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Russell TL, Tiusaba L, Smith JC, Alexander R, Mahlet Q, Ho CP, Pohl HG, Varda BK. Getting to the bottom of why children with spina bifida use the emergency department: A qualitative analysis of parent and stakeholder perspectives. J Pediatr Urol 2024:S1477-5131(24)00265-1. [PMID: 38802289 DOI: 10.1016/j.jpurol.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Children with Spina Bifida (SB) have considerable healthcare utilization, including Emergency Department use (EDU). We aimed to elicit reasons for EDU using qualitative analysis of interviews with both patient-caregiver dyads and stakeholders. METHODS A cohort of children with SB followed at our institution between 2016 and 2020 was identified and patient and clinical characteristics abstracted. Purposeful sampling by age and degree of past EDU was performed. Semi-structured interviews of dyads were performed using iteratively revised interview guides. Spanish-language interviews were conducted by a native Spanish speaker and transcripts professionally translated. Supplemental interviews with stakeholders, namely knowledgeable healthcare professionals, were also conducted. A qualitative framework approach was used for analysis, including open followed by closed independent coding with calculation of inter-rater reliability. A final interpretation of coding reports assessing convergence, divergence, and variation in themes across participant characteristics. RESULTS 116 families (4 Spanish-speaking) and 7 stakeholders were interviewed. Sampling yielded a heterogenous cohort for EDU (56% with 0-10, 44% with >10 visits) and age (25% 0-4, 44% 5-11, 31% > 11 years). IRR was optimal (κ = 0.9). Themes in perceived reasons for EDU were 1) desire for "one-stop-shop" care, 2) an emergent medical problem, 3) providers' instructions, 4) negative past healthcare experience, 5) intrinsic caregiver moderators, and 6) temporospatial influences. Themes 1, 2, and 5 predominated in dyads, whereas themes 6, 3, and 5 were most common in stakeholders. Stakeholders focused largely on negative institutional and patient characteristics. Among dyads only, theme #1 was disproportionately emphasized by Spanish-speaking patients. DISCUSSION Families desired access to coordinated expert care, testing and imaging. The ED offers this for children with SB, regardless of clinical acuity. This may be especially valued by families with inherent challenges to navigating the healthcare system. Negative experiences in community clinical settings, healthcare provider recommendations and intrinsic parental factors were themes that seemed to contribute to seeking this "one-stop-shop" type of care. Care coordination may reduce ED reliance, but themes for the interviews suggest a systems-based efforts should weave in the community care setting. CONCLUSIONS For both stakeholders and caregivers, the ED represented a valued form of immediate access to multispecialty, expert care and testing in the context of perceived lack of timely, coordinated outpatient care. This may be moderated by intrinsic caregiver factors and negative past experiences. Although stakeholders discussed ideas that fit into patient-caregiver themes, the also uniquely focused on systems-based and patient-caregiver limitations.
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Affiliation(s)
- Teresa L Russell
- Division of Urology, Children's National Hospital, Washington, DC, USA; Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, DC, USA
| | - Laura Tiusaba
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, DC, USA
| | - Jacob C Smith
- Division of Urology, Children's National Hospital, Washington, DC, USA
| | - Rachel Alexander
- Division of Urology, Children's National Hospital, Washington, DC, USA
| | - Qene Mahlet
- Division of Urology, Children's National Hospital, Washington, DC, USA
| | - Christina P Ho
- Division of Urology, Children's National Hospital, Washington, DC, USA
| | - Hans G Pohl
- Division of Urology, Children's National Hospital, Washington, DC, USA
| | - Briony K Varda
- Division of Urology, Children's National Hospital, Washington, DC, USA.
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Kucherov V, Russell T, Smith J, Zimmermann S, Johnston EK, Rana MS, Hill E, Ho CP, Pohl HG, Varda BK. Antibiotic Overtreatment of Presumed Urinary Tract Infection among Children with Spina Bifida. J Pediatr 2024:114092. [PMID: 38734134 DOI: 10.1016/j.jpeds.2024.114092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 04/26/2024] [Accepted: 05/05/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE To identify factors associated with overtreatment of presumed urinary tract infection (UTI) among children with spina bifida using such criteria. STUDY DESIGN A retrospective review of children with spina bifida (age < 21 years) evaluated in the Emergency Department (ED) at a single institution was performed. Patients with a urinalysis (UA) performed who were reliant on assisted bladder emptying were included. The primary outcome was overtreatment, defined as receiving antibiotics for presumed UTI but ultimately not meeting spina bifida UTI criteria (≥ 2 urologic symptoms plus pyuria and urine culture growing >100k CFU/mL). The primary exposure was whether the components of the criteria available at the time of the ED visit (≥ 2 urologic symptoms plus pyuria) were met when antibiotics were initiated. RESULTS Among 236 ED encounters, overtreatment occurred in 80% of cases in which antibiotics were initiated (47% of the entire cohort). Pyuria with <2 urologic symptoms was the most important factor associated with overtreatment (OR 9.6). Non-Hispanic White race was associated with decreased odds of overtreatment (OR 0.3). CONCLUSIONS Overtreatment of presumed UTI among patients with spina bifida was common. Pyuria, which is not specific to UTI in this population, was the main driver of overtreatment. Symptoms are a cornerstone of UTI diagnosis among children with spina bifida, should be collected in a standardized manner, and considered in a decision to treat.
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Ong KS, Reeder M, Alriksson-Schmidt AI, Rice S, Feldkamp ML. Parents' report on the health care management of spina bifida in early childhood. J Pediatr Rehabil Med 2022; 15:621-631. [PMID: 36530103 PMCID: PMC10964179 DOI: 10.3233/prm-220027] [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] [Indexed: 12/15/2022] Open
Abstract
PURPOSE This study aimed to describe health care use by type of health providers and care settings visited by children with spina bifida (SB) and to compare this use between children with and without a shunt. METHODS Health care use data were extracted from a larger study on the health and functioning of children with SB aged 3-6 years. The present study focused on the medical information subsection of a parent-reported survey related to SB care, general care, specialty care (e.g., neurosurgery), emergency care, and complications related to SB and shunts. RESULTS Parents of 101 children with SB participated. Most of the children were male with myelomeningocele and had a shunt. They visited a health care provider for SB care an average of 7.4 times and a specialist an average of 11.9 times in the previous 12 months. Most visited a multidisciplinary clinic for SB-related care and a private physician's office for general care. Children with a shunt had more SB-related medical visits, more visits to a specialist, and a greater number of different types of specialists than those without it. Frequency of emergency room visits did not differ between the two groups. Health providers informed parents about headaches, vomiting, and fever as signs of complications, and some parents did report shunt-related complications. CONCLUSION SB is a complex medical condition requiring that children receive medical care from various medical specialists, especially for children with a shunt. Findings on health care use suggest high levels of monitoring and care coordination that parents navigate to care for their child.
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Affiliation(s)
- Katherine S. Ong
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew Reeder
- Department of Pediatrics, Division of Medical Genetics, University of Utah, Salt Lake City, UT, USA
| | - Ann I. Alriksson-Schmidt
- Orthopedics, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Sydney Rice
- Department of Pediatrics, University of Arizona, Tucson, AZ, USA
| | - Marcia L. Feldkamp
- Department of Pediatrics, Division of Medical Genetics, University of Utah, Salt Lake City, UT, USA
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Loftus CJ, Ahn J, Rice-Townsend S, Avansino J, Schmidt J, Hagedorn JC, Wood R, Shnorhavorian M, Fuchs MD, McCracken KA, Hewitt G, Amies-Oelschlager AME, Merguerian P, Smith CA. Experiences and attitudes of young adults with congenital bowel and bladder conditions. J Pediatr Urol 2021; 17:701.e1-701.e8. [PMID: 34217590 DOI: 10.1016/j.jpurol.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 05/07/2021] [Accepted: 06/11/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Young adults with complex congenital bowel and bladder anomalies are a vulnerable population at risk for poor health outcomes. Their experiences with the healthcare system and attitudes towards their health are understudied. OBJECTIVE Our objective was to describe how young adults with congenital bladder and bowel conditions perceive their current healthcare in the domains of bladder and bowel management, reproductive health, and transition from pediatric to adult care. STUDY DESIGN At a camp for children with chronic bowel and bladder conditions, we offered a 50-question survey to the 62 adult chaperones who themselves had chronic bowel and bladder conditions. Of the 51 chaperones who completed the survey (a response rate of 82%), 30 reported a congenital condition and were included. RESULTS The cohort of 30 respondents had a median age of 23 years and almost half of the subjects (46%) reported not having transitioned into adult care. Most reported bowel (81%) and bladder (73%) management satisfaction despite high rates of stool accidents (85%), urinary accidents (46%), and recurrent urinary tract infections (70%). The majority of respondents (90%) expressed interest in having a reproductive health provider as part of their healthcare team. The median ages of the first conversation regarding transition to adult care and feeling confident in managing self-healthcare were 18 and 14 years, respectively. Most (85%) reported feeling confident in navigating the medical system. DISCUSSION In this cohort of young adults who reported confidence with self-care and navigating the medical system, the proportion who had successfully transitioned into to adult care was low. These data highlight the need for improved transitional care and the importance of patient-provider and provider-provider communication throughout the transition process. CONCLUSION These data highlight the need to understand the experience of each individual patient in order to provide care that aligns with their goals.
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Affiliation(s)
- Christopher J Loftus
- University of Washington, Department of Urology, 1959 NE Pacific St, Seattle, WA, 98195, USA.
| | - Jennifer Ahn
- Seattle Children's Hospital, Department of Pediatric Urology, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Sam Rice-Townsend
- Seattle Children's Hospital, Department of Pediatric Surgery, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Jeffrey Avansino
- Seattle Children's Hospital, Department of Pediatric Surgery, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Jackson Schmidt
- University of Washington, Department of Urology, 1959 NE Pacific St, Seattle, WA, 98195, USA.
| | - Judith C Hagedorn
- University of Washington, Department of Urology, 1959 NE Pacific St, Seattle, WA, 98195, USA.
| | - Richard Wood
- Nationwide Children's Hospital, Department of Pediatric Colorectal & Pelvic Reconstructive Surgery, 700 Children's Dr, Columbus, OH, 43205, USA.
| | - Margarett Shnorhavorian
- Seattle Children's Hospital, Department of Pediatric Urology, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Molly D Fuchs
- Nationwide Children's Hospital, Department of Pediatric Urology, 700 Children's Dr, Columbus, OH, 43205, USA.
| | - Katherine A McCracken
- Nationwide Children's Hospital, Department of Pediatric & Adolescent Gynecology & Obstetrics, 700 Children's Dr, Columbus, OH, 43205, USA.
| | - Geri Hewitt
- Nationwide Children's Hospital, Department of Pediatric & Adolescent Gynecology & Obstetrics, 700 Children's Dr, Columbus, OH, 43205, USA.
| | - Anne-Marie E Amies-Oelschlager
- Seattle Children's Hospital, Department of Pediatric and Adolescent Gynecology, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Paul Merguerian
- Seattle Children's Hospital, Department of Pediatric Urology, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Caitlin A Smith
- Seattle Children's Hospital, Department of Pediatric Surgery, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
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Rague JT, Kim S, Hirsch JA, Meyer T, Rosoklija I, Larson JE, Swaroop VT, Bowman RM, Bowen DK, Cheng EY, Gordon EJ, Chu DI, Isakova T, Yerkes EB, Chu DI. Assessment of Health Literacy and Self-reported Readiness for Transition to Adult Care Among Adolescents and Young Adults With Spina Bifida. JAMA Netw Open 2021; 4:e2127034. [PMID: 34581795 PMCID: PMC8479582 DOI: 10.1001/jamanetworkopen.2021.27034] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Health literacy has been shown to play an important role in transitions of care in adult populations, with low health literacy associated with adverse health outcomes. The role of health literacy in the transition from pediatric to adult care has been less well studied. Among adolescents and young adults with spina bifida, high rates of unsuccessful transition have been shown, but how patient health literacy affects transition readiness remains unknown. OBJECTIVE To determine whether health literacy is associated with transition readiness in adolescents and young adults with spina bifida. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study involved collection of patient-reported questionnaires between June 2019 and March 2020 at a multidisciplinary spina bifida center at a single, free-standing children's hospital. Patient demographic and clinical characteristics were obtained from medical record review. Patients were aged 12 years or older with a diagnosis of spina bifida (myelomeningocele and nonmyelomeningocele) whose primary language was English or Spanish. Data analysis was performed from October 2020 to March 2021. EXPOSURES Health literacy as assessed by the Brief Health Literacy Screening Tool. MAIN OUTCOMES AND MEASURES The primary outcome was total Transition Readiness Assessment Questionnaire (TRAQ) score, normalized into units of SD. Nested, multivariable linear regression models assessed the association between health literacy and TRAQ scores. RESULTS The TRAQ and Brief Health Literacy Screening Tool were completed by 200 individuals (median [range] age, 17.0 [12.0-31.0] years; 104 female participants [52.0%]). Most of the patients were younger than 18 years (110 participants [55.0%]) and White (136 participants [68.0%]) and had myelomeningocele (125 participants [62.5%]). The mean (SD) TRAQ score was 3.3 (1.1). Sixty-six participants (33.0%) reported inadequate health literacy, 60 participants (30.0%) reported marginal health literacy, and 74 participants (37.0%) reported adequate health literacy. In univariable analysis, health literacy, age, type of spina bifida, level of education, self-administration vs completion of the questionnaires with assistance, ambulatory status, and urinary incontinence were associated with total TRAQ score. In all nested, sequentially adjusted, multivariable models, higher health literacy remained a significant, stepwise, independent variable associated with higher TRAQ score. In the fully adjusted model, having adequate compared with inadequate health literacy was associated with an increase in normalized TRAQ score of 0.49 SD (95% CI, 0.19-0.79). CONCLUSIONS AND RELEVANCE Patient-reported transition readiness is associated with health literacy, even after adjustment for education level and other demographic and clinical factors. Developing and implementing health literacy-sensitive care programs during the transition process may improve patient transition readiness.
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Affiliation(s)
- James T. Rague
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Soojin Kim
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Josephine A. Hirsch
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Theresa Meyer
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Ilina Rosoklija
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Jill E. Larson
- Division of Orthopedic Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Vineeta T. Swaroop
- Division of Orthopedic Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Robin M. Bowman
- Division of Neurosurgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Diana K. Bowen
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Earl Y. Cheng
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Elisa J. Gordon
- Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel I. Chu
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham
| | - Tamara Isakova
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth B. Yerkes
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - David I. Chu
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Shobeiri P, Presedo A, Karimi A, Momtazmanesh S, Vosoughi F, Nabian MH. Orthopedic management of myelomeningocele with a multidisciplinary approach: a systematic review of the literature. J Orthop Surg Res 2021; 16:494. [PMID: 34389028 PMCID: PMC8361640 DOI: 10.1186/s13018-021-02643-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Myelomeningocele (MMC) is the most common and severe form of spina bifida and imposes a significant burden on patients and the healthcare system. Recently, the multidisciplinary management of MMC has become popular. Herein, we aimed to review the orthopedic management, outcomes, and complications of the of patients with MMC eyeing a multidisciplinary approach. Methods We searched PubMed and EMBASE to find relevant studies published before August 2020. All studies that included clinical management of MMC patients and published earlier than 2000 were considered for review on the condition that they reported at least one orthopedic intervention and the rate of complications. We excluded review articles, case reports, case series, letters, commentaries, editorials, and conference abstracts. The primary and secondary goals of our review were to report the outcomes and complication rates of multidisciplinary management for MMC patients. Results Twenty-six studies included data for the management of 229,791 patients with MMC and were selected. Sixteen studies reported multidisciplinary management in addition to orthopedic management. From those, 11 (42.31%) included urologic management, 13 (50%) neurosurgical management, 11 (42.31%) neurologic management, and 5 (19.23%) gastrointestinal management. All studies included postnatal operations and related management. No randomized clinical trial was found in our search. Conclusion Orthopedic approaches play a key role in MMC management by alleviating spinal deformities, particularly scoliosis, and hip, foot, and ankle complications. However, the most appropriate management, whether surgical or non-surgical, may vary for different patients, given disease severity and the age of patients. Graphical abstract ![]()
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Affiliation(s)
- Parnian Shobeiri
- School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ana Presedo
- Department of Pediatric Orthopedics, Hôpital Robert Debre, Paris, France
| | - Amirali Karimi
- School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Sara Momtazmanesh
- School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Fardis Vosoughi
- Department of Orthopedic and trauma surgery, Shariati Hospital and School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Center of Orthopedic Trans-Disciplinary Applied Research (COTAR), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mohammad Hossein Nabian
- Department of Orthopedic and trauma surgery, Shariati Hospital and School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran. .,Center of Orthopedic Trans-Disciplinary Applied Research (COTAR), Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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Loftus CJ, Ahn J, Hagedorn JC, Cain M, Holt S, Merguerian P, Shnorhavorian M. The impact of the dependent care provision on individuals with spina bifida transitioning to adulthood. J Pediatr Urol 2021; 17:289.e1-289.e9. [PMID: 33563555 DOI: 10.1016/j.jpurol.2021.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Under the Affordable Care Act, the Dependent Care Provision (DCP) was enacted in 2010 and expanded healthcare coverage for millions of young adults ages 19-25 by allowing them to stay on their parents' insurance until age 26. It is unknown whether the DCP has impacted young adults with SB who are at risk for lapses in insurance coverage as they transition into adult care. OBJECTIVE Our aim was to determine the impact of the DCP on access to care (insurance status) and healthcare-quality (hospital admissions for potentially preventable conditions). METHODS Using the National Inpatient Sample (an all-payor national dataset of hospital admissions), we analyzed pre/post DCP changes for admissions of SB patients ages 19-25. Our outcomes of interest were rates of insurance coverage and proportion of admissions due to potentially preventable conditions (UTI, pyelonephritis, skin conditions, osteomyelitis, sepsis, and pneumonia). Analysis included a difference-in-differences logistic regression model which compared the pre/post DCP difference (2006-s quarter of 2010 vs. 2011-2013) in patients ages 19-25 to the difference in patients ages 26-32 who were ineligible for the DCP policy. RESULTS For admissions of SB patients ages 19-25, the DCP was not associated with improved insurance status compared to admissions ages 26-32 (0% vs. -0.4%, p = 0.10) and rates of private insurance decreased in both age groups, but more so in ages 26-32 (-2.0% vs. -3.9%, p < 0.001). Private insurance rates increased for admissions of white patients ages 19-25 but not for black and Hispanic groups. An increase in overall insurance status was also seen in young adults from high-income zip codes. Admissions for potentially preventable conditions increased in both age groups by a similar degree (+2.6% vs. +2.5%, p = 0.82). DISCUSSION Under the Affordable Care Act, the DCP failed to improve rates of private insurance or decrease rates of noninsurance for admissions of young adults with SB. Certain race and socioeconomic groups benefited more from this national healthcare policy. Meanwhile, admissions for potentially preventable conditions are common in spina bifida patients, and increased over the study period, suggesting a need for further investigation into optimizing the delivery of healthcare to this complex patient population. CONCLUSION The DCP did not result in improved overall insurance rates or in improved rates of private insurance for admissions of SB patients 18-25 years old.
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Affiliation(s)
- Christopher J Loftus
- Department of Urology, University of Washington Medical Center, 1959 NE Pacific St, Box 356510, Seattle, WA 98195, USA.
| | - Jennifer Ahn
- Department of Urology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, United States
| | - Judith C Hagedorn
- Department of Urology, University of Washington Medical Center, 1959 NE Pacific St, Box 356510, Seattle, WA 98195, USA
| | - Mark Cain
- Department of Urology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, United States
| | - Sarah Holt
- Department of Urology, University of Washington Medical Center, 1959 NE Pacific St, Box 356510, Seattle, WA 98195, USA
| | - Paul Merguerian
- Department of Urology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, United States
| | - Margarett Shnorhavorian
- Department of Urology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, United States
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Hopson B, Shamblin I, Zimmerman K, Rocque B, Salehani A, Blount JP. Scope of care in the first four years of life for individuals born with myelomeningocele: A single institution experience1. J Pediatr Rehabil Med 2021; 14:667-673. [PMID: 34864701 PMCID: PMC9003993 DOI: 10.3233/prm-200803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Children with myelomeningocele are known to be consumers of substantial healthcare resources, with many early hospital encounters. The purpose of this study was to survey the extent of medical and surgical care that patients with myelomeningocele receive during the first four years of life. METHODS Clinical and demographic data were collected on newborn infants with open myelomeningocele from the Children's of Alabama Spina Bifida Web Tracker, a prospective, comprehensive spina bifida database. Additional data pertaining to all hospital admissions, surgical procedures, and clinic visits were collected from the medical record. RESULTS One hundred and fourteen subjects with a primary diagnosis of myelomeningocele between 2004 and 2015 were included. Males slightly predominated (55%), 61.4% were Caucasian, 11% Hispanic/Latino; 28% had a mid-lumbar functional lesion level. Over the first four years of life, 688 total surgical procedures were performed (an average of 86 per child): 438 in year 1, 100 in year 2, 84 in year 3, and 66 in year 4. The mean number of hospital visits was 40.5. Total average drive time per patient over 4 years being 103.8 hours. Average number of nights spent in the hospital was 51. CONCLUSION Children with myelomeningocele need multiple hospitalizations, surgeries, and medical encounters in the first 4 years of life. These data will be valuable when counselling new parents and prospective parents of children with this condition.
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Affiliation(s)
- Betsy Hopson
- Department of Neurosurgery, Division of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Isaac Shamblin
- Department of Neurosurgery, Division of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kathrin Zimmerman
- Department of Neurosurgery, Division of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brandon Rocque
- Department of Neurosurgery, Division of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Arsalaan Salehani
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeffrey P Blount
- Department of Neurosurgery, Division of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
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Alriksson-Schmidt AI, Ong K, Reeder MR, Thibadeau JK, Feldkamp ML. Site, frequency, and duration of pain in young children with spina bifida. J Pediatr Rehabil Med 2021; 14:571-582. [PMID: 34776433 PMCID: PMC8764594 DOI: 10.3233/prm-190661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
PURPOSE To investigate the: (1) percent of children with spina bifida (SB) complaining of pain, (2) frequency, duration, and cause of pain by sex, level of lesion type of SB, and ambulation status, (3) body sites reported to hurt, by variables in objective 2, and (4) associations between physical and mental/emotional health between caregiver and child. METHODS Cross-sectional study of 101 caregivers of children (3 to 6 years old) with SB. Survey data and information from medical records were included. Pearson chi-square, one-way ANOVA, Fisher's exact test, logistic regressions, and bivariate correlations were used. RESULTS Seventy percent reported that their child complained of pain, which did not significantly differ by sex, level of lesion, type of SB, or ambulation status. Most (86%) were reported to have experienced pain for less than 24 hours. The most frequently reported pain site was the head, followed by the abdomen and the lower body. Number of pain sites was moderately correlated with frequency of pain complaints. Correlations between how caregivers reported their own physical/mental/emotional health and how they rated that of their children ranged from weak (r = 0.22) to moderate (r = 0.55). CONCLUSION Almost seven of ten children reportedly complained of pain ranging from at least once a month to everyday. Pain needs to be routinely assessed and treated in this population.
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Affiliation(s)
- Ann I Alriksson-Schmidt
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Orthopedics, Lund, Sweden
| | - Katherine Ong
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew R Reeder
- Department of Pediatrics, Division of Medical Genetics, University of Utah, Salt Lake City, UT, USA
| | | | - Marcia L Feldkamp
- Department of Pediatrics, Division of Medical Genetics, University of Utah, Salt Lake City, UT, USA
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10
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Riddle S, Meinzen-Derr J, Tabangin M, Woodward J, Wiley S. Emergency department utilization among pediatric spina bifida patients. J Pediatr Rehabil Med 2019; 12:375-381. [PMID: 31744029 PMCID: PMC8011457 DOI: 10.3233/prm-180561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE There is a gap in knowledge regarding the use of emergency services by pediatric spina bifida patients. The goal of this study was to describe Emergency Department utilization patterns in this population. METHODS Through a retrospective observational study, patients with spina bifida who visited the emergency department during a four-year period were identified; medical and demographic information was obtained though the Centers for Disease Control National Spina Bifida Patient Registry. Chief complaints and final diagnoses of visits were classified and related to medical needs of spina bifida to determine the appropriate care level. RESULTS Among 303 children within the registry, 161 patients (53%) accounted for 579 visits. 70% of visits were for spina bifida-related complaints. Approximately half (51.7%) had a shunt-related chief complaint, although final diagnosis was largely unrelated to the shunt. Admission rate was 39%, higher than institutional baseline, and largely represented by genitourinary (GU) complaints. CONCLUSION Pediatric patients with spina bifida presenting to a single center emergency department were most likely to present with shunt and urinary concerns; these patients were most likely to be admitted. This potentially suggests that improving outpatient care for bladder management may decrease emergency department use among this population.
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Affiliation(s)
- Stefanie Riddle
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Jareen Meinzen-Derr
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Meredith Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jason Woodward
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Susan Wiley
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
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Tradewell M, Pariser JJ, Nimeh T, Elliott SP. Systematic review and practice policy statements on urinary tract infection prevention in adults with spina bifida. Transl Androl Urol 2018; 7:S205-S219. [PMID: 29928619 PMCID: PMC5989108 DOI: 10.21037/tau.2018.04.21] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 12/03/2022] Open
Abstract
Urinary tract infection (UTI) is a source of morbidity and healthcare costs in adults with spina bifida (ASB). UTI prevention strategies are often recommended, but the evidence of various approaches remains unclear. We performed a systematic review to inform a best practice policy statement for UTI prevention in ASB. On behalf of the Neurogenic Bladder Research Group (NBRG.org), we developed an a priori protocol and searched the published English literature for 30 outcomes questions addressing UTI prevention in ASB. The questions spanned the categories of antibiotics, oral supplements, bladder management factors and social support. Where there was little literature in ASB, we included literature from similar populations with neurogenic bladder (NB). Data was abstracted and then reviewed with recommendations made by consensus of all authors. Level of Evidence (LoE) and Grade of Recommendation (GoR) were according to the Oxford grading system. Of 6,433 articles identified by our search, we included 99 publications. There was sufficient evidence to support use of the following: saline bladder irrigation (LoE 1, GoR B), gentamicin bladder instillation (LoE 3, GoR C), single-use intermittent catheterization (IC) (LoE 2, GoR B), hydrophilic catheters for IC (LoE 2, GoR C), intradetrusor onabotulinumtoxinA injection (LoE 3, GoR C), hyaluronic acid (HA) instillation (LoE 1, GoR B), and care coordination (LoE 3, GoR C). There was sufficient evidence to recommend against use of the following: sterile IC (LoE 1, GoR B), oral antibiotic prophylaxis (LoE 2, GoR B), treatment of asymptomatic bacteriuria (LoE 2, GoR B), cranberry (LoE 2, GoR B), methenamine salts (LoE 1, GoR B), and ascorbic acid (LoE1, GoR B). There was insufficient evidence to make a recommendation for other outcomes. Overall, there are few studies in UTI prevention in the specific population of ASB. Research in populations similar to ASB helps to guide recommendations for UTI prevention in the challenging patient group of ASB. Future studies in UTI prevention specific to ASB are needed and should focus on areas shown to be of benefit in similar populations.
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Affiliation(s)
- Michael Tradewell
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Joseph J Pariser
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Tony Nimeh
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
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12
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Alriksson-Schmidt A, Josenby AL, Lindquist B, Westbom L. Pain and health status in adults with myelomeningocele living in Sweden. J Pediatr Rehabil Med 2018; 11:255-264. [PMID: 30507588 PMCID: PMC6311378 DOI: 10.3233/prm-170517] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To increase knowledge about pain and general health in adults with myelomeningocele, a health condition with several risk factors for pain such as musculoskeletal deformities, shunt dysfunctions, bowel problems, and urinary tract infections/stones. METHODS Descriptive correlational pilot study (N= 51, 53% males). Chi-square tests were used to test associations among presence, impact, severity, and pain site in relation to sex and age. ANOVA was used to analyze associations between sex, age, and general health (today). RESULTS Seventy-three percent reported pain in the past four weeks. No significant sex or age differences were associated with the presence of pain. Women were significantly more likely to report that pain interfered with work, χ2(1, N= 41) = 5.53, p= 0.02. There were significant main effects for sex and age on general health (today), F(2, 44) = 5.63, p= 0.007, adjusted R2= 0.17. Women scored lower on general health (today) (mean = 63.58) than men (mean = 76.33). Older individuals reported worse general health (today) than did younger (B=-0.89, t=-2.79, p= 0.008). CONCLUSIONS Pain was frequent, and pain sites differed widely. Women were more likely to report that pain interfered with work, and scored lower on health, as did older persons.
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Affiliation(s)
- Ann Alriksson-Schmidt
- Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden.,Skåne University Hospital, Lund, Sweden
| | - Annika Lundkvist Josenby
- Skåne University Hospital, Lund, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
| | - Barbro Lindquist
- Department of Habilitation, Halmstad County Hospital, Halmstad, Sweden
| | - Lena Westbom
- Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences Lund, Paediatrics, Lund University, Lund, Sweden
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13
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Loftus CJ, Moore DC, Cohn JA, Milam DF, Dmochowski RR, Wood D, Kaufman MR, Wood HM. Postoperative Complications of Patients With Spina Bifida Undergoing Urologic Laparotomy: A Multi-institutional Analysis. Urology 2017. [DOI: 10.1016/j.urology.2017.06.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Abstract
OBJECTIVE To determine feasibility of using the interactive Mobile Health and Rehabilitation (iMHere) system in spina bifida and its effects on psychosocial and medical outcomes. DESIGN In a randomized controlled trial, 13 intervention participants using the iMHere system and receiving usual care and 10 control participants receiving usual care were followed for 1 year. RESULTS Feasibility of use of the system was demonstrated by participants using a customized smartphone system for reminders to conduct various self-care tasks, upload photos of wounds, manage medications, complete mood surveys, and for secure messaging. High usage of the system was associated with positive changes in the subscales of the Adolescent Self-Management and Independence Scale II. CONCLUSION Use of the iMHere system in spina bifida is feasible and was associated with short-term self-reported improvements in self-management skill. This system holds promise for use in many diverse chronic care models to support and increase self-management skills.
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Effectiveness of a Wellness Program for Individuals With Spina Bifida and Spinal Cord Injury Within an Integrated Delivery System. Arch Phys Med Rehabil 2016; 97:1969-1978. [PMID: 27311718 DOI: 10.1016/j.apmr.2016.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 04/29/2016] [Accepted: 05/09/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To determine whether an evidence-based wellness program for individuals with spina bifida and spinal cord injury would improve health outcomes and patient experience of care, result in a positive return on investment (ROI), and provide evidence for scalability. DESIGN Nonrandomized, noncontrolled cohort study; 2 years of enrollment. SETTING Academic hospital-based outpatient physiatry clinic partnered with an insurance division within an integrated health care delivery and financing system. PARTICIPANTS Individuals (N=69) with spina bifida and spinal cord injury were consented; 4 were excluded (5.7%), and the remaining 65 (94.2%) participated in the intervention. INTERVENTIONS Evidence-based wellness program consisting of care coordination from a mobile nurse, patient education, and patient incentives. MAIN OUTCOME MEASURES Validated measures of function, mood, quality of life, and perception of care delivery; knowledge of preventable conditions; self-rating of health; and utilization and cost. RESULTS Improvements in all main outcome measures were seen after 2 years of enrollment. Although cost in year 1 of enrollment increased because of hospitalizations and the overall ROI was negative, a small positive ROI was seen in year 2 of enrollment. CONCLUSIONS Participation in an evidence-based wellness program was associated with improved health and experience of care. Scaling the program to larger numbers may result in an overall positive ROI.
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Eswara JR, Kielb S, Koyle MA, Wood D, Wood HM. The Recommendations of the 2015 American Urological Association Working Group on Genitourinary Congenitalism. Urology 2016; 88:1-7. [DOI: 10.1016/j.urology.2015.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 10/30/2015] [Accepted: 11/14/2015] [Indexed: 11/27/2022]
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17
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Baskin LS. This Month in Pediatric Urology. J Urol 2015. [DOI: 10.1016/j.juro.2014.10.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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