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Larson IA, Zaniletti I, Gupta R, Wright SM, Winterer C, Toburen C, Williams K, Goodwin EJ, Northup RM, Roderick E, Hall M, Colvin JD. Accuracy of the Exeter Hospitalizations-Office Visits-Medical Conditions-Extra Care-Social Concerns Index for Identifying Children With Complex Chronic Medical Conditions in the Clinical Setting. Acad Pediatr 2023; 23:1553-1560. [PMID: 37516350 DOI: 10.1016/j.acap.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE Our objective was to determine the accuracy of a point-of-care instrument, the Hospitalizations-Office Visits-Medical Conditions-Extra Care-Social Concerns (HOMES) instrument, in identifying patients with complex chronic conditions (CCCs) compared to an algorithm used to identify patients with CCCs within large administrative data sets. METHODS We compared the HOMES to Feudtner's CCCs classification system. Using administrative algorithms, we categorized primary care patients at a children's hospital into 3 categories: no chronic conditions, non-complex chronic conditions, and CCCs. We randomly selected 100 patients from each category. HOMES scoring was completed for each patient. We performed an optimal cut-point analysis on 80% of the sample to determine which total HOMES score best identified children with ≥1 CCC and ≥2 CCCs. Using the optimal cut points and the remaining 20% of the study population, we determined the odds and area under the curve (AUC) of having ≥1 CCC and ≥2 CCCs. RESULTS The median (interquartile range [IQR]) age was 4 (IQR: 0, 8). Using optimal cut points of ≥7 for ≥1 CCC and ≥11 for ≥2 CCCs, the odds of having ≥1 CCC was 19 times higher than lower scores (odds ratio [OR] 19.1 [95% confidence interval [CI]: 9.75, 37.5]) and of having ≥2 CCCs was 32 times higher (OR 32.3 [95% CI: 12.9, 50.6]). The AUCs were 0.76 for ≥1 CCC (sensitivity 0.82, specificity 0.80) and 0.74 for ≥2 CCCs (sensitivity 0.92, specificity 0.74). CONCLUSIONS The HOMES accurately identified patients with CCCs.
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Affiliation(s)
- Ingrid A Larson
- Administration (IA Larson), Children's Mercy Hospital Kansas, Overland Park
| | - Isabella Zaniletti
- Analytics, Children's Hospital Association (I Zaniletti and M Hall), Kansas City, Kans
| | - Rupal Gupta
- Department of Pediatrics (R Gupta, SM Wright, C Winterer, C Toburen, K Williams, EJ Goodwin, RM Northup, E Roderick, M Hall, and JD Colvin), Children's Mercy Kansas City, Mo
| | - S Margaret Wright
- Department of Pediatrics (R Gupta, SM Wright, C Winterer, C Toburen, K Williams, EJ Goodwin, RM Northup, E Roderick, M Hall, and JD Colvin), Children's Mercy Kansas City, Mo
| | - Courtney Winterer
- Department of Pediatrics (R Gupta, SM Wright, C Winterer, C Toburen, K Williams, EJ Goodwin, RM Northup, E Roderick, M Hall, and JD Colvin), Children's Mercy Kansas City, Mo
| | - Cristy Toburen
- Department of Pediatrics (R Gupta, SM Wright, C Winterer, C Toburen, K Williams, EJ Goodwin, RM Northup, E Roderick, M Hall, and JD Colvin), Children's Mercy Kansas City, Mo
| | - Kristi Williams
- Department of Pediatrics (R Gupta, SM Wright, C Winterer, C Toburen, K Williams, EJ Goodwin, RM Northup, E Roderick, M Hall, and JD Colvin), Children's Mercy Kansas City, Mo
| | - Emily J Goodwin
- Department of Pediatrics (R Gupta, SM Wright, C Winterer, C Toburen, K Williams, EJ Goodwin, RM Northup, E Roderick, M Hall, and JD Colvin), Children's Mercy Kansas City, Mo
| | - Ryan M Northup
- Department of Pediatrics (R Gupta, SM Wright, C Winterer, C Toburen, K Williams, EJ Goodwin, RM Northup, E Roderick, M Hall, and JD Colvin), Children's Mercy Kansas City, Mo
| | - Edie Roderick
- Department of Pediatrics (R Gupta, SM Wright, C Winterer, C Toburen, K Williams, EJ Goodwin, RM Northup, E Roderick, M Hall, and JD Colvin), Children's Mercy Kansas City, Mo
| | - Matt Hall
- Analytics, Children's Hospital Association (I Zaniletti and M Hall), Kansas City, Kans; Department of Pediatrics (R Gupta, SM Wright, C Winterer, C Toburen, K Williams, EJ Goodwin, RM Northup, E Roderick, M Hall, and JD Colvin), Children's Mercy Kansas City, Mo
| | - Jeffrey D Colvin
- Department of Pediatrics (R Gupta, SM Wright, C Winterer, C Toburen, K Williams, EJ Goodwin, RM Northup, E Roderick, M Hall, and JD Colvin), Children's Mercy Kansas City, Mo.
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Tucker MH, Toburen C, Koons T, Petrini C, Palmer R, Pallotto EK, Simpson E. Improving safe sleep practices in an urban inpatient newborn nursery and neonatal intensive care unit. J Perinatol 2022; 42:515-521. [PMID: 34987167 DOI: 10.1038/s41372-021-01288-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/19/2021] [Accepted: 11/25/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To improve safe sleep compliance in a newborn nursery (NN) and neonatal intensive care unit (NICU) to >80% in 1 year. STUDY DESIGN Prospective quality improvement study of infants admitted to a NN and NICU. Interventions were targeted at parent education, staff education, and system processes. RESULTS Compliance with safe sleep improved to >80% in both units. Tracking of process measures revealed NICU parents received safe sleep education 98-100% of the time. No change was observed in the balancing measures. Transfers from the NN to the NICU for temperature instability did not increase. Parent satisfaction with discharge preparedness did not change (98.2% prior to and 99.6% after). CONCLUSION We achieved improved compliance with safe sleep practices in our NN and NICU through education of staff and parents and improved system processes. We believe this will translate to improved safe sleep practices used by parents at home.
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Affiliation(s)
- Megan H Tucker
- Division of Neonatology, Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, MO, United States.
| | - Cristy Toburen
- General Academic Pediatrics, Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Trudy Koons
- Division of Neonatology, Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Carol Petrini
- Department of Neonatology, Truman Medical Center, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Rebecca Palmer
- Division of Neonatology, Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, MO, United States.,Department of Neonatology, Children's Medical Center, Dallas, TX, United States
| | - Eugenia K Pallotto
- Division of Neonatology, Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, MO, United States.,Department of Neonatology, Levine Children's Hospital, Atrium Health, Charlotte, NC, United States
| | - Elizabeth Simpson
- Division of Neonatology, Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, MO, United States
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