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Hersh C, Warren M, Horick N, Sorbo J, Callans K, Fracchia S, Radano M, Hartnick C. Development and validation of the caregiver Burden from infant home NGT care instrument. Int J Pediatr Otorhinolaryngol 2024; 181:111986. [PMID: 38805934 DOI: 10.1016/j.ijporl.2024.111986] [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: 04/02/2024] [Revised: 05/10/2024] [Accepted: 05/17/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE To design and validate an age and condition-specific health status instrument to best reflect the parental experience caring for these children with complex needs and home Nasogastric Tube (NGT) placement. STUDY DESIGN Combined Qualitative and Quantitative design, testing and implementation for item production and reduction, followed by formal validation by evaluating validity, reliability, and establishing a clinically meaningful change score. SETTINGS Tertiary care, multi-disciplinary aerodigestive center. PARTICIPANTS All caregivers whose infant met criteria for eligibility for discharge home from the NICU or Special Care Nursery (SCN) with NGT in place were offered inclusion in this group. Intervention/Exposure: Structured qualitative interviews of these caregivers to explore and define these concepts and domains, to item generate and then reduce, and then psychometric analyses. METHODS Structured, moderated qualitative interviews with parents/caregivers of children who have undergone home NGT care of their children for item creation, design, and then reduction. Reliability was assessed by Cronbach alpha analysis. Construct validity and clinically meaningful change score was assessed using various query methods. MAIN OUTCOME MEASURES Cronbach's alpha to assess reliability, a priori hypotheses validity analyses, and minimally important clinical difference calculation. RESULTS Scaled scores of this condition specific instrument ranged from 14 to 74 where higher scores indicate better QOL related to managing the NGT. Cronbach's alpha with all 14 items was 0.93. Validity was assessed by a self-assessment question to discriminate between change (95% CI: 8.5-14.1; p < 0.0001) as well as by other comparators to identify the instrument's ability to discriminate among populations where parents felt a difference in experience. The minimally important difference was calculated at 18 points. CONCLUSION This represents the initial validation of the first condition and age-specific health status instrument to assess parent experience of caring for infants requiring a home NGT for dysphagia.
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Affiliation(s)
- Cheryl Hersh
- Massachusetts General Hospital for Children, Boston, MA, USA
| | | | - Nora Horick
- Brigham and Women's Hospital, Boston, MA, USA
| | - Jessica Sorbo
- Massachusetts General Hospital for Children, Boston, MA, USA
| | | | | | - Marcela Radano
- Massachusetts General Hospital for Children, Boston, MA, USA
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2
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Nathwani AA, Fayed N, Grandi SM, Orkin J, Cohen E. Mental health of caregivers of children with medical complexity: group-based trajectory modelling. Arch Dis Child 2024:archdischild-2023-326425. [PMID: 38388207 DOI: 10.1136/archdischild-2023-326425] [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: 10/06/2023] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To describe the mental health trajectories of caregivers of children with medical complexity (CMC) and explore child characteristics associated with below-average caregiver mental health. DESIGN A secondary analysis of prospectively collected data from 123 caregivers of children aged <16 years with medical complexity from a multicentre randomised trial conducted from December 2016 to June 2021. MAIN OUTCOME MEASURE The Patient-Reported Outcomes Measurement Information System Global Mental Health Scale was used to measure caregivers' self-reported mental health well-being. Group-based trajectory analysis was used to identify clusters of caregivers with similar changes in mental health across 24 months. Logistic regression was used to identify child-related predictors of mental health among caregivers. RESULTS A final model with three distinct groups was selected, corresponding to caregivers with average (n=39), moderately below-average (n=65) and severely below-average (n=19) mental health scores, all with stable trajectories and high posterior probabilities (>90%). Moderately and severely below-average caregiver mental health groups, merged into one group, were associated with a greater number of child medical technology devices (adjusted OR (aOR) 1.44, 95% CI 1.01 to 2.04), gross motor difficulties (aOR 3.51, 95% CI 1.02 to 12.05) and worse child emotional (aOR 0.93, 95% CI 0.87 to 0.99) and psychological well-being (aOR 0.93, 95% CI 0.88 to 0.99). CONCLUSION Most caregivers of CMC reported persistently below-average mental health. The intensity of caregiving, as indicated by medical technology and child functional needs, is a potential risk factor for below-average caregiver mental health. Future design and evaluation of interventions focused on support for caregivers of CMC are warranted.
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Affiliation(s)
- Apsara Ali Nathwani
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nora Fayed
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Sonia M Grandi
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Julia Orkin
- Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eyal Cohen
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Edwin S H Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
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3
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Cohen E, Quartarone S, Orkin J, Moretti ME, Emdin A, Guttmann A, Willan AR, Major N, Lim A, Diaz S, Osqui L, Soscia J, Fu L, Gandhi S, Heath A, Fayed N. Effectiveness of Structured Care Coordination for Children With Medical Complexity: The Complex Care for Kids Ontario (CCKO) Randomized Clinical Trial. JAMA Pediatr 2023; 177:461-471. [PMID: 36939728 PMCID: PMC10028546 DOI: 10.1001/jamapediatrics.2023.0115] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Importance Children with medical complexity (CMC) have chronic conditions and high health needs and may experience fragmented care. Objective To compare the effectiveness of a structured complex care program, Complex Care for Kids Ontario (CCKO), with usual care. Design, Setting, and Participants This randomized clinical trial used a waitlist variation for randomizing patients from 12 complex care clinics in Ontario, Canada, over 2 years. The study was conducted from December 2016 to June 2021. Participants were identified based on complex care clinic referral and randomly allocated into an intervention group, seen at the next available clinic appointment, or a control group that was placed on a waitlist to receive the intervention after 12 months. Intervention Assignment of a nurse practitioner-pediatrician dyad partnering with families in a structured complex care clinic to provide intensive care coordination and comprehensive plans of care. Main Outcomes and Measures Co-primary outcomes, assessed at baseline and at 6, 12, and 24 months postrandomization, were service delivery indicators from the Family Experiences With Coordination of Care that scored (1) coordination of care among health care professionals, (2) coordination of care between health care professionals and families, and (3) utility of care planning tools. Secondary outcomes included child and parent health outcomes and child health care system utilization and cost. Results Of 144 participants randomized, 141 had complete health administrative data, and 139 had complete baseline surveys. The median (IQR) age of the participants was 29 months (9-102); 83 (60%) were male. At 12 months, scores for utility of care planning tools improved in the intervention group compared with the waitlist group (adjusted odds ratio, 9.3; 95% CI, 3.9-21.9; P < .001), with no difference between groups for the other 2 co-primary outcomes. There were no group differences for secondary outcomes of child outcomes, parent outcomes, and health care system utilization and cost. At 24 months, when both groups were receiving the intervention, no primary outcome differences were observed. Total health care costs in the second year were lower for the intervention group (median, CAD$17 891; IQR, 6098-61 346; vs CAD$37 524; IQR, 9338-119 547 [US $13 415; IQR, 4572-45 998; vs US $28 136; IQR, 7002-89 637]; P = .01). Conclusions and Relevance The CCKO program improved the perceived utility of care planning tools but not other outcomes at 1 year. Extended evaluation periods may be helpful in assessing pediatric complex care interventions. Trial Registration ClinicalTrials.gov Identifier: NCT02928757.
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Affiliation(s)
- Eyal Cohen
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Samantha Quartarone
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Julia Orkin
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Myla E Moretti
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Clinical Trials Unit, Ontario Child Health Support Unit, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Abby Emdin
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Hospital, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Andrew R Willan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nathalie Major
- Department of Paediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Audrey Lim
- Department of Pediatrics, Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | - Sanober Diaz
- Provincial Council for Maternal and Child Health, Toronto, Ontario, Canada
| | - Lisa Osqui
- Provincial Council for Maternal and Child Health, Toronto, Ontario, Canada
| | - Joanna Soscia
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Lawrence M. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Anna Heath
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Statistical Science, University College London, London, United Kingdom
| | - Nora Fayed
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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4
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Cardenas A, Esser K, Wright E, Netten K, Edwards A, Rose J, Vigod S, Cohen E, Orkin J. Caring for the Caregiver (C4C): An Integrated Stepped Care Model for Caregivers of Children With Medical Complexity. Acad Pediatr 2023; 23:236-243. [PMID: 35680082 DOI: 10.1016/j.acap.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/19/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022]
Abstract
Children with medical complexity (CMC) are a medically fragile subset of children who rely on parental caregivers for substantial care needs. Caregivers of CMC often experience adverse health outcomes such as depression and anxiety, sleep deprivation, financial hardships, and social isolation. Caregivers of CMC are at risk of premature mortality, which is thought to be mediated by chronic and elevated stress, as well as psychiatric morbidity risk. Access to mental health care, where the needs of both the caregiver and child are considered, can enable caregivers to meet high caregiving demands and improve both child and caregiver outcomes. We describe the Caring for the Caregiver (C4C) model, a novel integrated stepped care model consisting of collaboration between a psychiatrist and a pediatric complex care program. This model provides support in 3 steps: 1) early identification of distress, 2) social work assessment, intervention and psychotherapy, and 3) psychiatric care, including diagnosis or medication initiation, for caregivers of CMC. This innovative model will be the first to embed support for the mental health needs of caregivers of CMC within a pediatric team, facilitating access to psychiatric care and serving as a foundation for future integrated stepped care models.
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Affiliation(s)
- Analyssa Cardenas
- Child Health Evaluative Sciences (A Cardenas, K Esser, E Cohen, and J Orkin), The Hospital for Sick Children, Toronto, ON, Canada
| | - Kayla Esser
- Child Health Evaluative Sciences (A Cardenas, K Esser, E Cohen, and J Orkin), The Hospital for Sick Children, Toronto, ON, Canada
| | - Elisabeth Wright
- Department of Psychiatry (E Wright, S Vigod), Women's College Hospital, Toronto, ON, Canada; Department of Psychiatry (E Wright, S Vigod), University of Toronto, Toronto, ON, Canada
| | - Kathy Netten
- Division of Pediatric Medicine (K Netten, A Edwards, E Cohen, and J Orkin), The Hospital for Sick Children, , Toronto, ON, Canada
| | - Ashley Edwards
- Division of Pediatric Medicine (K Netten, A Edwards, E Cohen, and J Orkin), The Hospital for Sick Children, , Toronto, ON, Canada
| | - Julie Rose
- SickKids Family Advisory Network (J Rose), The Hospital for Sick Children, Toronto, ON, Canada
| | - Simone Vigod
- Department of Psychiatry (E Wright, S Vigod), Women's College Hospital, Toronto, ON, Canada; Department of Psychiatry (E Wright, S Vigod), University of Toronto, Toronto, ON, Canada
| | - Eyal Cohen
- Child Health Evaluative Sciences (A Cardenas, K Esser, E Cohen, and J Orkin), The Hospital for Sick Children, Toronto, ON, Canada; Division of Pediatric Medicine (K Netten, A Edwards, E Cohen, and J Orkin), The Hospital for Sick Children, , Toronto, ON, Canada; Department of Pediatrics (E Cohen, J Orkin), University of Toronto, Toronto, ON, Canada; Edwin S.H. Leong Centre for Healthy Children (E Cohen), University of Toronto, Toronto, ON, Canada
| | - Julia Orkin
- Child Health Evaluative Sciences (A Cardenas, K Esser, E Cohen, and J Orkin), The Hospital for Sick Children, Toronto, ON, Canada; Division of Pediatric Medicine (K Netten, A Edwards, E Cohen, and J Orkin), The Hospital for Sick Children, , Toronto, ON, Canada; Department of Pediatrics (E Cohen, J Orkin), University of Toronto, Toronto, ON, Canada.
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5
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Parpia C, Moore C, Beatty M, Miranda S, Adams S, Stinson J, Desai A, Bartlett L, Culbert E, Cohen E, Orkin J. Evaluation of a Secure Messaging System in the Care of Children With Medical Complexity: Mixed Methods Study. JMIR Form Res 2023; 7:e42881. [PMID: 36821356 PMCID: PMC9999262 DOI: 10.2196/42881] [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: 09/27/2022] [Revised: 12/21/2022] [Accepted: 01/10/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND The Connecting2gether (C2) platform is a web and mobile-based information-sharing tool that aims to improve care for children with medical complexity and their families. A key feature of C2 is secure messaging, which enables parental caregivers (PCs) to communicate with their child's care team members (CTMs) in a timely manner. OBJECTIVE The objectives of this study were to (1) evaluate the use of a secure messaging system, (2) examine and compare the content of messages to email and phone calls, and (3) explore PCs' and CTMs' perceptions and experiences using secure messaging as a method of communication. METHODS This is a substudy of a larger feasibility evaluation of the C2 platform. PCs of children with medical complexity were recruited from a tertiary-level complex care program to use the C2 platform for 6 months. PCs could invite CTMs involved in their child's care to register on the platform. Messages were extracted from C2, and phone and email data were extracted from electronic medical records. Quantitative data from the use of C2 were analyzed using descriptive statistics. Messaging content codes were iteratively developed through a review of the C2 messages and phone and email communication. Semistructured interviews were completed with PCs and CTMs. Communication and interview data were analyzed using thematic analysis. RESULTS A total of 36 PCs and 66 CTMs registered on the C2 platform. A total of 1861 messages were sent on C2, with PCs and nurse practitioners sending a median of 30 and 74 messages, respectively. Of all the C2 messages, 85.45% (1257/1471) were responded to within 24 hours. Email and phone calls focused primarily on clinical concerns and medications, whereas C2 messaging focused more on parent education, proactive check-ins, and nonmedical aspects of the child's life. Four themes emerged from the platform user interviews related to C2 messaging: (1) connection to the care team, (2) efficient communication, (3) clinical uses of secure messaging, and (4) barriers to use. CONCLUSIONS Overall, our study provides valuable insight into the benefits of secure messaging in the care of children with medical complexity. Secure messaging provided the opportunity for continued family teaching, proactive check-ins from health care providers, and casual conversations about family and child life, which contributed to PCs feeling an improved sense of connection with their child's health care team. Secure messaging can be a beneficial additional communication method to improve communication between PCs and their care team, reducing the associated burden of care coordination and ultimately enhancing the experience of care delivery. Future directions include the evaluation of secure messaging when integrated into electronic medical records, as this has the potential to work well with CTM workflow, reduce redundancy, and allow for new features of secure messaging.
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Affiliation(s)
- Camilla Parpia
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Clara Moore
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | - Sherri Adams
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,SickKids Research Institute, Toronto, ON, Canada.,Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer Stinson
- SickKids Research Institute, Toronto, ON, Canada.,Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Arti Desai
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Leah Bartlett
- Royal Victoria Regional Health Center, Barrie, ON, Canada
| | | | - Eyal Cohen
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,SickKids Research Institute, Toronto, ON, Canada
| | - Julia Orkin
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,SickKids Research Institute, Toronto, ON, Canada.,Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
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6
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Diskin C, Buchanan F, Cohen E, Dewan T, Diaczun T, Gordon M, Lee E, MooreHepburn C, Major N, Orkin J, Patel H, Gill PJ. The impact of the COVID-19 pandemic on children with medical complexity. BMC Pediatr 2022; 22:496. [PMID: 35999625 PMCID: PMC9398046 DOI: 10.1186/s12887-022-03549-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 07/29/2022] [Indexed: 12/02/2022] Open
Abstract
Background Descriptions of the COVID-19 pandemic’s indirect consequences on children are emerging. We aimed to describe the impacts of the pandemic on children with medical complexity (CMC) and their families. Methods A one-time survey of Canadian paediatricians using the Canadian Paediatric Surveillance Program (CPSP) was conducted in Spring 2021. Results A total of 784 paediatricians responded to the survey, with 70% (n = 540) providing care to CMC. Sixty-seven (12.4%) reported an adverse health outcome due to a COVID-19 pandemic-related disruption in healthcare delivery. Disruption of the supply of medication and equipment was reported by 11.9% of respondents (n = 64). Respondents reported an interruption in family caregiving (47.5%, n = 252) and homecare delivery (40.8%, n = 218). Almost 47% of respondents (n = 253) observed a benefit to CMC due to COVID-19 related changes in healthcare delivery, including increased availability of virtual care and reduction in respiratory illness. Some (14.4%) reported that CMC were excluded from in-person learning when their peers without medical complexity were not. Conclusion Canadian paediatricians reported that CMC experienced adverse health outcomes during the COVID-19 pandemic, including disruptions to family caregiving and community supports. They also describe benefits related to the pandemic including the expansion of virtual care. These results highlight the need for healthcare, community and education policymakers to collaborate with families to optimize their health. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03549-y.
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Affiliation(s)
- Catherine Diskin
- Division of Paediatric Medicine, Department of Paediatrics, University of TorontoThe Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Francine Buchanan
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Eyal Cohen
- Division of Paediatric Medicine, Department of Paediatrics, University of TorontoThe Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Tammie Dewan
- Alberta's Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Tessa Diaczun
- Division of General Pediatrics, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | - Esther Lee
- Division of General Pediatrics, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Charlotte MooreHepburn
- Division of Paediatric Medicine, Department of Paediatrics, University of TorontoThe Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Nathalie Major
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Julia Orkin
- Division of Paediatric Medicine, Department of Paediatrics, University of TorontoThe Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Hema Patel
- Division of General Pediatrics, Department of Pediatrics, The Montreal Children's Hospital, McGill University, Montréal, Quebec, Canada
| | - Peter J Gill
- Division of Paediatric Medicine, Department of Paediatrics, University of TorontoThe Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
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7
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Bird M, Carter N, Lim A, Kazmie N, Fajardo C, Reaume S, McGillion MH. A Novel Hospital-to-Home System for Children With Medical Complexities: Usability Testing Study. JMIR Form Res 2022; 6:e34572. [PMID: 35969456 PMCID: PMC9419046 DOI: 10.2196/34572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Children with medical complexity (CMC) are a group of young people who have severe complex chronic conditions, substantial family-identified service needs, functional limitations, and high health care resource use. Technology-enabled hospital-to-home interventions designed to deliver comprehensive care in the home setting are needed to ease CMC family stress, provide proactive and comprehensive care to this fragile population, and avoid hospital admissions, where possible. Objective In this usability testing study, we aimed to assess areas of strength and opportunity within the DigiComp Kids system, a hospital-to-home intervention for CMC and their families and care providers. Methods Hospital-based clinicians, family members of medically complex children, and home-based clinicians participated in DigiComp Kids usability testing. Participants were recorded and tasked to think aloud while completing usability testing tasks. Participants were scored on the metrics of effectiveness, efficiency, and satisfaction, and the total usability score was calculated using the Single Usability Metric. Participants also provided insights into user experiences during the postusability testing interviews. Results A total of 15 participants (5 hospital-based clinicians, 6 family members, and 4 home-based clinicians) participated in DigiComp Kids usability testing. The participants were able to complete all assigned tasks independently. Error-free rates for tasks ranged from 58% to 100%; the average satisfaction rating across groups was ≥80%, as measured by the Single Ease Question. Task times of participants were variable compared with the task times of an expert DigiComp Kids user. Single Usability Metric scores ranged from 80.5% to 89.5%. In qualitative interviews, participants stressed the need to find the right fit between user needs and the effort required to use the system. Interviews also revealed that the value of the DigiComp Kids system was in its ability to create a digital bridge between hospital and home, enabling participants to foster and maintain connections across boundaries. Conclusions Usability testing revealed strong scores across the groups. Insights gained include the importance of tailoring the implementation of the system to match individual user needs, streamlining key system features, and consideration of the meaning attached to system use by participants to allow for insight into system adoption and sustainment.
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Affiliation(s)
- Marissa Bird
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Nancy Carter
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Audrey Lim
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Nadia Kazmie
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | | | - Shannon Reaume
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Michael H McGillion
- School of Nursing, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
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8
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Diskin C, Malik K, Gill PJ, Rashid N, Chan CY, Nelson KE, Thomson J, Berry J, Agrawal R, Orkin J, Cohen E. Research priorities for children with neurological impairment and medical complexity in high-income countries. Dev Med Child Neurol 2022; 64:200-208. [PMID: 34462917 PMCID: PMC9291325 DOI: 10.1111/dmcn.15037] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 07/16/2021] [Accepted: 08/03/2021] [Indexed: 02/05/2023]
Abstract
AIM To identify the highest-priority clinical research areas related to children with neurological impairment and medical complexity among clinicians and caregivers. METHOD A modified, three-stage Delphi study using online surveys and guided by a steering committee was completed. In round 1, clinicians and family caregivers suggested clinical topics and related questions that require research to support this subgroup of children. After refinement of the suggestions by the steering committee, participants contributed to 1 (family caregivers) or 2 (clinicians) subsequent rounds to develop a prioritized list. RESULTS A diverse international expert panel consisting of 49 clinicians and 12 family caregivers provided 601 responses. Responses were distilled into 26 clinical topics comprising 126 related questions. The top clinical topics prioritized for research were irritability and pain, child mental health, disorders of tone, polypharmacy, sleep, aspiration, behavior, dysautonomia, and feeding intolerance. The clinician expert panel also prioritized 10 specific research questions. INTERPRETATION Study findings support a research agenda for children with neurological impairment and medical complexity focused on addressing clinical questions, prioritized by an international group of clinicians and caregivers.
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Affiliation(s)
- Catherine Diskin
- Division of Paediatric MedicineDepartment of PaediatricsThe Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | - Kristina Malik
- Department of PediatricsUniversity of Colorado School of MedicineAuroraCOUSA,Special Care ClinicChildren’s Hospital ColoradoAuroraCOUSA
| | - Peter J Gill
- Division of Paediatric MedicineDepartment of PaediatricsThe Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada,Child Health Evaluative SciencesSickKids Research InstituteTorontoOntarioCanada,Institute for Health Policy, Management and EvaluationUniversity of TorontoTorontoOntarioCanada,Centre for Evidence‐Based MedicineUniversity of OxfordOxfordUK
| | - Nada Rashid
- The Hospital for Sick ChildrenTorontoOntarioCanada
| | - Carol Y Chan
- Child Health Evaluative SciencesSickKids Research InstituteTorontoOntarioCanada
| | - Katherine E Nelson
- Division of Paediatric MedicineDepartment of PaediatricsThe Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada,Child Health Evaluative SciencesSickKids Research InstituteTorontoOntarioCanada,Institute for Health Policy, Management and EvaluationUniversity of TorontoTorontoOntarioCanada
| | - Joanna Thomson
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOHUSA,Division of Hospital MedicineCincinnati Children’s Hospital Medical CenterCincinnatiOHUSA
| | - Jay Berry
- Division of General PediatricsChildren’s Hospital BostonBostonMAUSA,Department of PediatricsHarvard Medical SchoolBostonMAUSA
| | - Rishi Agrawal
- Department of PediatricsHarvard Medical SchoolBostonMAUSA,Division of Hospital‐Based MedicineDepartment of PediatricsAnn & Robert H. Lurie Children’s Hospital of ChicagoNorthwestern University Feinberg School of MedicineChicagoILUSA,Section of Chronic DiseaseLa Rabida Children’s HospitalChicagoILUSA
| | - Julia Orkin
- Division of Paediatric MedicineDepartment of PaediatricsThe Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada,Child Health Evaluative SciencesSickKids Research InstituteTorontoOntarioCanada
| | - Eyal Cohen
- Division of Paediatric MedicineDepartment of PaediatricsThe Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada,Child Health Evaluative SciencesSickKids Research InstituteTorontoOntarioCanada,Institute for Health Policy, Management and EvaluationUniversity of TorontoTorontoOntarioCanada,Edwin S.H. Leong Centre for Healthy ChildrenUniversity of TorontoTorontoOntarioCanada,CanChild Centre for Childhood Disability ResearchMcMaster UniversityHamiltonOntarioCanada
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9
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Lin JLL, Quartarone S, Aidarus N, Chan CY, Hubbert J, Orkin J, Fayed N, Major N, Soscia J, Lim A, French SD, Moretti ME, Cohen E. Process Evaluation of a Hub-and-Spoke Model to Deliver Coordinated Care for Children with Medical Complexity across Ontario: Facilitators, Barriers and Lessons Learned. Healthc Policy 2021; 17:104-122. [PMID: 34543180 PMCID: PMC8437255 DOI: 10.12927/hcpol.2021.26574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Complex Care for Kids Ontario (CCKO) is a multi-year strategy aimed at expanding a hub-and-spoke model to deliver coordinated care for children with medical complexity (CMC) across Ontario. Objective: This paper aims to identify the facilitators, barriers and lessons learned from the implementation of the Ontario CCKO strategy. Method: Alongside an outcome evaluation of the CCKO strategy, we conducted a process evaluation to understand the implementation context, process and mechanisms. Semi-structured interviews were conducted with 38 healthcare leaders, clinicians and support staff from four regions involved in CCKO care delivery and/or governance. Results: Facilitators to CCKO implementation were sustained engagement of system-wide stakeholders, inter-organizational partnerships, knowledge sharing and family engagement. Barriers to CCKO implementation were resources and funding, fragmentation of care, aligning perspectives between providers and clinical staff recruitment and retention. Conclusion: A flexible approach is required to implement a complex, multi-centre policy strategy. Other jurisdictions considering such a model of care delivery would benefit from attention to contextual variations in implementation setting, building cross-sector engagement and buy-in, and offering continuous support for modifications to the intervention as and when required.
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Affiliation(s)
- Jia Lu Lilian Lin
- PhD Candidate, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Samantha Quartarone
- Clinical Research Project Coordinator, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
| | - Nasra Aidarus
- Senior Program Manager, Provincial Council for Maternal and Child Health, Toronto, ON
| | - Carol Y Chan
- Clinical Research Project Manager, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
| | - Jackie Hubbert
- Clinical Director, Labatt Family Heart Centre and Critical Care Services, The Hospital for Sick Children, Toronto, ON
| | - Julia Orkin
- Medical Officer, Integrated Community Partnerships and Complex Care Program, The Hospital for Sick Children; Associate Professor, Department of Paediatrics, University of Toronto, Toronto, ON
| | - Nora Fayed
- Assistant Professor, School of Rehabilitation Therapy, Queen's University, Kingston, ON
| | - Nathalie Major
- Medical Director, Champlain Complex Care Program, Children's Hospital of Eastern Ontario; Assistant Professor, Department of Paediatrics, University of Ottawa, Ottawa, ON
| | - Joanna Soscia
- Nurse Practitioner and Clinical Practice Lead, Complex Care Program, The Hospital for Sick Children, Toronto, ON
| | - Audrey Lim
- Medical Lead, Complex Care Program, McMaster Children's Hospital - Hamilton Health Sciences; Associate Professor, Department of Pediatrics, McMaster University, Hamilton, ON
| | - Simon D French
- Professor, Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia
| | - Myla E Moretti
- Health Economist and Senior Research Associate, Clinical Trials Unit, Ontario Child Health Support Unit, The Hospital for Sick Children, Toronto, ON
| | - Eyal Cohen
- Professor, Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto; Senior Scientist and Program Head, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
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10
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Saunders NR, Gandhi S, Chen S, Vigod S, Fung K, De Souza C, Saab H, Kurdyak P. Health Care Use and Costs of Children, Adolescents, and Young Adults With Somatic Symptom and Related Disorders. JAMA Netw Open 2020; 3:e2011295. [PMID: 32701161 PMCID: PMC7378752 DOI: 10.1001/jamanetworkopen.2020.11295] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Somatic symptom and related disorders are highly prevalent mental health disorders among young people. Presentation can be varied, and patients often face long delays and see multiple practitioners to receive a diagnosis. OBJECTIVE To evaluate the health care use and costs in a population-based sample of children and young people with somatic symptom and related disorders in Ontario, Canada. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used linked health and administrative databases in Ontario, Canada, where health services are funded through a universal single-payer health insurance plan. Participants included children aged 4 to 12 years, adolescents aged 13 to 17 years, and young adults aged 18 to 24 years residing in Ontario, Canada, during the period of April 1, 2008, to March 31, 2015. Included participants had a first health record diagnosis of somatic symptom and related disorders and were grouped based on the setting of their index somatic symptom and related disorders contact: outpatient, emergency department, or inpatient. Data were analyzed from August 1, 2017, to February 1, 2018. EXPOSURES One year before and 1 year after diagnosis of somatic symptom and related disorders. MAIN OUTCOMES AND MEASURES Outcome measures included overall and mental health-specific ambulatory and acute care visits and overall health system costs and sector-specific costs. RESULTS A total of 33 272 patients (median [interquartile range {IQR}] age, 20 [16-22] years; 17 387 female [52.3%]) were included in the analysis. Among these patients, 3875 (11.6%) were aged 4 to 12 years, 7273 (21.9%) were aged 13 to 17 years, and 22 124 (66.5%) were aged 18 to 24 years. A total of 17 893 (53.8%) had their index visit as outpatients, whereas 13 310 (40.0%) and 2069 (6.2%) were diagnosed in the emergency department and inpatient settings, respectively. Ambulatory physician visits were frequent and persisted 1 year after diagnosis within each setting (before vs after 1 year, median [IQR] visits, inpatient setting: 7 [3-13] vs 7 [3-13]; emergency department setting: 4 [2-8] vs 4 [2-9]; outpatient setting: 3 [1-7] vs 4 [2-7]; P < .001). After diagnosis, many did not receive physician-delivered mental health care (35.3% [730 of 2069] in an inpatient setting, 59.1% [7866 of 13 310] in an emergency department setting, 58.5% [10 467 of 17 893] in an outpatient setting; P < .001). Acute care use was frequent and remained so after diagnosis across settings. Of those hospitalized as inpatients at diagnosis, 37.7% (779 of 2069) were readmitted within 1 year. Mean (SD) 2-year patient costs were CAD$9845 ($39 725) (median [IQR], $2401 [$960-$7019]). Hospitalized patients had a 2-year mean (SD) cost of $51 424 ($100 416) (median [IQR], $21 997 [$12 510-$45 841]) per-patient expenditure. CONCLUSION AND RELEVANCE This study found that children and young people with somatic symptom and related disorders frequently used the health system with substantial health system costs before and after diagnosis. Many of these patients did not receive physician-delivered mental health care. These findings suggest that this population may be under-recognized, and initiatives for early recognition and engagement with mental health support may be warranted.
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Affiliation(s)
- Natasha Ruth Saunders
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
| | | | | | - Simone Vigod
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Claire De Souza
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Hana Saab
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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11
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Ehlenbach ML, Coller RJ. Growing Evidence for Successful Care Management in Children With Medical Complexity. Pediatrics 2020; 145:peds.2019-3982. [PMID: 32229618 DOI: 10.1542/peds.2019-3982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Mary L Ehlenbach
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Ryan J Coller
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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