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Nkoy F, Stone B, Hofmann M, Fassl B, Zhu A, Mahtta N, Murphy N. Home-Monitoring Application for Children With Medical Complexity: A Feasibility Trial. Hosp Pediatr 2021; 11:492-502. [PMID: 33827786 DOI: 10.1542/hpeds.2020-002097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Mobile apps are suggested for supporting home monitoring and reducing emergency department (ED) visits and hospitalizations for children with medical complexity (CMC). None have been implemented. We sought to assess the MyChildCMC app (1) feasibility for CMC home monitoring, (2) ability to detect early deteriorations before ED and hospital admissions, and (3) preliminary impact. METHODS Parents of CMC (aged 1-21 years) admitted to a children's hospital were randomly assigned to MyChildCMC or usual care. MyChildCMC subjects recorded their child's vital signs and symptoms daily for 3 months postdischarge and received real-time feedback. Feasibility measures included parent's enrollment, retention, and engagement. The preliminary impact was determined by using quality of life, parent satisfaction with care, and subsequent ED and hospital admissions and hospital days. RESULTS A total of 62 parents and CMC were invited to participate: 50 enrolled (80.6% enrollment rate) and were randomly assigned to MyChildCMC (n = 24) or usual care (n = 26). Retention at 1 and 3 months was 80% and 74%, and engagement was 68.3% and 62.6%. Run-chart shifts in vital signs were common findings preceding admissions. The satisfaction score was 26.9 in the MyChildCMC group and 24.1 in the control group (P = .035). No quality of life or subsequent admission differences occurred between groups. The 3-month hospital days (pre-post enrollment) decreased from 9.25 to 4.54 days (rate ratio = 0.49; 95% confidence interval = 0.39-0.62; P < .001) in the MyChildCMC group and increased from 1.08 to 2.46 days (rate ratio = 2.29; 95% confidence interval = 1.47-3.56; P < .001) in the control group. CONCLUSIONS MyChildCMC was feasible and appears effective, with the potential to detect early deteriorations in health for timely interventions that might avoid ED and hospitalizations. A larger and definitive study of MyChildCMC's impact and sustainability is needed.
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Affiliation(s)
- Flory Nkoy
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Bryan Stone
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Michelle Hofmann
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Bernhard Fassl
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Angela Zhu
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Namita Mahtta
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Nancy Murphy
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
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2
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Geake J, Ballard E, O'Rourke P, Wainwright CE, Reid DW, Bell SC. Centralised versus outreach models of cystic fibrosis care should be tailored to the needs of the individual patient. Intern Med J 2020; 50:232-235. [PMID: 32037704 DOI: 10.1111/imj.14724] [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: 05/16/2019] [Revised: 07/31/2019] [Accepted: 07/31/2019] [Indexed: 11/28/2022]
Abstract
Cystic fibrosis (CF) is a common life-limiting genetic condition. As the disease progresses access to specialist tertiary multi-disciplinary care services may become necessary. For patients living in regional/remote Australia, accessing such services may be a challenge. Here, we describe long-term outcomes for CF patients according to their access to specialist CF centre care in childhood.
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Affiliation(s)
- James Geake
- Department of Respiratory and Sleep Medicine, Lyell McEwin Hospital, Adelaide, South Australia, Australia.,Department of Respiratory and Sleep Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Emma Ballard
- Department of Lung Inflammation and Infection, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Peter O'Rourke
- Department of Lung Inflammation and Infection, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Claire E Wainwright
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - David W Reid
- Department of Lung Inflammation and Infection, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Scott C Bell
- Department of Lung Inflammation and Infection, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
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3
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Health Disparities. Respir Med 2020. [DOI: 10.1007/978-3-030-42382-7_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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4
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Bell SC, Mall MA, Gutierrez H, Macek M, Madge S, Davies JC, Burgel PR, Tullis E, Castaños C, Castellani C, Byrnes CA, Cathcart F, Chotirmall SH, Cosgriff R, Eichler I, Fajac I, Goss CH, Drevinek P, Farrell PM, Gravelle AM, Havermans T, Mayer-Hamblett N, Kashirskaya N, Kerem E, Mathew JL, McKone EF, Naehrlich L, Nasr SZ, Oates GR, O'Neill C, Pypops U, Raraigh KS, Rowe SM, Southern KW, Sivam S, Stephenson AL, Zampoli M, Ratjen F. The future of cystic fibrosis care: a global perspective. THE LANCET RESPIRATORY MEDICINE 2020; 8:65-124. [DOI: 10.1016/s2213-2600(19)30337-6] [Citation(s) in RCA: 351] [Impact Index Per Article: 87.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/19/2019] [Accepted: 08/14/2019] [Indexed: 02/06/2023]
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5
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Nkoy FL, Hofmann MG, Stone BL, Poll J, Clark L, Fassl BA, Murphy NA. Information needs for designing a home monitoring system for children with medical complexity. Int J Med Inform 2018; 122:7-12. [PMID: 30623786 DOI: 10.1016/j.ijmedinf.2018.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/08/2018] [Accepted: 11/25/2018] [Indexed: 10/27/2022]
Abstract
Background Children with medical complexity (CMC) are a growing population of medically fragile children with unique healthcare needs, who have recurrent emergency department (ED) and hospital admissions due to frequent acute escalations of their chronic conditions. Mobile health (mHealth) tools have been suggested to support CMC home monitoring and prevent admissions. No mHealth tool has ever been developed for CMC and challenges exist. Objective To: 1) assess information needs for operationalizing CMC home monitoring, and 2) determine technology design functionalities needed for building a mHealth application for CMC. Methods Qualitative descriptive study conducted at a tertiary care children's hospital with a purposive sample of English-speaking caregivers of CMC. We conducted 3 focus group sessions, using semi-structured, open-ended questions. We assessed caregiver's perceptions of early symptoms that commonly precede acute escalations of their child conditions, and explored caregiver's preferences on the design functionalities of a novel mHealth tool to support home monitoring of CMC. We used content analysis to assess caregivers' experience concerning CMC symptoms, their responses, effects on caregivers, and functionalities of a home monitoring tool. Results Overall, 13 caregivers of CMC (ages 18 months to 19 years, mean = 9 years) participated. Caregivers identified key symptoms in their children that commonly presented 1-3 days prior to an ED visit or hospitalization, including low oxygen saturations, fevers, rapid heart rates, seizures, agitation, feeding intolerance, pain, and a general feeling of uneasiness about their child's condition. They believed a home monitoring system for tracking these symptoms would be beneficial, providing a way to identify early changes in their child's health that could prompt a timely and appropriate intervention. Caregivers also reported their own symptoms and stress related to caregiving activities, but opposed monitoring them. They suggested an mHealth tool for CMC to include the following functionalities: 1) symptom tracking, targeting commonly reported drivers (symptoms) of ED/hospital admissions; 2) user friendly (ease of data entry), using voice, radio buttons, and drop down menus; 3) a free-text field for reporting child's other symptoms and interventions attempted at home; 4) ability to directly access a health care provider (HCP) via text/email messaging, and to allow real-time sharing of child data to facilitate care, and 5) option to upload and post a photo or video of the child to allow a visual recall by the HCP. Conclusions Caregivers deemed a mHealth tool beneficial and offered a set of key functionalities to meet information needs for monitoring CMC's symptoms. Our future efforts will consist of creating a prototype of the mHealth tool and testing it for usability among CMC caregivers.
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Affiliation(s)
- Flory L Nkoy
- University of Utah, Pediatric Department, SLC, Utah, United States.
| | | | - Bryan L Stone
- University of Utah, Pediatric Department, SLC, Utah, United States
| | - Justin Poll
- Intermountain Healthcare, SLC, Utah, United States
| | - Lauren Clark
- University of Utah, Pediatric Department, SLC, Utah, United States
| | - Bernhard A Fassl
- University of Utah, Pediatric Department, SLC, Utah, United States
| | - Nancy A Murphy
- University of Utah, Pediatric Department, SLC, Utah, United States
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6
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Simon TD, Whitlock KB, Haaland W, Wright DR, Zhou C, Neff J, Howard W, Cartin B, Mangione-Smith R. Effectiveness of a Comprehensive Case Management Service for Children With Medical Complexity. Pediatrics 2017; 140:peds.2017-1641. [PMID: 29192004 DOI: 10.1542/peds.2017-1641] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To assess whether children with medical complexity (CMC) exposed to a hospital-based comprehensive case management service (CCMS) experience improved health care quality, improved functional status, reduced hospital-based utilization, and/or reduced overall health care costs. METHODS Eligible CMC at Seattle Children's Hospital were enrolled in a cluster randomized controlled trial between December 1, 2010, and September 29, 2014. Participating primary care providers (PCPs) were randomly assigned, and CMC either had access to an outpatient hospital-based CCMS or usual care directed by their PCP. The CCMS included visits to a multidisciplinary clinic ≥ every 6 months for 1.5 years, an individualized shared care plan, and access to CCMS providers. Differences between control and intervention groups in change from baseline to 12 months and baseline to 18 months (difference of differences) were tested. RESULTS Two hundred PCPs caring for 331 CMC were randomly assigned. Intervention group (n = 181) parents reported more improvement in the Consumer Assessment of Healthcare Providers and Systems version 4.0 Child Health Plan Survey global health care quality ratings than control group parents (6.7 [95% confidence interval (CI): 3.5-9.8] vs 1.3 [95% CI: 1.9-4.6] at 12 months). We did not detect significant differences in child functional status and most hospital-based utilization between groups. The difference in change of overall health care costs was higher in the intervention group (+$8233 [95% CI: $1701-$16 937]) at 18 months). CCMS clinic costs averaged $3847 per child-year. CONCLUSIONS Access to a CCMS generally improved health care quality, but was not associated with changes in child functional status or hospital-based utilization, and increased overall health care costs among CMC.
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Affiliation(s)
- Tamara D Simon
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington; and .,Centers for Clinical and Translational Research and
| | - Kathryn B Whitlock
- Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Wren Haaland
- Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Davene R Wright
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington; and.,Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Chuan Zhou
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington; and.,Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - John Neff
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington; and
| | - Waylon Howard
- Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Brian Cartin
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington; and
| | - Rita Mangione-Smith
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington; and.,Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
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7
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O'Sullivan BG, Stoelwinder JU, McGrail MR. Specialist outreach services in regional and remote Australia: key drivers and policy implications. Med J Aust 2017; 207:98-99. [DOI: 10.5694/mja16.00949] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 12/02/2016] [Indexed: 11/17/2022]
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8
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Weber HC, Robinson PF, Saxby N, Beggs SA, Els I, Ehrlich RI. Do children with cystic fibrosis receiving outreach care have poorer clinical outcomes than those treated at a specialist cystic fibrosis centre? Aust J Rural Health 2016; 25:34-41. [PMID: 27859825 PMCID: PMC5347938 DOI: 10.1111/ajr.12334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2016] [Indexed: 11/27/2022] Open
Abstract
Introduction Although cystic fibrosis (CF) centre care is generally considered ideal, children living in regional Australia receive outreach care supported by the academic CF centres. Methods This is a retrospective database review of children with CF treated at the Royal Children's Hospital in Melbourne and its outreach clinics in Albury (Victoria), and Tasmania. The aim was to compare the outcomes of children with CF managed at an academic centre with that of outreach care, using lung function, nutritional status and Pseudomonas aeruginosa colonisation. Three models of care, namely CF centre care, Shared care and predominantly Local care, were compared, based on the level of involvement of CF centre multidisciplinary team. In our analyses, we controlled for potential confounders, such as socio‐economic status and the degree of remoteness, to determine its effect on the outcome measures. Results There was no difference in lung function, i.e. forced expiratory volume in 1 s (FEV1), the prevalence of Pseudomonas aeruginosa colonisation or nutritional status (body mass index (BMI)) between those receiving CF centre care and various modes of outreach care. Neither socio‐economic status, measured by the Socio‐Economic Index for Area (SEIFA) for disadvantage, nor distance from an urban centre (Australian Standard for Geographical Classification (ASGC)) were associated with lung function and nutritional outcome measures. There was however an association between increased Pseudomonas aeruginosa colonisation and poorer socio‐economic status. Conclusion Outcomes in children with CF in regional and remote areas receiving outreach care supported by an academic CF centre were no different from children receiving CF centre care.
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Affiliation(s)
- Heinrich C Weber
- Faculty of Health, University of Tasmania, Rural Clinical School, Burnie, Tasmania, Australia
| | - Philip F Robinson
- Paediatrics - Respiratory Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Nicole Saxby
- Dietetics/Cystic Fibrosis, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Sean A Beggs
- Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Ingrid Els
- Paediatrics, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Rodney I Ehrlich
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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9
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Cox A, Piper S, Singh-Grewal D. Pediatric rheumatology consultant workforce in Australia and New Zealand: the current state of play and challenges for the future. Int J Rheum Dis 2016; 20:647-653. [PMID: 26864133 DOI: 10.1111/1756-185x.12802] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM There have been no formal assessments of current levels of the pediatric rheumatology workforce in Australia and New Zealand. Despite this it is felt that we fall well behind international guidelines placing children and adolescents with rheumatic diseases at risk of suboptimal care. Overcoming this shortfall in specialist pediatric rheumatology care requires documentation and recognition of the shortfall and a commitment from the health system to support improvements to supplement the current specialist workforce. The purpose of this survey was to assess the current state of play of the pediatric rheumatology workforce in Australia and New Zealand. METHODS The Australian Paediatric Rheumatology Group (APRG) conducted a survey, which examined the current pediatric rheumatology workforce in Australia and New Zealand. The survey was sent via email link to a survey hosted by Zoomerang™ to 49 physicians known to treat patients with pediatric rheumatic diseases and they were asked to forward the survey to any others who they knew saw children with rheumatic disease. RESULTS Currently there is a shortfall in the pediatric rheumatology workforce of 68% based on minimum requirements and a shortfall of 225% based on an ideal scenario. CONCLUSION Currently in Australia and New Zealand we fail to provide the level of care to children with pediatric rheumatic diseases comparable to other developed health economies worldwide. The current deficiency requires an increase in resource allocation to clinical service and speciality training to overcome this disparity and ensure children in Australia and New Zealand receive internationally recognized standards of care.
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Affiliation(s)
- Angela Cox
- Monash Children's Hospital and The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Sue Piper
- Monash Children's Hospital and The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Davinder Singh-Grewal
- The Sydney Children's Hospital Network, Sydney, Australia.,The John Hunter Children's Hospital, Newcastle, Australia.,The Discipline of Maternal and Child Health, The University of New South Wales, Sydney, Australia.,The School of Paediatrics and Child Health, The University of Sydney, Sydney, NSW, Australia
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10
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O'Sullivan BG, McGrail MR, Joyce CM, Stoelwinder J. Service distribution and models of rural outreach by specialist doctors in Australia: a national cross-sectional study. AUST HEALTH REV 2016; 40:330-336. [DOI: 10.1071/ah15100] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 07/17/2015] [Indexed: 11/23/2022]
Abstract
Objective This paper describes the service distribution and models of rural outreach by specialist doctors living in metropolitan or rural locations. Methods The present study was a national cross-sectional study of 902 specialist doctors providing 1401 rural outreach services in the Medicine in Australia: Balancing Employment and Life study, 2008. Five mutually exclusive models of rural outreach were studied. Results Nearly half of the outreach services (585/1401; 42%) were provided to outer regional or remote locations, most (58%) by metropolitan specialists. The most common model of outreach was drive-in, drive-out (379/902; 42%). In comparison, metropolitan-based specialists were less likely to provide hub-and-spoke models of service (odd ratio (OR) 0.31; 95% confidence interval (CI) 0.21–0.46) and more likely to provide fly-in, fly-out models of service (OR 4.15; 95% CI 2.32–7.42). The distance travelled by metropolitan specialists was not affected by working in the public or private sector. However, rural-based specialists were more likely to provide services to nearby towns if they worked privately. Conclusions Service distribution and models of outreach vary according to where specialists live as well as the practice sector of rural specialists. Multilevel policy and planning is needed to manage the risks and benefits of different service patterns by metropolitan and rural specialists so as to promote integrated and accessible services. What is known about this topic? There are numerous case studies describing outreach by specialist doctors. However, there is no systematic evidence describing the distribution of rural outreach services and models of outreach by specialists living in different locations and the broad-level factors that affect this. What does this paper add? The present study provides the first description of outreach service distribution and models of rural outreach by specialist doctors living in rural versus metropolitan areas. It shows that metropolitan and rural-based specialists have different levels of service reach and provide outreach through different models. Further, the paper highlights that practice sector has no effect on metropolitan specialists, but private rural specialists limit their travel distance. What are the implications for practitioners? The complexity of these patterns highlights the need for multilevel policy and planning approaches to promote integrated and accessible outreach in rural and remote Australia.
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11
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Edirippulige S, Reyno J, Armfield NR, Bambling M, Lloyd O, McNevin E. Availability, spatial accessibility, utilisation and the role of telehealth for multi-disciplinary paediatric cerebral palsy services in Queensland. J Telemed Telecare 2015; 22:391-6. [PMID: 26519377 DOI: 10.1177/1357633x15610720] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/14/2015] [Indexed: 11/16/2022]
Abstract
AIMS The purpose of this study was to understand the methods of current delivery of health care services to cerebral palsy (CP) patients in Queensland, Australia. The study also examines the current use of telehealth by clinicians and their perceptions about telehealth use. METHODS Patient records during July 2013-July 2014 were accessed from the Queensland Paediatric Rehabilitation Service (QPRS) to collect information relating to the service delivery for CP patients. Analysis was carried out to examine the patient locations and travel distances using ArcMap geoprocessing software. In addition, 13 face-to-face semi structured interviews were conducted with clinicians from the QPRS and the Cerebral Palsy Health Service (CPHS) to understand the perceptions of clinicians relating to the current level of health care delivery. We also examined the clinicians' current use of telehealth and their opinions about this method. RESULTS Records of 329 paediatric CP patients were accessed and reviewed. The majority of patients (96%, n = 307) who attended the clinics at the Royal Children's Hospital (RCH), Brisbane, were from remote, rural or regional areas of Queensland. Only 4% of patients (n = 13) were from major cities. During 12 months, patients had attended nine outreach programmes that were conducted by the QPRS and CPHS. The study found that non-local patients were required to travel an average distance of 836 km to access QPRS and CPHS services in Brisbane. The average distance for receiving a consultation at an outreach clinic was 173 km. Clinicians perceived that access to health care services to CP patients in Queensland is inadequate. Nearly all clinicians interviewed had some experience in using telehealth. They had high satisfaction levels with the method. CONCLUSIONS Traditional methods of delivering services to CP patients do not meet their needs. Clinicians have found telehealth is a feasible and satisfactory delivery method. However, the use of telehealth is still limited.
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Affiliation(s)
| | - John Reyno
- Centre for Online Health, The University of Queensland, Australia
| | - Nigel R Armfield
- Centre for Online Health, The University of Queensland, Australia Centre for Children's Health Research, Australia
| | | | - Owen Lloyd
- Lady Cilento Children's Hospital, Australia
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12
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O'Sullivan BG, Stoelwinder JU, McGrail MR. The stability of rural outreach services: a national longitudinal study of specialist doctors. Med J Aust 2015; 203:297. [PMID: 26424065 DOI: 10.5694/mja15.00369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 08/04/2015] [Indexed: 11/17/2022]
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13
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Affiliation(s)
- Iolo Doull
- Regional Cystic Fibrosis Centre, Department of Paediatric Respiratory Medicine, Children's Hospital for Wales, Cardiff, CF14 4XW, UK.
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14
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Pediatric hospital medicine and children with medical complexity: past, present, and future. Curr Probl Pediatr Adolesc Health Care 2012; 42:113-9. [PMID: 22483081 PMCID: PMC3359150 DOI: 10.1016/j.cppeds.2012.01.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 01/16/2012] [Indexed: 11/20/2022]
Abstract
Children with medical complexity, regardless of underlying diagnoses, share similar functional and resource use consequences, including: intensive service needs, reliance on technology, polypharmacy, and/or home care or congregate care to maintain a basic quality of life, high health resource utilization, and, an elevated need for care coordination. The emerging field of complex care is focused on the holistic medical care of these children, which requires both broad general pediatrics skills and specific expertise in care coordination and communication with patients, families, and other medical and non-medical care providers. Many pediatric hospitalists have developed an interest in care coordination for CMC, and pediatric hospitalists are in an ideal location to embrace complex care. As a result of these factors, complex care has emerged as a field with many pediatric hospitalists at the helm, in arenas ranging from clinical care of these patients, research into their care, and education of future providers. The objective of this section of the review article is to outline the past, present, and possible future of children with medical complexity within several arenas in the field of pediatric hospital medicine, including practice management, clinical care, research, education, and quality improvement.
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15
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16
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Cohen E, Jovcevska V, Kuo DZ, Mahant S. Hospital-based comprehensive care programs for children with special health care needs: a systematic review. ACTA ACUST UNITED AC 2011; 165:554-61. [PMID: 21646589 DOI: 10.1001/archpediatrics.2011.74] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To examine the effectiveness of hospital-based comprehensive care programs in improving the quality of care for children with special health care needs. DATA SOURCES A systematic review was conducted using Ovid MEDLINE, CINAHL, EMBASE, PsycINFO, Sociological Abstracts SocioFile, and Web of Science. STUDY SELECTION Evaluations of comprehensive care programs for categorical (those with single disease) and noncategorical groups of children with special health care needs were included. Selected articles were reviewed independently by 2 raters. DATA EXTRACTION Models of care focused on comprehensive care based at least partially in a hospital setting. The main outcome measures were the proportions of studies demonstrating improvement in the Institute of Medicine's quality-of-care domains (effectiveness of care, efficiency of care, patient or family centeredness, patient safety, timeliness of care, and equity of care). DATA SYNTHESIS Thirty-three unique programs were included, 13 (39%) of which were randomized controlled trials. Improved outcomes most commonly reported were efficiency of care (64% [49 of 76 outcomes]), effectiveness of care (60% [57 of 95 outcomes]), and patient or family centeredness (53% [10 of 19 outcomes). Outcomes less commonly evaluated were patient safety (9% [3 of 33 programs]), timeliness of care (6% [2 of 33 programs]), and equity of care (0%). Randomized controlled trials occurred more frequently in studies evaluating categorical vs noncategorical disease populations (11 of 17 [65%] vs 2 of 16 [17%], P = .008). CONCLUSIONS Although positive, the evidence supporting comprehensive hospital-based programs for children with special health care needs is restricted primarily to nonexperimental studies of children with categorical diseases and is limited by inadequate outcome measures. Additional high-quality evidence with appropriate comparative groups and broad outcomes is necessary to justify continued development and growth of programs for broad groups of children with special health care needs.
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Affiliation(s)
- Eyal Cohen
- Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada.
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17
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Stern M, Niemann N, Wiedemann B, Wenzlaff P. Benchmarking improves quality in cystic fibrosis care: a pilot project involving 12 centres. Int J Qual Health Care 2011; 23:349-56. [DOI: 10.1093/intqhc/mzr017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Cohen E, Kuo DZ, Agrawal R, Berry JG, Bhagat SKM, Simon TD, Srivastava R. Children with medical complexity: an emerging population for clinical and research initiatives. Pediatrics 2011; 127:529-38. [PMID: 21339266 PMCID: PMC3387912 DOI: 10.1542/peds.2010-0910] [Citation(s) in RCA: 787] [Impact Index Per Article: 60.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Children with medical complexity (CMC) have medical fragility and intensive care needs that are not easily met by existing health care models. CMC may have a congenital or acquired multisystem disease, a severe neurologic condition with marked functional impairment, and/or technology dependence for activities of daily living. Although these children are at risk of poor health and family outcomes, there are few well-characterized clinical initiatives and research efforts devoted to improving their care. In this article, we present a definitional framework of CMC that consists of substantial family-identified service needs, characteristic chronic and severe conditions, functional limitations, and high health care use. We explore the diversity of existing care models and apply the principles of the chronic care model to address the clinical needs of CMC. Finally, we suggest a research agenda that uses a uniform definition to accurately describe the population and to evaluate outcomes from the perspectives of the child, the family, and the broader health care system.
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Affiliation(s)
- Eyal Cohen
- Division of Pediatric Medicine, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8.
| | - Dennis Z. Kuo
- Center for Applied Research and Evaluation, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Rishi Agrawal
- Division of Hospital Based Medicine, Department of Pediatrics, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ,Section of Chronic Disease, La Rabida Children's Hospital, Chicago, Illinois
| | - Jay G. Berry
- Division of General Pediatrics, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
| | | | - Tamara D. Simon
- Division of Hospital Medicine, Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, Washington; and
| | - Rajendu Srivastava
- Division of Inpatient Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah
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