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Bassareo PP, Mcmahon CJ, Prendiville T, James A, Roberts P, Oslizlok P, Walsh MA, Kenny D, Walsh KP. Planning Transition of Care for Adolescents Affected by Congenital Heart Disease: The Irish National Pathway. Pediatr Cardiol 2023; 44:24-33. [PMID: 35737012 DOI: 10.1007/s00246-022-02955-4] [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: 05/02/2022] [Accepted: 06/08/2022] [Indexed: 01/24/2023]
Abstract
At some point in their life, adolescent patients with a congenital heart disease (CHD) transition from paediatric services to adult care facilities. The process is not without any risks, as it is often linked with a significantly progressive deterioration in adolescents' health and loss of follow-up. In fact, transition patients often encounter troubles in finding a care giver who is comfortable managing their condition, or in re-establishing trust with the new care provider. Planning the rules of transition is pivotal in preventing these risks. Unfortunately, the American and European guidelines on CHD provide just generic statements about transition. In a recently published worldwide inter-societies consensus document, a hybrid model of transition, which should be adapted for use in high- and low- resource settings, has been suggested. Currently, in literature there are a few models of transition for CHD patients, but they are by far local models and cannot be generalized to other regions or countries. This paper describes the Irish model for transition of care of CHD patients. Due to the peculiarity of the healthcare organization in the Republic of Ireland, which is centralized with one main referral centre for paediatric cardiology (in Dublin, with a few smaller satellite centres all around, according to the "hub and spoke" model) and one centre for adult with CHD (in Dublin), the model can be considered as a national one and the first to be released in the old continent.
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Affiliation(s)
- Pier Paolo Bassareo
- School of Medicine, University College of Dublin, Dublin, Republic of Ireland. .,Mater Misericordiae University Hospital, Eccles St, Inns Quay, Dublin 7, Dublin, D07 R2WY, Republic of Ireland. .,Children's Health Ireland (CHI) at Crumlin, Dublin, Republic of Ireland.
| | - Colin Joseph Mcmahon
- School of Medicine, University College of Dublin, Dublin, Republic of Ireland.,Children's Health Ireland (CHI) at Crumlin, Dublin, Republic of Ireland
| | - Terence Prendiville
- School of Medicine, University College of Dublin, Dublin, Republic of Ireland.,Children's Health Ireland (CHI) at Crumlin, Dublin, Republic of Ireland
| | - Adam James
- Children's Health Ireland (CHI) at Crumlin, Dublin, Republic of Ireland
| | - Phil Roberts
- Children's Health Ireland (CHI) at Crumlin, Dublin, Republic of Ireland
| | - Paul Oslizlok
- Children's Health Ireland (CHI) at Crumlin, Dublin, Republic of Ireland
| | - Mark Anthony Walsh
- School of Medicine, University College of Dublin, Dublin, Republic of Ireland.,Mater Misericordiae University Hospital, Eccles St, Inns Quay, Dublin 7, Dublin, D07 R2WY, Republic of Ireland.,Children's Health Ireland (CHI) at Crumlin, Dublin, Republic of Ireland
| | - Damien Kenny
- Mater Misericordiae University Hospital, Eccles St, Inns Quay, Dublin 7, Dublin, D07 R2WY, Republic of Ireland.,Children's Health Ireland (CHI) at Crumlin, Dublin, Republic of Ireland.,Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Kevin Patrick Walsh
- School of Medicine, University College of Dublin, Dublin, Republic of Ireland.,Mater Misericordiae University Hospital, Eccles St, Inns Quay, Dublin 7, Dublin, D07 R2WY, Republic of Ireland.,Children's Health Ireland (CHI) at Crumlin, Dublin, Republic of Ireland
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Zhang QL, Lin WH, Lin SH, Cao H, Chen Q. Using Telemedicine Strategy to Implementing Nutrition Management for Neonates After Congenital Heart Disease Surgery: A New Nutrition Management Strategy. Front Pediatr 2022; 10:918742. [PMID: 35783326 PMCID: PMC9243536 DOI: 10.3389/fped.2022.918742] [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] [Received: 04/12/2022] [Accepted: 05/23/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the effect of remote nutrition management on promoting the growth and development of neonates after congenital heart disease (CHD) surgery. MATERIALS AND METHODS This study retrospectively analyzed the clinical data of 32 neonates after CHD surgery who received remote nutrition management from January 2021 to July 2021 in our hospital. The clinical data of 30 neonates after CHD surgery, who did not receive remote nutrition management from June 2020 to December 2020, was used as control. The growth and development of the two groups were compared. RESULTS Three months after discharge, the weight, height, and weight-for-age z score (WAZ) of the intervention group was significantly higher than those of the control group. The amount of milk in the intervention group was also significantly more than that of the control group, and more neonates in the intervention group added high-energy milk or breast milk fortifier than the intervention group. The parental care ability of the intervention group was significantly higher than that of the control group. The incidence of respiratory tract infection and readmission in the intervention group was significantly lower than that in the control group. CONCLUSION As a new nutrition management strategy for neonates after CHD surgery, remote nutrition management can effectively improve the nutritional status of neonates and promote their growth and development.
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Affiliation(s)
- Qi-Liang Zhang
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Wen-Hao Lin
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Shi-Hao Lin
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
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Abstract
Introduction: Advancements in surgery and management have resulted in a growing population of aging adults with tetralogy of Fallot (TOF). As a result, there has been a parallel growth in late complications associated with the sequelae from the underlying cardiac anomalies as well as the surgical and other interventional treatments.Areas covered: Here, we review challenges related to an aging population of patients with TOF, particularly late complications, and highlight advances in management and key areas for future research. Pulmonary regurgitation, heart failure, arrhythmias, and aortic complications are some of these late complications. There is also a growing incidence of acquired cardiovascular disease, obesity, and diabetes associated with aging. Management of these late complications and acquired comorbidities continues to evolve as research provides insights into long-term outcomes from medical therapies and surgical interventions.Expert opinion: The management of an aging TOF population will continue to transform with advances in imaging technologies to identify subclinical disease and valve replacement technologies that will prevent and mitigate disease progression. In the coming years, we speculate that there will be more data to support the use of novel heart failure therapies in TOF and consensus guidelines on the management of refractory arrhythmias and aortic complications.
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Affiliation(s)
- Jennifer P Woo
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, California, USA
| | - Doff B McElhinney
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, California, USA
| | - George K Lui
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, California, USA
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A transition clinic intervention to improve follow-up rates in adolescents and young adults with congenital heart disease. Cardiol Young 2020; 30:633-640. [PMID: 32279695 PMCID: PMC7778829 DOI: 10.1017/s1047951120000682] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Children with congenital heart disease (CHD) require lifelong cardiology follow-up. Many experience gaps in care around the age of transition to adult-oriented care with associated comorbidity. We describe the impact of a clinic-based intervention on follow-up rates in this high-risk population. METHODS Patients ≥11 years seen in a paediatric outpatient CHD Transition Clinic completed self-assessment questionnaires, underwent focused teaching, and were followed on a clinic registry with assessment of care continuation. The cohort "lost to follow-up" rate, defined as absence from care at least 6 months beyond the recommended timeframe, was compared with a control group. Secondary outcomes included questionnaire scores and adult cardiology referral trends. RESULTS Over 26 months, 53 participants completed an initial Transition Clinic visit; 43% (23/53) underwent a second visit. Median participant age was 18.0 years (interquartile range 16.0, 22.0). The cohort's "lost to follow-up" rate was 7.3%, which was significantly lower than the control rate (25.9%, p < 0.01). Multivariable regression analyses demonstrated clinic participation as the only factor independently associated with follow-up rates (p = 0.048). Transition readiness was associated with older age (p = 0.01) but not sex, univentricular heart, interventional history, or surgical complexity. One-third of adult participants transferred to adult care. CONCLUSIONS A CHD Transition Clinic intervention can improve follow-up rates in adolescents and young adults. Age is an important factor in transition readiness, and retention of adults in paediatric care appears multi-factorial. We postulate that serial assessments of self-management, focused education, and registry utilisation may improve patient outcomes by reducing lapses in care.
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McLoughlin A, Matthews C, Hickey TM. "They're kept in a bubble": Healthcare professionals' views on transitioning young adults with congenital heart disease from paediatric to adult care. Child Care Health Dev 2018; 44:736-745. [PMID: 29882316 DOI: 10.1111/cch.12581] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Due to medical advances, growing numbers of adolescents with congenital heart disease (CHD) survive into adulthood and transferring from paediatric to adult healthcare. This transfer is significant step in a young person's life, and this study examines the views of Irish healthcare professionals' on how best to manage this transition. METHODS Purposeful sampling was used to invite participation by healthcare professionals (HCPs) from a variety of disciplines whose caseloads include adolescents and young adults with CHD. Fourteen professionals participated in semistructured interviews regarding their experiences of the transition process and their recommendations. Data were collected during Spring 2016 and analysed using thematic analysis. RESULTS Results indicated that the current approach to transition and transfer could be improved. Professionals identified barriers hindering the transition process such as cultural and attitudinal differences between HCPs dealing with child and adult patients, inadequate preparation and education of patients about their condition, parental reluctance to transfer, and concern about parents' role in on-going treatment. Measures such as better support and education for both the patients and their parents were recommended, in order to facilitate a smoother transition process for all parties involved. Additionally, HCPs identified the need for better collaboration and communication, both between paediatric and adult healthcare professionals and between hospitals, to ensure greater continuity of care for patients. CONCLUSIONS Action is required in order to improve the current transition process. Measures need to be taken to address the barriers that currently prevent a smooth transition process for young adult CHD patients. Professionals recommended the implementation of a structured transition clinic to deal with the wide variety of needs of transitioning adolescent patients and their families. Recommendations for future research are also made.
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Affiliation(s)
| | - C Matthews
- Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - T M Hickey
- University College Dublin, Dublin, Ireland
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Kasmi L, Bonnet D, Montreuil M, Kalfa D, Geronikola N, Bellinger DC, Calderon J. Neuropsychological and Psychiatric Outcomes in Dextro-Transposition of the Great Arteries across the Lifespan: A State-of-the-Art Review. Front Pediatr 2017; 5:59. [PMID: 28393063 PMCID: PMC5364136 DOI: 10.3389/fped.2017.00059] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/10/2017] [Indexed: 11/17/2022] Open
Abstract
Advances in prenatal diagnosis, perioperative management, and postoperative care have dramatically increased the population of survivors of neonatal and infant heart surgery. The high survival rate of these patients into adulthood has exposed the alarming prevalence of long-term neuropsychological and psychiatric morbidities. Dextro-transposition of the great arteries (d-TGA) is one of the most extensively studied cyanotic congenital heart defect (CHD) with regard to neurodevelopmental outcomes. Landmark studies have described a common neurodevelopmental and behavioral phenotype associated with d-TGA. Children with d-TGA display impairments in key neurocognitive areas, including visual-spatial and fine motor abilities, executive functioning, processing speed, and social cognition. As they grow older, they may face additional challenges with a worsening of deficits in higher order cognitive skills, problems in psychosocial adjustment and a higher-than-expected rate of psychiatric disorders, such as attention-deficit hyperactivity disorder, depression, and anxiety. The aim of this review is to summarize the available recent data on neuropsychological and psychiatric outcomes in individuals with d-TGA after the arterial switch operation. We present findings within a life-span perspective, with a particular emphasis on the emerging literature on adolescent and young adult outcomes. Finally, we propose avenues for future research in the CHD adult neuropsychology field. Among these avenues, we explore the potential mechanisms by which pediatric neurodevelopmental impairments may have lifelong adverse effects as well as alternative interventions that could optimize outcomes.
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Affiliation(s)
- Leila Kasmi
- Laboratory of Psychopathology and Neuropsychology, Department of Psychology, University Paris 8, Paris Lumières - CNRS , Saint-Denis , France
| | - Damien Bonnet
- Referral Center for Complex Congenital Cardiac Malformations, Department of Congenital and Pediatric Cardiology, Necker Hospital, University Paris Descartes, Sorbonne Paris Cité , Paris , France
| | - Michèle Montreuil
- Laboratory of Psychopathology and Neuropsychology, Department of Psychology, University Paris 8, Paris Lumières - CNRS , Saint-Denis , France
| | - David Kalfa
- Division of Cardiac, Thoracic, and Vascular Surgery, Section of Pediatric Cardiac Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Irving Medical Center, Columbia University , New York, NY , USA
| | - Nikoletta Geronikola
- Laboratory of Psychopathology and Neuropsychology, Department of Psychology, University Paris 8, Paris Lumières - CNRS , Saint-Denis , France
| | - David C Bellinger
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Johanna Calderon
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
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Creating Opportunities for Optimal Nutritional Experiences for Infants With Complex Congenital Heart Disease. J Pediatr Health Care 2016; 30:599-605. [PMID: 27666504 DOI: 10.1016/j.pedhc.2016.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 08/10/2016] [Accepted: 08/12/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION To our knowledge, successful breastfeeding in the population with single ventricle congenital heart disease has not been reported in the literature, particularly during the interstage period. METHOD A retrospective case study including inpatient nutrition and a complete history of daily logs with the home surveillance monitoring program was performed. RESULTS Successful full breastfeeding (exceeding prescribed weight growth goals) after Stage I surgery was achieved during the interstage period. The infant was discharged at 3.41 kg, not consistently breastfeeding, and progressed to 7.05 kg at 5 months of age, fully breastfeeding. CONCLUSION Supporting breastfeeding for infants who have undergone repairs for single ventricle anatomy can be challenging but can be accomplished. It requires a concerted team effort, clear communication, and collaboration among caregivers, the mother, and her supporters.
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Dolgner SJ, Deen JF, Stout KK. Transitioning the Pediatric Patient to the Adult Congenital Heart Disease Service. CURRENT PEDIATRICS REPORTS 2016. [DOI: 10.1007/s40124-016-0098-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Abstract
PURPOSE OF REVIEW At present, 85-90% of those born with congenital heart disease (CHD) grow up to become adults. With few exceptions, reparative surgery is not curative and requires long-term surveillance. Caregivers could be changed from pediatric cardiologists to adult CHD specialists (or cardiologists) during this process. This study will focus on the current practice of transition in CHD. RECENT FINDINGS Residua and sequelae may progress in severity with age and induce late complications, such as arrhythmias, cardiac failure, thromboembolism, sudden cardiac death, reoperation, cardiac intervention, and arrhythmia ablation. There are other obstacles that further complicate adult CHD, including pregnancy and delivery, noncardiac surgery, psychosocial problems, health insurance coverage, and extracardiac complications, making close follow-up and proper management mandatory. Because of this, several specialized centers have been established to respond to this need, and several studies focusing on transition have been published recently. SUMMARY Provision of comprehensive care by multidisciplinary teams including adult CHD specialists, adult and pediatric cardiologists and cardiovascular surgeons, specialized nurses, and other specific disciplines are the fundamental features in care facilities for adult CHD. Training and education should be focused on adult CHD fellows who represent the next generation that will assume responsibility for this patient population. Proper transition from pediatric cardiologists and cardiovascular surgeons to adult CHD care team, including adult CHD specialists and/or cardiologists trained in this field, is mandatory.
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Cohen SE, Hooper SR, Javalkar K, Haberman C, Fenton N, Lai H, Mahan JD, Massengill S, Kelly M, Cantú G, Medeiros M, Phillips A, Sawicki G, Wood D, Johnson M, Benton MH, Ferris M. Self-Management and Transition Readiness Assessment: Concurrent, Predictive and Discriminant Validation of the STARx Questionnaire. J Pediatr Nurs 2015; 30:668-76. [PMID: 26165785 DOI: 10.1016/j.pedn.2015.05.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/16/2015] [Accepted: 05/18/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The STARx Questionnaire was designed with patient and provider input, to measure self-management and transition skills in adolescents and young adults (AYA) with chronic health conditions. With proven reliability and an empirically-based factor structure, the self-report STARx Questionnaire requires further validation to demonstrate its clinical and research utility. In this study we examine the concurrent, predictive, and discriminant validity of the STARx Questionnaire. METHODS To examine concurrent validity, the STARx Questionnaire was compared to two other published transition readiness tools. Predictive validity was examined using linear regressions between the STARx Total Score and literacy, medication adherence, quality of life, and health services use. Discriminant validity was examined by comparing the performance of three chronic illness conditions on the STARx Total Score and associated subscales. RESULTS The STARx Questionnaire and its subscales positively correlated with the scores for both transition readiness tools reflecting strong concurrent validity. The STARx Questionnaire also correlated positively with the literacy, self-efficacy, and adherence measures indicating strong predictive validity; however, it did not correlate with either quality of life or health care utilization. The performance of AYA across three different clinical conditions was not significant, indicating the clinical utility of this HCT tool for a variety of chronic health conditions. CONCLUSION The strong validity of the STARx Questionnaire, in tandem with its strong reliability, indicated adequate psychometric properties for this generic self-report measure. These strong psychometric properties should contribute to the STARx being a viable measure of health care transition for both research and clinical purposes.
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Affiliation(s)
- Sarah E Cohen
- The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Stephen R Hooper
- The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Karina Javalkar
- The University of North Carolina at Chapel Hill School of Public Health, 135 Dauer Dr, Chapel Hill, NC
| | - Cara Haberman
- Wake Forest University, 1834 Wake Forest Rd, Winston-Salem, NC; Victory Junction Camp, 4500 Adam's Way, Randleman, NC
| | - Nicole Fenton
- The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Hsiao Lai
- The Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC
| | - John D Mahan
- Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH; The Ohio State University, Columbus, OH
| | - Susan Massengill
- Levine Children's Hospital at Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC
| | - Maureen Kelly
- The University of North Carolina at Chapel Hill School of Nursing, Carrington Hall, CB#7460, Chapel Hill, NC
| | - Guillermo Cantú
- Escuela de Medicina, Universidad Panamericana, Puerto Vallarta, Mexico
| | - Mara Medeiros
- Hospital Infantil de México Federico Gómez, Calle Dr. Márquez 162, Cuahtemoc, Doctores, Ciudad de México, D.F., Mexico
| | | | | | - David Wood
- East Tennessee State University James H. Quillen College of Medicine, 178 Maple Avenue, Mountain Home, TN
| | - Meredith Johnson
- The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Mary H Benton
- The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Maria Ferris
- The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC.
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Ferris M, Cohen S, Haberman C, Javalkar K, Massengill S, Mahan JD, Kim S, Bickford K, Cantu G, Medeiros M, Phillips A, Ferris MT, Hooper SR. Self-Management and Transition Readiness Assessment: Development, Reliability, and Factor Structure of the STARx Questionnaire. J Pediatr Nurs 2015. [PMID: 26209873 DOI: 10.1016/j.pedn.2015.05.009] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The Self-Management and Transition to Adulthood with Rx=Treatment (STARx) Questionnaire was developed to collect information on self-management and health care transition (HCT) skills, via self-report, in a broad population of adolescents and young adults (AYAs) with chronic conditions. METHODS Over several iterations, the STARx questionnaire was created with AYA, family, and health provider input. The development and pilot testing of the STARx Questionnaire took place with the assistance of 1219 AYAs with different chronic health conditions, in multiple institutions and settings over three phases: item development, pilot testing, reliability and factor structuring. RESULTS The three development phases resulted in a final version of the STARx Questionnaire. The exploratory factor analysis of the third version of the 18-item STARx identified six factors that accounted for about 65% of the variance: Medication management, Provider communication, Engagement during appointments, Disease knowledge, Adult health responsibilities, and Resource utilization. Reliability estimates revealed good internal consistency and temporal stability, with the alpha coefficient for the overall scale being .80. The STARx was developmentally sensitive, with older patients scoring significantly higher on nearly every factor than younger patients. CONCLUSION The STARx Questionnaire is a reliable, self-report tool with adequate internal consistency, temporal stability, and a strong, multidimensional factor structure. It provides another assessment strategy to measure self-management and transition skills in AYAs with chronic conditions.
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Affiliation(s)
- M Ferris
- The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC.
| | - S Cohen
- The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - C Haberman
- Wake Forest University, Winston-Salem, NC; Victory Junction Camp, Randleman, NC
| | - K Javalkar
- The University of North Carolina at Chapel Hill School of Public Health, Chapel Hill, NC
| | - S Massengill
- Levine Children's Hospital at Carolinas Medical Center, Charlotte, NC
| | - J D Mahan
- Nationwide Children's Hospital, Columbus, OH; The Ohio State University, Columbus, OH
| | - S Kim
- Nationwide Children's Hospital, Columbus, OH; The Ohio State University, Columbus, OH
| | - K Bickford
- The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - G Cantu
- Escuela de Medicina, Universidad Panamericana
| | - M Medeiros
- Hospital Infantil de México Federico Gómez
| | - A Phillips
- Hospital Infantil de México Federico Gómez
| | - M T Ferris
- The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - S R Hooper
- The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
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