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Xu R, Hayes LC, Cai PY, Meers A, Tulley K, Antonelli RC, Estrada CR. Characterizing psychosocial services in a pediatric urology practice. J Pediatr Urol 2024; 20:242.e1-242.e8. [PMID: 38030431 PMCID: PMC11032223 DOI: 10.1016/j.jpurol.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/29/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Psychosocial needs, which encompass behavioral health and social determinants of health (SDOH), are important mediators of the patient experience and health outcomes. However, many practices have limited experience with systematically assessing the non-billable psychosocial services provided to patients and families. OBJECTIVE To characterize the non-billable activities of three psychosocial providers in a pediatric urology practice at a freestanding children's hospital. STUDY DESIGN Following Institutional Review Board approval, an adapted version of the Care Coordination Measurement Tool (CCMT) was used to collect data prospectively on non-billable activities performed by a psychologist, social worker (SW), and certified child life specialist (CCLS) in a pediatric urology department. Variables included activity type, time spent per activity, and outcomes affected. Demographic data included age, sex, race, state, zip code, insurance type, and language. RESULTS From April to October 2022, 3096 activities were performed in support of psychosocial needs over 947 encounters for 527 patients. The median patient age was 9.2 years (IQR 4.8-12.4); 48.4 % were male. The psychosocial providers most commonly identified care coordination needs related to delivery of urologic care (73.4 %), mental/behavioral/developmental health (29.1 %), and referral and appointment management (19.9 %). The largest proportion of time was spent on providing direct psychosocial support (45.9 %), consisting of psychosocial assessments, education, and other behavioral health interventions. A large proportion of time was also spent on care coordination activities, namely logistics and navigation support (35.9 %). Relative time allocation across activities varied by provider type (p < 0.001); care coordination constituted 64.2 % of non-billable activities for the psychologist, 57.8 % for the SW, and 12.3 % for the CCLS. Activities were associated with treatment plan modification in 37.7 % (n = 357), outpatient coordination in 22.5 % (n = 213), and treatment plan adherence in 19.0 % (n = 180) of encounters. DISCUSSION This study enhances our understanding of psychosocial needs of patients in a pediatric urology practice by assessing non-billable psychosocial services not otherwise captured in the clinical workflow. In addition to direct psychosocial support, care coordination activities constitute a large proportion of such services. These data provide valuable insight into the range of activities necessary for the provision of specialty pediatric medical care. CONCLUSION Psychosocial providers in a pediatric urology practice perform many non-billable care coordination and psychosocial support activities. Characterizing these activities is important for beginning to understand patients' psychosocial needs and informing resource deployment.
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Affiliation(s)
- Rena Xu
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Surgery, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Lillian C Hayes
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Peter Y Cai
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Surgery, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Amanda Meers
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Social Work, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Kelsey Tulley
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Child Life Services, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Richard C Antonelli
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Carlos R Estrada
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Surgery, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
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Luchristt D, Kawasaki A. Successful sacral neuromodulation treatment of refractory faecal incontinence in a patient with spina bifida and partial sacral agenesis. BMJ Case Rep 2023; 16:e254835. [PMID: 37669822 PMCID: PMC10481722 DOI: 10.1136/bcr-2023-254835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
A woman in her early 20s with a history of lumbosacral lipomyelomeningocele with associated partial sacral agenesis and tethered cord was referred for possible sacral neuromodulation treatment of her refractory faecal incontinence. Anorectal testing revealed a thinned and weakened anal sphincter complex with absent left-sided bulbocavernosus and anal wink reflexes.Through a two-stage approach, she underwent successful placement of a chronic tined quadripolar sacral nerve lead and implanted pulse generator. Despite significant distortion of normal bony anatomic landmarks, bilateral S3 and S4 foraminal entry was possible, with intraoperative motor and sensory testing providing key confirmation of appropriate lead placement. The patient had a substantial improvement in her baseline frequency and urgency with a near-complete resolution of faecal incontinence episodes during her test phase.
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Affiliation(s)
- Douglas Luchristt
- Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Amie Kawasaki
- Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
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Brandon E, Green P, Palozzi L, Kassam-Lallani D, Lauzon A, Nenadovic V, Puthen R, Rudden L, Ballantyne M. Nurse Practitioners in a Canadian Pediatric Rehabilitation Hospital: A Description of Roles and Scope of Practice. J Pediatr Health Care 2023; 37:e1-e10. [PMID: 37245130 DOI: 10.1016/j.pedhc.2023.04.011] [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: 12/11/2022] [Revised: 03/13/2023] [Accepted: 04/23/2023] [Indexed: 05/29/2023]
Abstract
The nurse practitioner role is strongly suited to meet the needs of children with complex developmental conditions in pediatric rehabilitation settings as they have a unique combination of clinical expertise. To meet the increasing demands in a large Canadian pediatric rehabilitation hospital, the NP role was implemented in several clinical program settings to improve access to care. This paper describes the contributions of NPs to nine specialized inpatient and outpatient programs in NP-led, collaborative NP and physician or interagency care team models of practice. The initial challenges of role implementation and implications for NP practice, research and leadership are discussed.
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Zhang H, Wu Y, Sun W, Li W, Huang X, Sun T, Wu M, Huang Z, Chen S. How does people-centered integrated care in medical alliance in China promote the continuity of healthcare for internal migrants: The moderating role of respect. Front Public Health 2023; 10:1030323. [PMID: 36684939 PMCID: PMC9845872 DOI: 10.3389/fpubh.2022.1030323] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/06/2022] [Indexed: 01/05/2023] Open
Abstract
Background Continuity is crucial to the health care of the internal migrant population and urgently needs improvements in China. Chinese government is committed to promoting healthcare continuity by improving the people-centered integrated care (PCIC) model in medical alliances. However, little is known about the driving mechanisms for continuity. Methods We created the questionnaire for this study by processes of a literature research, telephone interviews, two rounds of Delphi consultation. Based on the combination of quota sampling and judgment sampling, we collected 765 valid questionnaires from developed region and developing region in Zhejiang Province. Structural equation models were used to examined whether the attributes of PCIC (namely coordination, comprehensiveness, and accessibility of health care) associated with continuity, and explored the moderated mediating role of respect. Results The result of SEM indicated that coordination had direct effect on continuity, and also had mediating effect on continuity via comprehensiveness and accessibility. The hierarchical linear regression analysis showed that the interactive items of coordination and respect had a positive effect on the comprehensiveness (β = 0.132), indicating that respect has positive moderating effect on the relationship between coordination and comprehensiveness. The simple slope test indicated that in the developed region, coordination had a significant effect on comprehensiveness for both high respect group(β = 0.678) and low respect group (β = 0.508). The moderated mediation index was statistically significant in developed areas(β = 0.091), indicating that respect had moderated mediating effect on the relationship between coordination and continuity via comprehensiveness of healthcare in the developed region; however, the moderated mediation effect was not significant in the developing region. Conclusion Such regional differences of the continuity promoting mechanism deserve the attention of policy-makers. Governments and health authorities should encourage continuity of healthcare for migrants through improving the elements of PCIC-coordination, comprehensiveness and accessibility of healthcare, shaping medical professionalism of indiscriminate respect, and empowering migrants to have more autonomy over selection of services and decisions about their health.
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Affiliation(s)
- Hao Zhang
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Yan Wu
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Wei Sun
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Wuge Li
- Department of Clinical Medicine, School of Clinical Medicine, Hangzhou Medical College, Hangzhou, China
| | - Xianhong Huang
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Tao Sun
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Mengjie Wu
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Zhen Huang
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Shanquan Chen
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Vetrano IG, Barbotti A, Erbetta A, Mariani S, Bova SM, Colombo L, Caretti V, Marinoni F, Vestri E, Selvaggio GGO, Valentini LG. Multidisciplinary Management of Children with Occult Spinal Dysraphism: A Comprehensive Journey from Birth to Adulthood. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101546. [PMID: 36291482 PMCID: PMC9601159 DOI: 10.3390/children9101546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022]
Abstract
Occult spinal dysraphism (OSD) comprises different forms of failure in embryogenic development that can lead to genitourinary, spinal, or lower limb alterations, thus determining progressive neurological deterioration. The correct management of children harboring OSD represents a significant issue during their life up to adulthood. However, patients often have to entertain individual consultations with each specialist. We settled on a multidisciplinary team comprising pediatric neurosurgeons, urologists, neurologists, orthopedists, and other supporting physicians. We present the results of such actions by analyzing a series of 141 children with OSD subjected to neurosurgical procedures, evaluating the impact of multidisciplinary management on outcomes. We also evaluated the specific actions according to the different ages of OSD patients from birth to adulthood to provide a schematic plan that could represent a basis for establishing and disseminating the need for a multidisciplinary approach in OSD management. The multidisciplinary team allows all consultants to see the patient together, covering specific aspects of history and examination pertinent to their management. Offering a one-stop service prevents coordination issues between the different medical teams, avoids delays or cancellations of the various appointments, optimizes cost-effectiveness, and improves efficiency and parents’ satisfaction.
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Affiliation(s)
- Ignazio G. Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20133 Milan, Italy
- Correspondence:
| | - Arianna Barbotti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Alessandra Erbetta
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Sabrina Mariani
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Stefania M. Bova
- Pediatric Neurology Unit, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy
| | - Luca Colombo
- Pediatric Orthopedics and Traumatology Unit, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy
| | - Valentina Caretti
- Pediatric Orthopedics and Traumatology Unit, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy
| | - Federica Marinoni
- Pediatric Surgery Unit, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy
| | - Elettra Vestri
- Pediatric Surgery Unit, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy
| | | | - Laura G. Valentini
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
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Petronic Markovic I, Nikolic D, Stahl M, Tederko P, Hdyrya O, Negrini S, Zampolini M, Kiekens C. Evidence-based position paper of the UEMS PRM on the role of Physical and Rehabilitation Medicine (PRM) physician in the management of children and adults with spinal dysraphism. Eur J Phys Rehabil Med 2022; 58:511-519. [PMID: 35575455 PMCID: PMC9980507 DOI: 10.23736/s1973-9087.22.07536-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Spinal dysraphism (SD) or spina bifida (SB) is a congenital deformity that results from embryonic neural tube closure failure during fetal development. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section. This paper aims to evaluate the role of the physical and rehabilitation medicine (PRM) physician and PRM practice for children and adults with spinal dysraphism. A systematic literature review and a consensus procedure involved all European countries delegates represented in the UEMS PRM section through a Delphi process. The systematic literature review is reported together with thirty-two recommendations resulting from the Delphi procedure. The professional role of the PRM physician requires specific expertise in the treatment of patients with SD to plan, lead and monitor the rehabilitation process in an interdisciplinary setting and to participate in the assessment of the needs of these patients in the transitional phase from childhood to adulthood, with particular attention to the activity limitation and participation restriction.
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Affiliation(s)
- Ivana Petronic Markovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Physical Medicine and Rehabilitation, University Children's Hospital, Belgrade, Serbia
| | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia - .,Department of Physical Medicine and Rehabilitation, University Children's Hospital, Belgrade, Serbia
| | - Minna Stahl
- National Center for Pediatric and Adolescent Pain Management and Research, New Children's Hospital, HUS, Helsinki, Finland
| | - Piotr Tederko
- Department of Rehabilitation, Medical University of Warsaw, Warsaw, Poland
| | - Oksana Hdyrya
- Department of Rehabilitation and Alternative Medicine, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Stefano Negrini
- La Statale University, Milan, Italy.,IRCCS Galeazzi Orthopedic Institute, Milan, Italy
| | - Mauro Zampolini
- Department of Rehabilitation, San Giovanni Battista Hospital, Foligno, Perugia, Italy
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Needs and Research Priorities for Young People with Spinal Cord Lesion or Spina Bifida and Their Caregivers: A National Survey in Switzerland within the PEPSCI Collaboration. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030318. [PMID: 35327690 PMCID: PMC8947533 DOI: 10.3390/children9030318] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 11/17/2022]
Abstract
The aim of this study was to describe the needs and research priorities of Swiss children/adolescents and young adults (from here, “young people”) with spinal cord injury/disorder (SCI/D) or spina bifida (SB) and their parents in the health and life domains as part of the international Pan-European Pediatric Spinal Cord Injury (PEPSCI) collaboration. Surveys included queries about the satisfaction, importance, research priorities, quality of life (QoL), and characteristics of the young people. Fifty-three surveys with corresponding parent-proxy reports were collected between April and November 2019. The self-report QoL sum scores from young people with SCI/D and SB were 77% and 73%, respectively. Parent-proxy report QoL sum scores were lower, with 70% scores for parents of young people with SCI/D and 64% scores for parents of young people with SB. “Having fun”, “relation to family members”, and “physical functioning” were found to be highly important for all young people. “Physical functioning”, “prevention of pressure injuries”, “general health”, and “bowel management” received the highest scores for research priority in at least one of the subgroups. As parents tend to underestimate the QoL of their children and young people prioritized research topics differently, both young peoples’ and caregivers’ perspectives should be included in the selection of research topics.
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Castillo J, Fremion E, Morrison-Jacobus M, Bolin R, Perez A, Acosta E, Timmons K, Castillo H. Think globally, act locally: Quality improvement as a catalyst for COVID-19 related care during the transitional years. J Pediatr Rehabil Med 2021; 14:691-697. [PMID: 34864703 DOI: 10.3233/prm-210119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The COVID-19 pandemic has posed distinctive challenges to adolescents and young adults living with spina bifida, especially those from ethic minority populations. With this public health challenge in mind, developing a customized electronic health record to leverage registry data to promote and quantify COVID-19 vaccination uptake among this population is feasible. We provide a brief description of our activities in customizing an electronic health record to track vaccination uptake among adolescents and young adults with spina bifida (AYASB); and the lessons learned, in hopeful support of those scaling-up vaccination delivery across the globe for AYASB as they transition to adult-centered care. Thus, as providers think globally and act locally, COVID-19 immunization efforts can be implemented while providing culturally appropriate transition policies and services for individuals with neurodevelopmental disabilities.
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Affiliation(s)
- Jonathan Castillo
- Meyer Center for Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Ellen Fremion
- Spina Bifida Transition Clinic, Texas Children's Hospital, Houston, TX, USA.,Department of Internal Medicine, Transition Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Melissa Morrison-Jacobus
- Meyer Center for Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Spina Bifida Transition Clinic, Texas Children's Hospital, Houston, TX, USA
| | - Rhonda Bolin
- Meyer Center for Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Ana Perez
- Meyer Center for Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Eva Acosta
- Meyer Center for Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Kelly Timmons
- Population Health, Texas Children's Hospital, Houston TX, USA
| | - Heidi Castillo
- Meyer Center for Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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