Adolescents and young adults with SHCN-related service use and functional limitations reported worse HRQoL than those without service use and functional limitations (p's < 0.01). CONCLUSIONS PROMIS Pediatric and Adult SFs possess satisfactory known-groups validity related to SHCN status.
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Affiliation(s)
- Carrie R Howell
- Department of Epidemiology and Cancer Control, MS 735, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Heather E Gross
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Bryce B Reeve
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Darren A DeWalt
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, MS 735, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.
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Ruff RR, Sischo L, Broder H. Resiliency and socioemotional functioning in youth receiving surgery for orofacial anomalies. Community Dent Oral Epidemiol 2016; 44:371-80. [PMID: 26924625 DOI: 10.1111/cdoe.12222] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 01/28/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Restorative interventions for cleft lip and palate involve annual evaluations, adjunct treatment, and multiple surgeries. The purpose of this study was to investigate the longitudinal impact of cleft surgery on psychosocial functioning among youth with cleft. METHODS Data were derived from a 5-year, multicenter, prospective longitudinal study of children with cleft (N = 1196). Children completed psychological inventories for self-concept, anxiety, depression, mastery, and relatedness. Multilevel mixed-effects models were used to analyze the effects of craniofacial surgery for cleft on psychosocial outcomes over time. RESULTS There were 1196 participants at baseline, of whom 258 (27.5%) received a surgical intervention prior to their 1st follow-up visit. Approximately 78% of participants had cleft lip and palate, and 22% had cleft palate only. Surgery receipt was significantly associated with lower relatedness (β = -1.48, 95% CI = -2.91, -0.05) and mastery (β = -1.32, 95% CI = -2.49, -0.15) scores, although overall scores appeared to increase over time. Surgery was not related to anxiety (β = -0.15, 95% CI = -1.08, 0.79), depression (β = 0.18, 95% CI = -0.65, 1.01), and self-concept (β = -0.84, 95% CI = -1.83, 0.15). The treatment-time interaction was not significant. Significant differences in psychosocial functioning were found across sex, race/ethnicity, and age groups. CONCLUSIONS Surgery may have negative short-term impacts on psychosocial functioning, although effects may diminish over time. Given the limited postsurgical follow-up period, long-term change in psychological well-being and the moderating effects of surgery may not be fully realized. Further follow-up of children with cleft through adulthood to explore developmental trajectories of psychosocial functioning in more detail is recommended.
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Affiliation(s)
- Ryan Richard Ruff
- Department of Epidemiology and Health Promotion, New York University College of Dentistry, New York, NY, USA.,New York University College of Global Public Health, New York, NY, USA
| | - Lacey Sischo
- Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, NY, USA
| | - Hillary Broder
- Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, NY, USA
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Carona C, Silva N, Moreira H, Canavarro MC, Bullinger M. Does the small fit them all? The utility of Disabkids-10 Index for the assessment of pediatric health-related quality of life across age-groups, genders, and informants. J Child Health Care 2015; 19:466-77. [PMID: 24599030 DOI: 10.1177/1367493514522867] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study was twofold: First, to conduct a confirmatory factor analysis of the Portuguese versions of Disabkids-10; and second, to examine potential differences in factor structures between age-groups, genders, and informants. The sample included 293 school-aged children and adolescents with chronic health conditions and 197 parents. Both family members (whenever possible) completed the self- and proxy-report versions of Disabkids-10. The factorial model of Disabkids-10 had good fit for self-reported data and minimally acceptable fit for proxy-reported data. The multigroup analyses confirmed the model invariance across age-groups (children vs. adolescents), genders (boys vs. girls), and informants (children vs. parents). The generic developmental applicability of these questionnaires makes them recommended for health care routine assessments on pediatric intervention needs and outcomes.
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Affiliation(s)
- Carlos Carona
- Coimbra University, PortugalUniversity Clinic of Hamburg-Eppendorf, Germany
| | - Neuza Silva
- Coimbra University, PortugalUniversity Clinic of Hamburg-Eppendorf, Germany
| | - Helena Moreira
- Coimbra University, PortugalUniversity Clinic of Hamburg-Eppendorf, Germany
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Kurowski D, Russell D, Hamilton T, Napoli R, Rosati RJ. Factors for Hospitalization in a Medically Complex Population of Pediatric Home Care Patients. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2014. [DOI: 10.1177/1084822313518556] [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]
Abstract
Research has identified demographic, clinical, and technological characteristics that are associated with recurrent pediatric hospital admissions. However, research focusing on risk factors for hospitalization among pediatric home care patients is lacking. The purpose of this study was to identify characteristics associated with 60-day hospitalization among pediatric home care patients. To address this objective, we used information collected from pediatric home care patients, age 6 months to 17 years, who were served by a large not-for-profit home care agency in New York City between 2008 and 2012 ( N = 6,187). Results showed that 5.4% of patients in our study population were hospitalized. Specific characteristics that were significantly associated with hospitalization are described in detail.
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Affiliation(s)
| | - David Russell
- Visiting Nurse Service of New York, New York City, USA
| | | | - Rocco Napoli
- Visiting Nurse Service of New York, New York City, USA
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Neul SK, Minard CG, Currier H, Goldstein SL. Health-related quality of life functioning over a 2-year period in children with end-stage renal disease. Pediatr Nephrol 2013; 28:285-93. [PMID: 23052652 DOI: 10.1007/s00467-012-2313-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 08/30/2012] [Accepted: 09/05/2012] [Indexed: 01/10/2023]
Abstract
BACKGROUND Optimal care of the pediatric chronic kidney disease/end stage renal disease (CKD/ESRD) patient must now incorporate health-related quality of life (HRQOL) assessment and management. METHODS This study reports the first data on longitudinal change in global (PedsQL(TM)4.0) and disease-specific (PedsQL(TM)3.0 ESRD Module) HRQOL pediatric ESRD patient and proxy ratings over four assessment periods spanning approximately a 2-year period. General linear mixed modeling was used to analyze associations between patient demographics, medical variables, and patient and proxy HRQOL scores. RESULTS Self-reported and/or proxy data were available for at least two time-points for 53 patients (age 2-18 years; 60 % male), of whom 27 were receiving in-center hemodialysis. CONCLUSIONS Patient ratings on global health and physical activity, emotional, and social and disease-specific worry and communication domains were higher (i.e., better) than parent-proxy ratings, confirming the importance of obtaining both sources of information. Patients on dialysis longer, particularly females, reported worse emotional functioning; females also reported more physical appearance concerns. Parents rated older children and those on dialysis longer as functioning worse on multiple global and disease-specific (e.g., fatigue, relationship) domains. Parents also rated children as functioning increasingly worse in school over time. Further, patient ESRD history (acute onset vs. medically managed) impacted how parents viewed the burden of ESRD on their child over time.
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Affiliation(s)
- Shari K Neul
- Renal Section, Department of Pediatrics, Baylor College of Medicine & Texas Children's Hospital, One Baylor Plaza Houston, Houston, TX 77030, USA.
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