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Sakamoto M, Ishikawa H, Suzuki A. Evaluation of Parents' Use of a Child Health Care Information App and Their Health Literacy: Cross-Sectional Study. JMIR Pediatr Parent 2024; 7:e48478. [PMID: 38623727 PMCID: PMC11034361 DOI: 10.2196/48478] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 04/17/2024] Open
Abstract
Background Recently, digital media, including internet websites and smartphone apps, have become popular resources for parents in searching for child health care information. Higher health literacy among parents in obtaining adequate health care information and making proper decisions may lead to improved child health outcomes and a reduction in the burden on health care professionals. However, few studies have examined the association between the provision of child health care information apps and parents' health literacy. Objective This study aims to evaluate whether parents' use of an app that provides child health care information is associated with their health care knowledge, their health literacy, and emergency room visits for their children. Methods Participants were recruited during checkups for their 1.5-year-old children at health centers within Saku City in 2022. Parents who agreed to participate were included in this study; individuals were excluded if they were not the mother or father of the child or did not have a smartphone. Participants were asked if they had used the Oshiete-Doctor app, which was distributed by Saku City free of charge to improve the home nursing skills of parents and guardians. Sociodemographic data of parents and children, data on health care knowledge about children, data on the frequency of emergency room visits in the past 6 months, and health literacy scores (HLSs) of parents (measured with the HLS-EU-Q47 [European Health Literacy Survey Questionnaire]) were collected from participants in this cross-sectional survey. Univariable and multivariable analyses were conducted to examine the associations of app use with health care knowledge, health literacy, and emergency room visits. Results In total, 251 respondents completed the survey (response rate: 251/267, 94%). Although the proportion of health care workers was significantly higher among app users than among non-app users (P=.005), no other participant attributes were significantly associated with the use of the app. The proportions of participants with higher health care knowledge and participants with higher total HLSs were significantly higher among app users than among non-app users (P=.001 and P=.003, respectively). After adjusting for potentially confounding covariates, these proportions were still significantly higher among app users than among non-app users (P=.02 and P=.007, respectively). Emergency room visits were significantly more frequent among app users than among non-app users (P=.007) in the univariable analysis, but the association was not significant (P=.07) after adjusting for sociodemographic variables. Conclusions This study showed a significant association between parents' use of a child health care information app and higher child health care knowledge and health literacy. The use of the app may lead to more appropriate health decisions and behaviors in children's health care. Future studies are needed to evaluate the association between app use and emergency room visits.
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Affiliation(s)
| | - Hirono Ishikawa
- Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Asuka Suzuki
- Teikyo University Graduate School of Public Health, Tokyo, Japan
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Tseng Y, Lin Y, Hsu W, Kang Y, Su H, Cheng S, Tsai J, Chiu T, Huang H. Shared decision making with Oncologists and Palliative care specialists (SOP) model help advanced pancreatic cancer patients reaching goal concordant care: A prospective cohort study. Cancer Med 2023; 12:20119-20128. [PMID: 37740620 PMCID: PMC10587919 DOI: 10.1002/cam4.6590] [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] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Pancreatic cancer is often diagnosed at a late stage with a poor prognosis due to insidious symptoms and lack of evidence-based screening in general population. Palliative care's acceptance in Asian cultures is hindered by misconceptions and ineffective communication about management that improve quality of life other than cancer directed treatment. Our study aimed to determine the effect of the Shared decision-making with Oncologists and Palliative care specialists (SOP) model developed from the traditional shared decision-making (SDM) model on the palliative care acceptance rate and medical resource utilization. METHODS This is a prospective cohort study implementing the SOP model at the National Taiwan University Hospital from January 2018 to December 2019 for patients with advanced pancreatic cancer. Medical resource utilization was defined and recorded as the rate of hospitalization, emergency room (ER), and intensive care unit admissions. We compared the results between two groups: patients who received the SOP model in 2019 and patients who did not receive it in 2018. RESULTS 137 patients with advanced pancreatic cancer were included in our study. The result showed that the acceptance rate of palliative care significantly increased from 50% to 78.69% after the SOP model (p = 0.01). The hospitalization rate did not show a significant difference between 2018 (93.42%, 95% CI: 0.88-0.99) and 2019 (93.44%, 95% CI: 0.87-1.00). 83.61% (95% CI: 0.74-0.93) of our patients in 2019 had at least one ER visit; the rate was 81.5% (95% CI: 0.73-0.91) in 2018 (p = 0.28). The percentage of patients admitted to the ICU increased from 3.95% in 2018 to 8.2% (95% CI: -0.05-0.08) in 2019 (95% CI: 0.11-0.15) (p = 0.00). The hospitalization and ER visit showed no statistically difference between 2 years. CONCLUSIONS The modified SOP model markedly augmented palliative care's acceptance of patients with advanced pancreatic cancer. Adoption of the SOP model would provide these patients a more proactive and systematic approach to deliver needed healthcare.
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Affiliation(s)
- Yung‐Ling Tseng
- Department of EducationKuang Tien General HospitalTaichungTaiwan
| | - Yun‐Ching Lin
- Cancer Administration and Coordination centerNational Taiwan University HospitalTaipei cityTaiwan
| | - Wan‐Ju Hsu
- Cancer Administration and Coordination centerNational Taiwan University HospitalTaipei cityTaiwan
- Department of NursingNational Taiwan University HospitalTaipei cityTaiwan
| | - Ya‐Chun Kang
- Cancer Administration and Coordination centerNational Taiwan University HospitalTaipei cityTaiwan
| | - Hsin‐Yin Su
- Cancer Administration and Coordination centerNational Taiwan University HospitalTaipei cityTaiwan
| | - Shao‐Yi Cheng
- Department of Family MedicineNational Taiwan University HospitalTaipei cityTaiwan
| | - Jaw‐Shiun Tsai
- Department of Family MedicineNational Taiwan University HospitalTaipei cityTaiwan
| | - Tai‐Yuan Chiu
- Department of Family MedicineNational Taiwan University HospitalTaipei cityTaiwan
| | - Hsien‐Liang Huang
- Department of Family MedicineNational Taiwan University HospitalTaipei cityTaiwan
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Kim JH, Seo S, Kim JH, Koh SJ, Ahn Y, Jung KH, Ahn JH, Kim SB, Kim TW, Hong YS, Kim SY, Kim JE, Kim SW, Lee DH, Lee JC, Choi CM, Yoon S, Jeong JH, Kim HJ, Suh KJ, Kim SH, Kim YJ, Min YJ, Baek JH, Park SR. The impact of systematic assessment for adverse events on unscheduled hospital utilization in patients receiving neoadjuvant or adjuvant chemotherapy: A retrospective multicenter study. Cancer Med 2021; 11:705-714. [PMID: 34889062 PMCID: PMC8817089 DOI: 10.1002/cam4.4476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 10/24/2021] [Accepted: 11/14/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND This study was conducted to compare the reported adverse event (AE) profiles and unexpected use of medical services during chemotherapy between before and after the healthcare reimbursement of AE evaluation in patients with cancer. PATIENTS AND METHODS Using the electronic medical record database system, extracted patients with breast, lung, gastric, and colorectal cancers receiving neoadjuvant or adjuvant chemotherapy between September 2013 and December 2016 at four centers in Korea were matched using the 1:1 greedy method: pre-reimbursement group (n = 1084) and post-reimbursement group (n = 1084). Unexpected outpatient department (OPD), emergency room (ER) visit, hospitalization rates, and chemotherapy completion rates were compared between the groups. RESULTS The baseline characteristics were well-balanced between the groups. By chemotherapy cycle, hospitalization (1.8% vs. 2.3%; p = 0.039), and ER visit rates (3.3% vs. 3.9%; p = 0.064) were lower in the post-reimbursement group than that in the pre-reimbursement group. In particular, since cycle 2, ER visit and hospitalization rates were significantly lower in the post-reimbursement group than those in the pre-reimbursement group (2.6% vs. 3.3%; p = 0.020 and 1.4% vs. 2.0%; p = 0.007, respectively), although no significant differences were observed during cycle 1. The OPD visit rates were similar between both groups, regardless of cycles. The post-reimbursement group had a higher proportion of patients who completed chemotherapy as planned than the pre-reimbursement group (93.5% vs. 90.1%; p = 0.006). Post-reimbursement group had more AEs reported, including alopecia, fatigue, diarrhea, anorexia, and peripheral neuropathy, during cycle 1 than the pre-reimbursement group, which significantly decreased after cycle 2. CONCLUSION The introduction of healthcare reimbursement for AE evaluation may help physicians capture and appropriately manage AEs, consequently, decreasing hospital utilization and increasing chemotherapy completion rates.
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Affiliation(s)
- Jwa Hoon Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Division of Oncology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seyoung Seo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jee Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Su-Jin Koh
- Division of Hematology and Oncology, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Yongchel Ahn
- Department of Hematology and Oncology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung-si, Republic of Korea
| | - Kyung Hae Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin-Hee Ahn
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Bae Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tae Won Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong Sang Hong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sun Young Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Eun Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-We Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dae Ho Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Cheol Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang-Min Choi
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Shinkyo Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Ho Jeong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hwa Jung Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Koung Jin Suh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Se Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Young Joo Min
- Division of Hematology and Oncology, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Jin Ho Baek
- Department of Oncology/Hematology, Kyungpook National Universtiy Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Sook Ryun Park
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Chudy-Onwugaje K, Mamunes AP, Schwartz DA, Horst S, Cross RK. Predictors of High Health Care Utilization in Patients With Inflammatory Bowel Disease Within 1 Year of Establishing Specialist Care. Inflamm Bowel Dis 2020; 27:325-335. [PMID: 32488231 PMCID: PMC7885330 DOI: 10.1093/ibd/izaa070] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND A small proportion of patients with inflammatory bowel disease (IBD) consume a disproportionate amount of health care resources, with most of these spent on unplanned care in emergency room (ER) and hospital visits. Interventions in those at high risk in the outpatient setting could reduce the need for future inpatient care. We sought to describe the characteristics predictive of high health care utilization within 1 year after an initial IBD clinic encounter. METHODS This was a retrospective study of new IBD patients seen at the outpatient clinics of 2 tertiary IBD centers in the United States. Baseline sociodemographic and clinical characteristics were collected, and the number of IBD-related ER and hospital visits were recorded over the 1-year period after the initial clinic encounter. Patients with ≥2 visits (high utilizers) were compared with those with no visits. RESULTS Of the 735 patients included in the final analysis, 106 (14.4%) were high utilizers, and they had a mean of 2.9 visits (maximum = 10) in the 1 year after their initial encounter. In multivariate analysis, insurance coverage through medical assistance (odds ratio [OR] 3.57; 95% confidence interval [CI], 1.38-9.20), steroid use (OR 1.83; 95% CI, 1.11-3.04), short inflammatory bowel disease questionnaire score <50 (OR 2.29; 95% CI, 1.23-4.27), and current ostomy (OR 4.82; 95% CI, 1.51-15.37) were independently associated with high utilization. CONCLUSIONS Multidisciplinary care and resources should be preferentially channeled towards new clinic patients with severe disease and on medical assistance, as this could reduce future inpatient visits and result in cost savings.
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Affiliation(s)
- Kenechukwu Chudy-Onwugaje
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | | | - David A Schwartz
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University, Nashville, TN
| | - Sara Horst
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University, Nashville, TN
| | - Raymond K Cross
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD,Address correspondence to: Raymond K. Cross, MD, MS, 685 West Baltimore Street, Suite 8-00, Baltimore, MD 21201, USA. E-mail:
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Alsuhebani M, Walia H, Miller R, Elmaraghy C, Tumin D, Tobias JD, Raman VT. Overnight inpatient admission and revisit rates after pediatric adenotonsillectomy. Ther Clin Risk Manag 2019; 15:689-699. [PMID: 31239691 PMCID: PMC6560194 DOI: 10.2147/tcrm.s185193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 03/31/2019] [Indexed: 11/28/2022] Open
Abstract
Objective: Overnight admission may be necessary following adenotonsillectomy (T&A) in pediatric patients. This practice may reduce unplanned revisits following hospital discharge. Study design: Retrospective cohort study. Subjects: Children from the PHIS database. Methods: T&A performed in children during the years 2007–2015 were identified in the Pediatric Health Information System. The primary outcome was 7-day, all-cause readmission or emergency department (ED) revisit. Secondary analysis examined specific revisit types and 30-day revisits. The primary exposure was each institution’s annual rate of overnight stay after T&A. Results: The analysis included 411,876 procedures at 48 hospitals. Hospitals’ annual rates of overnight stay following T&A ranged from 3% to 100%, and 7-day revisit rates varied from 0% to 15%. The percentage or rate of 7-day revisits did not differ based on the use of overnight stay following T&A. At hospitals with higher overnight admission rates after T&A, 7-day revisits were more likely to take the form of inpatient admission rather than an ED visit. Conclusions: The current study confirms that pediatric hospitals vary widely in inpatient admission practices following T&A. This variation is not associated with differences in revisit rates at 7 and 30 days related to any cause. Although no mortality was noted in the current study, caution is suggested when deciding on the disposition of patients with comorbid conditions as risks related to various patients, anesthetic, and surgical-related issues exist. Risk stratification with appropriate identification of patients requiring overnight stay may be the most important for preventing acute care revisits after T&A.
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Affiliation(s)
- Mohammad Alsuhebani
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Hina Walia
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Rebecca Miller
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Charles Elmaraghy
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Ear, Nose & Throat Surgery, The Ohio State University, Columbus, OH, USA
| | - Dmitry Tumin
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology, The Ohio State University, Columbus, OH, USA
| | - Vidya T Raman
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology, The Ohio State University, Columbus, OH, USA
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Luo FY, Crawford S, Drouin O, Chadha R. Can we predict and prevent emergency department visits for postpartum hypertensive complications in patients with hypertensive disorders in pregnancy? J Matern Fetal Neonatal Med 2018; 33:2241-2245. [PMID: 30415592 DOI: 10.1080/14767058.2018.1547703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Hypertensive disorders of pregnancy are major causes of maternal mortality and morbidity, and postpartum hypertensive complications have significant implications on maternal health and public health care system. Antepartum community care programs for hypertension are in place at major centers of Canada, however, such a program for postpartum are usually lacking, and could be a cost-effective solution to reduce postpartum hypertensive complications.Objectives: To assess the proportion of women who present to the emergency department (ED) or outpatient clinics for postpartum hypertensive (PPHTN) complications up to 6 weeks postpartum, among pregnancies complicated by antenatal hypertensive disorders in Calgary, Canada. Secondary objectives were to identify risk factors for PPHTN complications, and to perform a cost-benefit analysis to support postpartum community care program (PCCP) as a way to decrease ED and clinic visits for PPHTN complications, and thus has a favorable economic impact on the public health care system.Study design: Retrospective cohort study using administrative databases, followed by chart review of ED visits to confirm diagnoses and estimate cost of visits and admissions. The participants were women followed by the Calgary Antenatal Community Care Program (ACCP) for hypertensive disorders, from 2014 to 2015, inclusive. The primary outcome was ED or clinic visit associated with an outpatient database record of hypertensive disorder diagnosis, within 42 days postpartum.Results: Among 319 deliveries included in the study, 30 women (9.4, 95%CI: 6.2-12.6%) visited ED or clinics for PPHTN. We identified multiple antihypertensive medication uses and abnormal postpartum gestational hypertension labs as risk factors for ED visit among these women. We estimate a CAD$152 per antenatal hypertensive patient cost benefit for PCCP.Conclusion: The proposed PCCP appears to have an economic benefit to health care system with a decrease in ED and clinic visits. Further studies with greater sample size could strengthen the findings in this study.
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Affiliation(s)
- Fang Yuan Luo
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Susan Crawford
- Alberta Perinatal Health Program, Alberta Health Services, Calgary, Canada
| | - Olivier Drouin
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Rati Chadha
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Canada
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