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Mestre TD, Lopes MJ, Mestre DM, Ferreira RF, Costa AP, Caldeira EV. Impact of family-centered care in families with children with intellectual disability: A systematic review. Heliyon 2024; 10:e28241. [PMID: 38560242 PMCID: PMC10981057 DOI: 10.1016/j.heliyon.2024.e28241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
Background Family-Centered Care (FCC) is an approach to healthcare planning, delivery and evaluation, based on beneficial partnerships between health professionals, patients and families. FCC may be particularly relevant for families with children with intellectual disability (ID), given their needs of continuum care. Objective To identify which components of the FCC are practiced and which health outcomes are considered effective in families with children with ID. Method A systematic review guided by the PRISMA STATEMENT 2020 approach and the STROBE reporting guidelines was performed on specific databases through the EBSCOhost Web platform: MEDLINE with Full Text, CINAHL PLUS with Full Text, Academic Search Complete and Psychology and Behavioral Sciences Collection. Peer-reviewed articles published in English or Portuguese languages from 2018 to September 2023 were retrieved. Methodological quality was established using the Quality Assessment Tool for Observational, Cohort and Cross-Sectional Studies - NHLBI, NIH. Results Ten studies met the eligibility criteria and were synthetized. The results revealed nine components, reflecting the way FCC was developed: shared decision-making; family education; respect for culture; family engagement; recognition of the family's needs, characteristics and interests; specialized care support; social and emotional support; family functionality; and family seen as a unit. The health outcomes demonstrate effective gains in improving children's health through family satisfaction with health services. Also achieved psychological and social benefits, with improved family well-being and quality of life, favoring family empowerment. Conclusions The evidence suggests that FCC components involves an effective partnership between the family and health professionals as the main key in developing care plans, as well as the experience that the family unit brings to the delivery of care. FCC approach include all family members as decision-makers, providing emotional, physical and instrumental levels of support. Health outcomes emerged in three strands; for children with ID, families and health services.
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Affiliation(s)
- Teresa Dionísio Mestre
- Comprehensive Health Research Centre [CHRC], Portugal
- Polytechnic Institute of Beja – Health Department, Portugal
| | - Manuel José Lopes
- Comprehensive Health Research Centre [CHRC], Portugal
- University of Évora – Health Department, Portugal
| | | | - Rogério Ferrinho Ferreira
- Comprehensive Health Research Centre [CHRC], Portugal
- Polytechnic Institute of Beja – Health Department, Portugal
| | - Ana Pedro Costa
- Comprehensive Health Research Centre [CHRC], Portugal
- Local Health Unit of Lower Alentejo [ULSBA], Beja, Portugal
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Graaf G, Hughes PM, deJong NA, Thomas KC. Family Support Services and Reported Parent Coping Among Caregivers of Children with Emotional, Behavioral, or Developmental Disorders. J Dev Behav Pediatr 2024; 45:e54-e62. [PMID: 38127916 PMCID: PMC10922057 DOI: 10.1097/dbp.0000000000001230] [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] [Received: 07/10/2023] [Accepted: 09/12/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Caregivers of children with special health care needs (CSHCN) experience substantial strain caring for their child's special needs because of high needs for health and other support services. Caregivers of CSHCN with emotional, behavioral, or developmental problems (EBDPs) report stress and poor mental health at higher rates than caregivers of other CSHCN. Although family support services are associated with caregiver mental health and well-being among families of CSHCN, the association of these factors with caregiver coping has been underexamined. METHOD Using the Double ABCX Model of Family Adaptation to guide variable selection, this study uses 2016 to 2019 data from the National Survey of Children's Health. Univariate, bivariate, and multivariate logistic analyses examined the association between caregivers' receipt of adequate care coordination and emotional support services and their reported coping with the day-to-day strains of parenting. These relationships are compared between caregivers of CSHCN with and without EBDPs. RESULTS Receipt of adequate care coordination was associated with higher rates of caregiver-reported positive coping for all caregivers of CSHCN who have no source of emotional support. Receipt of emotional support services was associated with increased reports of positive coping for caregivers for all CSHCN as well. Caregivers reporting only informal sources of emotional support, however, also reported higher rates of positive coping when compared with caregivers with no source of emotional support. CONCLUSION Mobilization of resources that can aid caregivers in coordinating care and provide emotional support may play a key role in positive caregiver coping for families of CSHCN.
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Affiliation(s)
- Genevieve Graaf
- School of Social Work, University of Texas at Arlington; 211 South Cooper Street, Box 19129, Arlington, TX 76019
| | - Phillip M Hughes
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
| | - Neal A deJong
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Kathleen C Thomas
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC
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Ming DY, Wong W, Jones KA, Antonelli RC, Gujral N, Gonzales S, Rogers U, Ratliff W, Shah N, King HA. Feasibility of Implementation of a Mobile Digital Personal Health Record to Coordinate Care for Children and Youth With Special Health Care Needs in Primary Care: Protocol for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e46847. [PMID: 37728977 PMCID: PMC10551780 DOI: 10.2196/46847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Electronic health record (EHR)-integrated digital personal health records (PHRs) via Fast Healthcare Interoperability Resources (FHIR) are promising digital health tools to support care coordination (CC) for children and youth with special health care needs but remain widely unadopted; as their adoption grows, mixed methods and implementation research could guide real-world implementation and evaluation. OBJECTIVE This study (1) evaluates the feasibility of an FHIR-enabled digital PHR app for CC for children and youth with special health care needs, (2) characterizes determinants of implementation, and (3) explores associations between adoption and patient- or family-reported outcomes. METHODS This nonrandomized, single-arm, prospective feasibility trial will test an FHIR-enabled digital PHR app's use among families of children and youth with special health care needs in primary care settings. Key app features are FHIR-enabled access to structured data from the child's medical record, families' abilities to longitudinally track patient- or family-centered care goals, and sharing progress toward care goals with the child's primary care provider via a clinician dashboard. We shall enroll 40 parents or caregivers of children and youth with special health care needs to use the app for 6 months. Inclusion criteria for children and youth with special health care needs are age 0-16 years; primary care at a participating site; complex needs benefiting from CC; high hospitalization risk in the next 6 months; English speaking; having requisite technology at home (internet access, Apple iOS mobile device); and an active web-based EHR patient portal account to which a parent or caregiver has full proxy access. Digital prescriptions will be used to disseminate study recruitment materials directly to eligible participants via their existing EHR patient portal accounts. We will apply an intervention mixed methods design to link quantitative and qualitative (semistructured interviews and family engagement panels with parents of children and youth with special health care needs) data and characterize implementation determinants. Two CC frameworks (Pediatric Care Coordination Framework; Patient-Centered Medical Home) and 2 evaluation frameworks (Consolidated Framework for Implementation Research; Technology Acceptance Model) provide theoretical foundations for this study. RESULTS Participant recruitment began in fall 2022, before which we identified >300 potentially eligible patients in EHR data. A family engagement panel in fall 2021 generated formative feedback from family partners. Integrated analysis of pretrial quantitative and qualitative data informed family-centered enhancements to study procedures. CONCLUSIONS Our findings will inform how to integrate an FHIR-enabled digital PHR app for children and youth with special health care needs into clinical care. Mixed methods and implementation research will help strengthen implementation in diverse clinical settings. The study is positioned to advance knowledge of how to use digital health innovations for improving care and outcomes for children and youth with special health care needs and their families. TRIAL REGISTRATION ClinicalTrials.gov NCT05513235; https://clinicaltrials.gov/study/NCT05513235. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46847.
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Affiliation(s)
- David Y Ming
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Willis Wong
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Richard C Antonelli
- Department of Pediatrics, Boston Children's Hospital, Harvard School of Medicine, Boston, MA, United States
| | - Nitin Gujral
- Innovation and Digital Health Accelerator, Boston Children's Hospital, Boston, MA, United States
| | - Sarah Gonzales
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Ursula Rogers
- AI Health, Duke University School of Medicine, Durham, NC, United States
| | - William Ratliff
- Duke Institute for Health Innovation, Duke University School of Medicine, Durham, NC, United States
| | - Nirmish Shah
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Heather A King
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veteran Affairs Health Care System, Durham, NC, United States
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Hynes DM, Thomas KC. Realigning theory with evidence to understand the role of care coordination in mental health services research. INTERNATIONAL JOURNAL OF CARE COORDINATION 2023; 26:55-61. [PMID: 37333504 PMCID: PMC10273861 DOI: 10.1177/20534345231153801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Current theoretical models intended to guide health services research and evaluation lack care coordination-its features and impacts. These aspects are critical for understanding the role of care coordination in healthcare use, quality, and outcomes. In this Focus article, we briefly review the well-known Andersen individual behavioral model (IBM) of healthcare use and the Donabedian health system and quality model (HSQM) together with recent practice-based evidence. We propose a new integrated theoretical model of healthcare and care coordination. The model can serve as a guide for future research to better understand the variation in care coordination services and delivery and its added value to improving mental health in different real-world settings.
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Affiliation(s)
- Denise M Hynes
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, USA
- Health Management and Policy Program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, and Center for Quantitative Life Sciences, Oregon State University, Corvallis, OR, USA
| | - Kathleen C Thomas
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy; Cecil G. Sheps Center for Health Services Research and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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5
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Ming DY, Zhao C, Tang X, Chung RJ, Rogers UA, Stirling A, Economou-Zavlanos NJ, Goldstein BA. Predictive Modeling to Identify Children With Complex Health Needs At Risk for Hospitalization. Hosp Pediatr 2023; 13:357-369. [PMID: 37092278 PMCID: PMC10158078 DOI: 10.1542/hpeds.2022-006861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND Identifying children at high risk with complex health needs (CCHN) who have intersecting medical and social needs is challenging. This study's objectives were to (1) develop and evaluate an electronic health record (EHR)-based clinical predictive model ("model") for identifying high-risk CCHN and (2) compare the model's performance as a clinical decision support (CDS) to other CDS tools available for identifying high-risk CCHN. METHODS This retrospective cohort study included children aged 0 to 20 years with established care within a single health system. The model development/validation cohort included 33 months (January 1, 2016-September 30, 2018) and the testing cohort included 18 months (October 1, 2018-March 31, 2020) of EHR data. Machine learning methods generated a model that predicted probability (0%-100%) for hospitalization within 6 months. Model performance measures included sensitivity, positive predictive value, area under receiver-operator curve, and area under precision-recall curve. Three CDS rules for identifying high-risk CCHN were compared: (1) hospitalization probability ≥10% (model-predicted); (2) complex chronic disease classification (using Pediatric Medical Complexity Algorithm [PMCA]); and (3) previous high hospital utilization. RESULTS Model development and testing cohorts included 116 799 and 27 087 patients, respectively. The model demonstrated area under receiver-operator curve = 0.79 and area under precision-recall curve = 0.13. PMCA had the highest sensitivity (52.4%) and classified the most children as high risk (17.3%). Positive predictive value of the model-based CDS rule (19%) was higher than CDS based on the PMCA (1.9%) and previous hospital utilization (15%). CONCLUSIONS A novel EHR-based predictive model was developed and validated as a population-level CDS tool for identifying CCHN at high risk for future hospitalization.
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Affiliation(s)
- David Y. Ming
- Departments of Pediatrics
- Medicine
- Population Health Sciences
| | | | - Xinghong Tang
- Janssen Research & Development, LLC, Raritan, New Jersey
| | | | - Ursula A. Rogers
- Duke AI Health, Duke University School of Medicine, Durham, North Carolina
| | - Andrew Stirling
- Duke AI Health, Duke University School of Medicine, Durham, North Carolina
| | | | - Benjamin A. Goldstein
- Departments of Pediatrics
- Population Health Sciences
- Biostatistics & Bioinformatics, and
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Cosgrove B, Knafl K, Van Riper M. A Mixed Methods Analysis of Care Coordination Needs and Desirable Features of an M-Health Application to Support Caregivers of Children With Down Syndrome. J Pediatr Health Care 2023; 37:30-39. [PMID: 36257899 PMCID: PMC9772063 DOI: 10.1016/j.pedhc.2022.08.002] [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] [Received: 05/13/2022] [Revised: 08/04/2022] [Accepted: 08/07/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Care coordination is critical for the management of health care needs of children with Down syndrome by encompassing management of health information and linking of providers. This study was designed to identify caregiver and health care provider experiences of care coordination to inform the development of an m-health application. METHOD In this mixed methods study, caregivers completed survey materials addressing the child's health care needs, m-health use, and care coordination experiences. A sample of caregivers and health care providers were interviewed to further understanding. RESULTS Most caregivers reported having a primary health care provider but wanted increased communication and help with care coordination. Interview data identified themes related to care coordination challenges, including information management, information sharing, use of health care guidelines, tracking health data, resources, technology use, previous application use, and coordination of schedules. DISCUSSION Qualitative themes were linked to desired features of an m-health application to aid in development.
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Affiliation(s)
- Beth Cosgrove
- Beth Cosgrove, Assistant Professor, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC; Kathleen Knafl, Professor, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marcia Van Riper, Professor, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Kathleen Knafl
- Beth Cosgrove, Assistant Professor, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC; Kathleen Knafl, Professor, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marcia Van Riper, Professor, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Marcia Van Riper
- Beth Cosgrove, Assistant Professor, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC; Kathleen Knafl, Professor, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marcia Van Riper, Professor, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC
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7
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Graaf G, Gigli K. Care coordination and unmet need for specialised health services among children with special healthcare needs in the USA: results from a cross-sectional analysis of the national survey of children with special healthcare needs. BMJ Open 2022; 12:e063373. [PMID: 36385031 PMCID: PMC9670924 DOI: 10.1136/bmjopen-2022-063373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To report rates of need and unmet need for specialised health services (occupational and speech therapies, durable medical equipment, home healthcare, and mobility and communication aids) from the National Survey of Children with Special Health Care Needs (CSHCN) (2009/2010) and assess the role of care coordination in having needs met. We distinguish between CSHCN with and without emotional, behavioural and developmental disorders (EBDPs) in the USA. DESIGN A cross sectional cohort study of a nationally representative sample of CSHCN from the National Survey of CSHCN for 2009/2010 used logistic regression to assess the relationship between EBDPs and need and unmet need for specialised services. It also estimates the association of care coordination with unmet need for all services, for CSHCN with and without EBDPs. SETTING A nationally representative sample of CSHCN in the USA. PARTICIPANTS Children ages 0-17 years of age. RESULTS Across all specialised health services, rates of unmet need were at or below 25%. Need and unmet need for most services was higher among CSHCN with EBDPs than those without. For CSHCN with and without EBDPs, adequate care coordination was associated with greater probability of having needs for therapy, home health and communication aids met. CONCLUSION Care coordination is essential to reducing barriers to a wide range of healthcare services for CSCHN. Policies requiring adequate insurance coverage for care coordination may play a critical role in ensuring access to specialised health services.
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Affiliation(s)
- Genevieve Graaf
- School of Social Work, University of Texas, Arlington, Texas, USA
| | - Kristin Gigli
- College of Nursing and Health Innovation, University of Texas, Arlington, Texas, USA
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Willgerodt MA, Blakeney EAR. Can relational coordination theory be used to understand and improve interprofessional care coordination in schools? A pilot study. J Interprof Care 2022; 36:761-764. [PMID: 35129028 PMCID: PMC9356112 DOI: 10.1080/13561820.2021.1997951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/02/2021] [Accepted: 10/15/2021] [Indexed: 10/19/2022]
Abstract
Attending to the health needs of students with chronic conditions requires a fluid exchange of information and coordination between parents, educators, administrators, and school healthcare professionals. Previous research often omits school nurses in this exchange, although their role is key to successful outcomes. Relational Coordination (RC) theory posits that cohesive relationships help support communication, enabling stakeholders to coordinate their work. This article preliminarily explores whether RC domains might be relevant in school health settings, utilizing existing qualitative data. Responses from focus group sessions were analyzed using a deductive and inductive analytic approach. Data were coded using the 7 RC domains as a priori codes. Frequent, timely, and accurate communication emerged as major themes in the communication domain. Shared knowledge was a major theme within the relationship domain. Problem-solving communication, shared goals, and mutual respect were minor themes. The results suggest that improving interprofessional collaboration (IPC) and health outcomes in children with chronic conditions using RC theory-informed interventions will be important to deepen the understanding of how these different domains interact and influence student health outcomes.
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Swann-Thomsen HE, Lindsay R, Rourk S, Hofacer R, Nguyen E. National Survey Data to Evaluate Case Management Services: A Systematic Review on Care Coordination Using the National Survey of Children With Special Health Care Needs. Prof Case Manag 2022; 27:124-140. [PMID: 35363658 DOI: 10.1097/ncm.0000000000000551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hillary E Swann-Thomsen
- Hillary E. Swann-Thomsen, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. She is currently an applied research scientist at St. Luke's Health System. Her research focuses on improving quality of care in vulnerable patient populations
- Ryan Lindsay, PhD, MPH, is an associate professor in the Department of Community and Public Health at Idaho State University with interests in the household production of health, healthcare access, and the interaction between substance use and infectious diseases. His research highlights the health of addicted, deaf, homeless, immigrant, and sex worker populations
- Seth Rourk, PharmD, was a student pharmacist at Idaho State University College of Pharmacy during the time of this work. He is currently an instructor and affiliate faculty in the Department of Pharmacy Practice at Idaho State University
- Rylon Hofacer, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. He is currently a healthcare economics analyst at Blue Cross of Idaho
- Elaine Nguyen, PharmD, MPH, is an assistant professor in the Department of Pharmacy Practice at Idaho State University. She is interested in chronic disease management, health services-related research, and the use of technology in patient care
| | - Ryan Lindsay
- Hillary E. Swann-Thomsen, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. She is currently an applied research scientist at St. Luke's Health System. Her research focuses on improving quality of care in vulnerable patient populations
- Ryan Lindsay, PhD, MPH, is an associate professor in the Department of Community and Public Health at Idaho State University with interests in the household production of health, healthcare access, and the interaction between substance use and infectious diseases. His research highlights the health of addicted, deaf, homeless, immigrant, and sex worker populations
- Seth Rourk, PharmD, was a student pharmacist at Idaho State University College of Pharmacy during the time of this work. He is currently an instructor and affiliate faculty in the Department of Pharmacy Practice at Idaho State University
- Rylon Hofacer, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. He is currently a healthcare economics analyst at Blue Cross of Idaho
- Elaine Nguyen, PharmD, MPH, is an assistant professor in the Department of Pharmacy Practice at Idaho State University. She is interested in chronic disease management, health services-related research, and the use of technology in patient care
| | - Seth Rourk
- Hillary E. Swann-Thomsen, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. She is currently an applied research scientist at St. Luke's Health System. Her research focuses on improving quality of care in vulnerable patient populations
- Ryan Lindsay, PhD, MPH, is an associate professor in the Department of Community and Public Health at Idaho State University with interests in the household production of health, healthcare access, and the interaction between substance use and infectious diseases. His research highlights the health of addicted, deaf, homeless, immigrant, and sex worker populations
- Seth Rourk, PharmD, was a student pharmacist at Idaho State University College of Pharmacy during the time of this work. He is currently an instructor and affiliate faculty in the Department of Pharmacy Practice at Idaho State University
- Rylon Hofacer, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. He is currently a healthcare economics analyst at Blue Cross of Idaho
- Elaine Nguyen, PharmD, MPH, is an assistant professor in the Department of Pharmacy Practice at Idaho State University. She is interested in chronic disease management, health services-related research, and the use of technology in patient care
| | - Rylon Hofacer
- Hillary E. Swann-Thomsen, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. She is currently an applied research scientist at St. Luke's Health System. Her research focuses on improving quality of care in vulnerable patient populations
- Ryan Lindsay, PhD, MPH, is an associate professor in the Department of Community and Public Health at Idaho State University with interests in the household production of health, healthcare access, and the interaction between substance use and infectious diseases. His research highlights the health of addicted, deaf, homeless, immigrant, and sex worker populations
- Seth Rourk, PharmD, was a student pharmacist at Idaho State University College of Pharmacy during the time of this work. He is currently an instructor and affiliate faculty in the Department of Pharmacy Practice at Idaho State University
- Rylon Hofacer, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. He is currently a healthcare economics analyst at Blue Cross of Idaho
- Elaine Nguyen, PharmD, MPH, is an assistant professor in the Department of Pharmacy Practice at Idaho State University. She is interested in chronic disease management, health services-related research, and the use of technology in patient care
| | - Elaine Nguyen
- Hillary E. Swann-Thomsen, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. She is currently an applied research scientist at St. Luke's Health System. Her research focuses on improving quality of care in vulnerable patient populations
- Ryan Lindsay, PhD, MPH, is an associate professor in the Department of Community and Public Health at Idaho State University with interests in the household production of health, healthcare access, and the interaction between substance use and infectious diseases. His research highlights the health of addicted, deaf, homeless, immigrant, and sex worker populations
- Seth Rourk, PharmD, was a student pharmacist at Idaho State University College of Pharmacy during the time of this work. He is currently an instructor and affiliate faculty in the Department of Pharmacy Practice at Idaho State University
- Rylon Hofacer, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. He is currently a healthcare economics analyst at Blue Cross of Idaho
- Elaine Nguyen, PharmD, MPH, is an assistant professor in the Department of Pharmacy Practice at Idaho State University. She is interested in chronic disease management, health services-related research, and the use of technology in patient care
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Brown A, Quaile M, Morris H, Tumin D, Parker CL, Warren L, Wall B, Crickmore K, Ledoux M, Eldridge DL, Aikman I. Outpatient Follow-up Care After Hospital Discharge of Children With Complex Chronic Conditions at a Rural Tertiary Care Hospital. Clin Pediatr (Phila) 2021; 60:512-519. [PMID: 34541911 DOI: 10.1177/00099228211047242] [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]
Abstract
OBJECTIVE To determine factors associated with completion of recommended outpatient follow-up visits in children with complex chronic conditions (CCCs) following hospital discharge. METHODS We retrospectively identified children aged 1 to 17 years diagnosed with a CCC who were discharged from our rural tertiary care children's hospital between 2017 and 2018 with a diagnosis meeting published CCC criteria. Patients discharged from the neonatal intensive care unit and patients enrolled in a care coordination program for technology-dependent children were excluded. RESULTS Of 113 eligible patients, 77 (68%) had outpatient follow-up consistent with discharge instructions. Intensive care unit (ICU) admission (P = .020) and prolonged length of stay (P = .004) were associated with decreased likelihood of completing recommended follow-up. CONCLUSIONS Among children with CCCs who were not already enrolled in a care coordination program, ICU admission was associated with increased risk of not completing recommended outpatient follow-up. This population could be targeted for expanded care coordination efforts.
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Affiliation(s)
| | - Mary Quaile
- East Carolina University, Greenville, NC, USA
| | | | | | - Clayten L Parker
- James and Connie Maynard Children's Hospital at Vidant Medical Center, Greenville, NC, USA
| | - Lana Warren
- James and Connie Maynard Children's Hospital at Vidant Medical Center, Greenville, NC, USA
| | - Bennett Wall
- James and Connie Maynard Children's Hospital at Vidant Medical Center, Greenville, NC, USA
| | - Kim Crickmore
- James and Connie Maynard Children's Hospital at Vidant Medical Center, Greenville, NC, USA
| | | | | | - Inga Aikman
- East Carolina University, Greenville, NC, USA
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Graaf G, Annis I, Martinez R, Thomas KC. Predictors of Unmet Family Support Service Needs in Families of Children with Special Health Care Needs. Matern Child Health J 2021; 25:1274-1284. [PMID: 33942229 DOI: 10.1007/s10995-021-03156-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study describes rates of perceived and unmet need for family support services (care coordination, respite care, and family mental health care) among a national sample of children with special health care needs (CSHCN), distinguishing children with emotional, behavioral, or developmental problems (EBDPs) from children with primarily physical chronic conditions. It also examines if a child having EBDPs is associated with perceived and unmet family support service needs and investigates public versus private health insurance's moderating effect on this association. METHODS Using data from the National Survey of Children with Special Health Care Needs (2005/2006 and 2009/2010), this cross-sectional study uses multi-level, fixed effects logistic regression. RESULTS When compared to CSHCN with no EBDPs, parents of CSHCN with EBDPs report greater need for all family support services and greater rates of unmet need for all support services. This pattern of greater need for CSHCN with EBDPs versus those without is similar among those with public and private health insurance. Among CSHCN with family support needs, however, the pattern differs. For CSHCN with EBDPs, having public insurance is associated with lower probabilities of unmet needs compared to private insurance. For CSHCN without EBDPs, having public insurance has a mixed effect on probability of reporting unmet need. CONCLUSION Having EBDPs and public insurance is associated with increased perceived need, but public insurance also confers particular benefit for children with EBDPs.
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Affiliation(s)
- Genevieve Graaf
- School of Social Work, University of Texas At Arlington, Social Work Complex-A, 112D 211 South Cooper Street, Box 19129, Arlington, TX, 76019, USA.
| | - Izabela Annis
- Eshelman School of Pharmacy, University of North Carolina At Chapel Hill, Chapel Hill, USA
| | - Regina Martinez
- School of Social Work, University of Texas At Arlington, Social Work Complex-A, 112D 211 South Cooper Street, Box 19129, Arlington, TX, 76019, USA
| | - Kathleen C Thomas
- Eshelman School of Pharmacy, University of North Carolina At Chapel Hill, Chapel Hill, USA
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12
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Brenner M, Doyle A, Begley T, Doyle C, Hill K, Murphy M. Enhancing care of children with complex healthcare needs: an improvement project in a community health organisation in Ireland. BMJ Open Qual 2021; 10:bmjoq-2020-001025. [PMID: 33619077 PMCID: PMC7903071 DOI: 10.1136/bmjoq-2020-001025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Integration of care for children with complex care needs is developing slowly internationally. There remains wide variation in the governance of, and access to, care for these children and their families. LOCAL PROBLEM There was a need to develop a service that would have a specific remit for organising the overall management and governance of the care of these children in the community. METHOD A bespoke model was established specifically to support the needs of children with complex healthcare needs (CHNs). The sole focus of the team is to provide the highest standard of care to these children and their families, and to enable families to remain central to decision-making. INTERVENTION The service for children with CHNs was established in August 2017 with the appointment of a service manager and case managers. A comprehensive training and education programme was put in place to support care to the children and their families. RESULTS The service is viewed as delivering high-quality care. Parents and stakeholders highlighted the value placed within the service on individualised care, specialist knowledge and the importance of advocacy. CONCLUSIONS The model recognises the exceptional lives these children and families live, given the complexities and challenges they have to overcome on a daily basis. The team have built a specialist knowledge and skill set in supporting families and others involved in the care of the child, as they are solely employed and dedicated to the provision of care to children with CHNs. The corporate governance structures seem strong and stand up to scrutiny very well in terms of parents' and stakeholders' perspectives and in the context of published international best practice.
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Affiliation(s)
- Maria Brenner
- School of Nursing & Midwifery, The University of Dublin Trinity College, Dublin, Ireland
| | - Amanda Doyle
- Primary Care General Manager, Health Service Executive, Ballyshannon, Ireland
| | - Thelma Begley
- School of Nursing & Midwifery, The University of Dublin Trinity College, Dublin, Ireland
| | - Carmel Doyle
- School of Nursing & Midwifery, The University of Dublin Trinity College, Dublin, Ireland
| | - Katie Hill
- School of Nursing & Midwifery, The University of Dublin Trinity College, Dublin, Ireland
| | - Maryanne Murphy
- School of Nursing & Midwifery, The University of Dublin Trinity College, Dublin, Ireland
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13
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Garver AE, Mohanty S, Dicianno BE, Turchi RM. Primary care providers need education and resources to provide optimal care for children and adults with spina bifida. J Pediatr Rehabil Med 2021; 14:681-689. [PMID: 34897106 DOI: 10.3233/prm-210039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE The objective of this study was to describe the knowledge, attitudes, and practices related to caring for youth with SB within a statewide pediatric primary care medical home network. METHODS Health care professionals who were members of the Pennsylvania Medical Home Program (PAMHP) statewide network were surveyed on sociological demographics, confidence in and knowledge of topics that impact the spina bifida (SB) population, education on SB, designating responsibility of care, tasks completed in the office, and transition from pediatric to adult care from October 2016 through November 2016. RESULTS Among 67 respondents, 78%believed counseling families/caregivers about the impact of SB on everyday life was a shared responsibility between primary care physicians (PCP) and SB clinics. Eighty five percent of participants indicated they had exposure to SB through clinical courses or didactics in training but only 54%of participants felt knowledgeable on the impact of SB on everyday life. CONCLUSION Findings suggest a need for increased educational efforts, improved awareness of SB, and access to evidence-based guidelines for PCPs to promote accessible and coordinated care to individuals with SB.
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Affiliation(s)
- Amanda E Garver
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Salini Mohanty
- Pennsylvania Chapter of the American Academy of Pediatrics, Media, PA, USA
| | - Brad E Dicianno
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Renee M Turchi
- Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, PA, USA.,Drexel University College of Medicine and Dornsife School of Public Health, Philadelphia, PA, USA
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14
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Leeb RT, Cree RA, Aird L, DeBiasi RL, Driggers RW, Garbarczyk E, Mofenson LM, Needle S, Rodriguez J, Curry C, García F, Godfred-Cato S, Hawks D, Rosenblum E, Dziuban E, Hudak M. A Framework for Coordination between Obstetric and Pediatric Providers in Public Health Emergencies: Lessons Learned from the Zika Outbreak in the United States, 2015 to 2017. Am J Perinatol 2020; 37:982-990. [PMID: 32438426 PMCID: PMC7416207 DOI: 10.1055/s-0040-1712104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Emergency response to emerging threats with the potential for vertical transmission, such as the 2015 to 2017 response to Zika virus, presents unique clinical challenges that underscore the need for better communication and care coordination between obstetric and pediatric providers to promote optimal health for women and infants. Published guidelines for routine maternal-infant care during the perinatal period, and models for transitions of care in various health care settings are available, but no broad framework has addressed coordinated multidisciplinary care of the maternal-infant dyad during emergency response. We present a novel framework and strategies to improve care coordination and communication during an emergency response. The proposed framework includes (1) identification and collection of critical information to inform care, (2) key health care touchpoints for the maternal-infant dyad, and (3) primary pathways of communication and modes of transfer across touchpoints, as well as practical strategies. This framework and associated strategies can be modified to address the care coordination needs of pregnant women and their infants with possible exposure to other emerging infectious and noninfectious congenital threats that may require long-term, multidisciplinary management. KEY POINTS: · Emerging congential threats present unique coordination challenges for obstetric and pediatric clinicians during emergency response.. · We present a framework to help coodinate care of pregnant women/infants exposed to congenital threats.. · The framework identifies critical information to inform care, health care touchpoints, and communication/information transfer pathways..
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Affiliation(s)
- Rebecca T. Leeb
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia,Address for correspondence Rebecca T. Leeb, PhD National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention4770 Buford Highway, Mailstop S106-4, Atlanta, GA 30341
| | - Robyn A. Cree
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Laura Aird
- Emerging Threats and Disaster Management, Pediatric Population Health, Department of Healthy Resilient Children, Youth and Families, American Academy of Pediatrics, Itasca, Illinois
| | - Roberta L. DeBiasi
- Division of Pediatric Infectious Diseases, Children’s National Hospital/Children’s National Research Institute, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Rita W. Driggers
- Johns Hopkins University School of Medicine, Sibley Memorial Hospital, Johns Hopkins Medicine, Washington, District of Columbia
| | - Elizabeth Garbarczyk
- Division of State Coverage Programs, Center for Medicaid & CHIP Services, Centers for Medicare and Medicaid Services, Baltimore, Maryland
| | - Lynne M. Mofenson
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia
| | | | - Jeannie Rodriguez
- National Association of Pediatric Nurse Practitioners, New York, New York,Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia
| | - Christine Curry
- University of Miami, Miller School of Medicine, Miami, Florida
| | | | - Shana Godfred-Cato
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Debra Hawks
- Practice Activities, Obstetrics and Immunization, American College of Obstetricians and Gynecologists, Washington, District of Columbia
| | - Elizabeth Rosenblum
- Department of Family Medicine & Public Health, Universtiy of California San Diego, San Diego, California
| | - Eric Dziuban
- Center for Global Health, Centers for Disease Prevention and Control, Windhoek, Namibia
| | - Mark Hudak
- Department of Pediatrics, University of Florida College of Medicine–Jacksonville, Jacksonville, Florida
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