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Valdez RS, Lyon SE, Corbett JP, Wellbeloved-Stone C, Hasan S, Taylor L, DeBoer MD, Cherñavvsky D, Patek SD. Macroergonomic components of the patient work system shaping dyadic care management during adolescence: a case study of type 1 diabetes. ERGONOMICS 2024:1-21. [PMID: 38712661 DOI: 10.1080/00140139.2024.2343942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 04/09/2024] [Indexed: 05/08/2024]
Abstract
The role of the social, physical, and organisational environments in shaping how patients and their caregivers perform work remains largely unexplored in human factors/ergonomics literature. This study recruited 19 dyads consisting of a parent and their child with type 1 diabetes to be interviewed individually and analysed using a macroergonomic framework. Our findings aligned with the macroergonomic factors as presented in previous models, while highlighting the need to expand upon certain components to gain a more comprehensive representation of the patient work system as relevant to dyadic management. Examples of design efforts that should follow from these findings include expanding existing data sharing options to include information from the external environment and capitalising on the capabilities of artificial intelligence as a decision support system. Future research should focus on longitudinally assessing patient work systems throughout transition periods in addition to more explicitly exploring the roles of social network members.
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Affiliation(s)
- Rupa S Valdez
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, Virginia, USA
- Health Discovery & Innovations, University of Virginia, Charlottesville, Virginia, USA
| | - Sophie E Lyon
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Saadiq Hasan
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Lauren Taylor
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Mark D DeBoer
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Virginia, Charlottesville, Virginia, USA
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
| | - Daniel Cherñavvsky
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
- Dexcom, Inc., San Diego, California, USA
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Scheer ER, Werner NE, Coller RJ, Nacht CL, Petty L, Tang M, Ehlenbach M, Kelly MM, Finesilver S, Warner G, Katz B, Keim-Malpass J, Lunsford CD, Letzkus L, Desai SS, Valdez RS. Designing for caregiving networks: a case study of primary caregivers of children with medical complexity. J Am Med Inform Assoc 2024; 31:1151-1162. [PMID: 38427845 PMCID: PMC11031225 DOI: 10.1093/jamia/ocae026] [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: 08/07/2023] [Revised: 01/21/2024] [Accepted: 02/01/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVE The study aimed to characterize the experiences of primary caregivers of children with medical complexity (CMC) in engaging with other members of the child's caregiving network, thereby informing the design of health information technology (IT) for the caregiving network. Caregiving networks include friends, family, community members, and other trusted individuals who provide resources, information, health, or childcare. MATERIALS AND METHODS We performed a secondary analysis of two qualitative studies. Primary studies conducted semi-structured interviews (n = 50) with family caregivers of CMC. Interviews were held in the Midwest (n = 30) and the mid-Atlantic region (n = 20). Interviews were transcribed verbatim for thematic analysis. Emergent themes were mapped to implications for the design of future health IT. RESULTS Thematic analysis identified 8 themes characterizing a wide range of primary caregivers' experiences in constructing, managing, and ensuring high-quality care delivery across the caregiving network. DISCUSSION Findings evidence a critical need to create flexible and customizable tools designed to support hiring/training processes, coordinating daily care across the caregiving network, communicating changing needs and care updates across the caregiving network, and creating contingency plans for instances where caregivers are unavailable to provide care to the CMC. Informaticists should additionally design accessible platforms that allow primary caregivers to connect with and learn from other caregivers while minimizing exposure to sensitive or emotional content as indicated by the user. CONCLUSION This article contributes to the design of health IT for CMC caregiving networks by uncovering previously underrecognized needs and experiences of CMC primary caregivers and drawing direct connections to design implications.
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Affiliation(s)
- Eleanore Rae Scheer
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA 22904, United States
| | - Nicole E Werner
- Department of Health and Wellness Design, Indiana University School of Public Health-Bloomington, Bloomington, IN 47405, United States
| | - Ryan J Coller
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Carrie L Nacht
- School of Public Health, San Diego State University, San Diego, CA 92182, United States
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA 92093, United States
| | - Lauren Petty
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA 22904, United States
| | - Mengwei Tang
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI 53706, United States
| | - Mary Ehlenbach
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Michelle M Kelly
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Sara Finesilver
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Gemma Warner
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Barbara Katz
- Family Voices of Wisconsin, Madison, WI 53705, United States
| | - Jessica Keim-Malpass
- Department of Pediatrics, University of Virginia, Charlottesville, VA 22903, United States
| | - Christopher D Lunsford
- Department of Orthopedics, Duke University, Durham, NC 27710, United States
- Department of Pediatrics, Duke University, Durham, NC 27707, United States
| | - Lisa Letzkus
- Department of Pediatrics, University of Virginia, Charlottesville, VA 22903, United States
| | - Shaalini Sanjiv Desai
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, United States
| | - Rupa S Valdez
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA 22904, United States
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, United States
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Keim-Malpass J, Lunsford C, Letzkus LC, Scheer E, Valdez RS. Establishing the Need for Anticipatory Symptom Guidance and Networked Models of Disease in Adaptive Family Management Among Children With Medical Complexity: Qualitative Study. JMIR Form Res 2023; 7:e52454. [PMID: 37801346 DOI: 10.2196/52454] [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: 09/04/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Caregivers of children with medical complexity navigate complex family management tasks for their child both in the hospital and home-based setting. The roles and relationships of members of their social network and the dynamic evolution of these family management tasks have been underexamined. OBJECTIVE The purpose of this study was to explore the structures and processes of family management among caregivers of children with medical complexity, with a focus on the underlying dynamic nature of family management practices and the role of members of their social network. METHODS This study used a qualitative approach to interview caregivers of children with medical complexity and members of their social network. Caregivers of children with medical complexity were recruited through an academic Children's Hospital Complex Care Clinic in the mid-Atlantic region and interviewed over a period of 1 to 3 days. Responses were analyzed using constructivist grounded theory and situational analysis to construct a new conceptual model. Only caregiver responses are reported here. RESULTS In total, 20 caregivers were included in this analysis. Caregiver perspectives revealed the contextual processes that allowed for practices of family management within the setting of rapidly evolving symptoms and health concerns. The dynamic and adaptive nature of this process is a key underlying action supporting this novel conceptual model. The central themes underpinning the adaptive family management model include symptom cues, ongoing surveillance, information gathering, and acute on chronic health concerns. The model also highlights facilitators and threats to successful family management among children with medical complexity and the networked relationship among the structures and processes. CONCLUSIONS The adaptive family management model provides a basis for further quantitative operationalization and study. Previously described self- or family management frameworks do not account for the underlying dynamic nature of the disease trajectory and the developmental stage progression of the child or adolescent, and our work extends existing work. For future work, there is a defined role for technology-enhanced personalized approaches to home-based monitoring. Due to the disparities caregivers and the children in this population already experience, technology-enhanced approaches must be built alongside key stakeholders with an equity orientation to technology co-development. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/14810.
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Affiliation(s)
- Jessica Keim-Malpass
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Christopher Lunsford
- Department of Physical Medicine and Rehabilitation, Duke University School of Medicine, Durham, NC, United States
| | - Lisa C Letzkus
- Division of Developmental Pediatrics, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Eleanore Scheer
- Department of Systems and Information Engineering, University of Virginia School of Engineering and Applied Sciences, Charlottesville, VA, United States
| | - Rupa S Valdez
- Department of Systems and Information Engineering, University of Virginia School of Engineering and Applied Sciences, Charlottesville, VA, United States
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
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Kieren MQ, Kelly MM, Garcia MA, Chen T, Ngo T, Baird J, Haskell H, Luff D, Mercer A, Quiñones-Pérez B, Williams D, Khan A. Parent Experiences with the Process of Sharing Inpatient Safety Concerns for Children with Medical Complexity: A Qualitative Analysis. Acad Pediatr 2023; 23:1535-1541. [PMID: 37302701 PMCID: PMC11099941 DOI: 10.1016/j.acap.2023.06.008] [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: 01/13/2023] [Revised: 05/26/2023] [Accepted: 06/03/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To describe the process of identifying and reporting inpatient safety concerns from the perspective of parents of children with medical complexity (CMC). METHODS We conducted a secondary analysis of qualitative data from semi-structured interviews with 31 English and Spanish-speaking parents of CMC at two tertiary children's hospitals. Interviews lasted 45-60 minutes and were audio-recorded, translated, and transcribed. Three researchers inductively and deductively coded transcripts using an iteratively refined codebook with validation by a fourth researcher. Thematic analysis was used to develop a conceptual model of the process of inpatient parent safety reporting. RESULTS We identified four steps illustrating the process of inpatient parent safety concern reporting 1) parent recognizing concern, 2) parent reporting concern, 3) staff/hospital response continuum, and 4) parent feelings of validation/invalidation. Many parents endorsed that they were the first to catch a safety concern and were identified as unique reporters of safety information. Parents typically described reporting their concerns verbally and in real-time to the person they felt could quickly remedy the situation. There was a spectrum of validation. Some parents reported their concerns were not acknowledged and addressed, which led them to feel overlooked, disregarded, or judged. Others reported their concerns were acknowledged and addressed, resulting in parents feeling heard and seen and often leading to changes in clinical care. CONCLUSIONS Parents described a multi-step process of reporting safety concerns during hospitalization and a spectrum of staff response and validation. These findings can inform family-centered interventions that support safety concern reporting in the inpatient setting.
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Affiliation(s)
- Madeline Q Kieren
- University of Wisconsin-Madison School of Medicine and Public Health, Department of Pediatrics (MQ Kieren, MM Kelly, MA Garcia, and T Chen)
| | - Michelle M Kelly
- University of Wisconsin-Madison School of Medicine and Public Health, Department of Pediatrics (MQ Kieren, MM Kelly, MA Garcia, and T Chen).
| | - Miguel A Garcia
- University of Wisconsin-Madison School of Medicine and Public Health, Department of Pediatrics (MQ Kieren, MM Kelly, MA Garcia, and T Chen)
| | - Tessa Chen
- University of Wisconsin-Madison School of Medicine and Public Health, Department of Pediatrics (MQ Kieren, MM Kelly, MA Garcia, and T Chen)
| | - Tiffany Ngo
- Division of General Pediatrics, Department of Medicine (A Mercer, B Quiñones-Pérez, and A Khan), Boston Children's Hospital
| | - Jennifer Baird
- Institute for Nursing and Interprofessional Research (J Baird), Children's Hospital Los Angeles
| | - Helen Haskell
- Mothers Against Medical Error (H Haskell) South Carolina Columbia
| | - Donna Luff
- Department of Anesthesiology (D Luff), Critical Care, and Pain Medicine, Boston Children's Hospital
| | - Alexandra Mercer
- Division of General Pediatrics, Department of Medicine (A Mercer, B Quiñones-Pérez, and A Khan), Boston Children's Hospital
| | - Bianca Quiñones-Pérez
- Division of General Pediatrics, Department of Medicine (A Mercer, B Quiñones-Pérez, and A Khan), Boston Children's Hospital
| | - David Williams
- Institutional Centers for Clinical and Translational Research (D Williams), Boston Children's Hospital
| | - Alisa Khan
- Division of General Pediatrics, Department of Medicine (A Mercer, B Quiñones-Pérez, and A Khan), Boston Children's Hospital; Department of Pediatrics (A Khan), Harvard Medical School
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Cui C, Li S, Chen W, Zhou H, Zheng X. Chinese families' knowledge, attitudes, and practices regarding seizure management for children with epilepsy: a mixed-methods study. Front Public Health 2023; 11:1081720. [PMID: 37255754 PMCID: PMC10225546 DOI: 10.3389/fpubh.2023.1081720] [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: 10/27/2022] [Accepted: 04/17/2023] [Indexed: 06/01/2023] Open
Abstract
Objective This study aimed to examine Chinese families' knowledge, attitudes, and practices regarding the management of acute seizures (AS) that occur outside the hospital in children with epilepsy (CWE) and factors that influence AS. Design A mixed-methods sequential explanatory study was conducted, which was integrated at the design and methods levels. In phase 1, a questionnaire was developed for this study, and a family functioning assessment was administered from Nov 2021 to Apr 2022. Multivariate logistic regression was used to analyze the knowledge, attitudes, and practices (KAP) and factors that influence AS. In phase 2, family caregivers (FCGs) were recruited from Jul to Aug 2022 to participate in a qualitative exploration, using semi-structured interviews and a combination of inductive and deductive methods. Setting The setting was five children's specialty hospitals in different regions of China. Participants The participants were FCGs of CWE. A total of 645 participants were included in the quantitative phase, and 15 FCGs (eight parents, five grandparents, and two others) were recruited for the qualitative phase. Results The FCGs' average total KAP score for AS management was 66.23 ± 15.12, with 45.42% of FCGs having a low level. Univariate and multivariate regression analyses showed that demographic factors, disease characteristics, and family function significantly predicted family management of AS. The three most salient themes and eight sub-themes from phase 2 were explored. The quantitative and qualitative databases were analyzed separately and combined through integration, and a conceptual model was constructed based on the individual and family self-management theory (IFSMT); the model consisted of context, knowledge, self-regulation, and promotion factors. Conclusion Chinese families have a positive attitude toward the management of out-of-hospital AS in CWE, but lack practice and related knowledge. AS management for CWE families was associated with the demographic characteristics of FCGs, epilepsy, and family characteristics. The research findings expand the existing application requirements of an Acute Seizure Action Plan and patient safety. Our results also indicate a pressing need for localized development of AS emergency medicine in family medicine, the establishment of auxiliary information systems, the utilization of caregivers' positive psychological resources, and improvements in family function for intergenerational care.
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Affiliation(s)
- Cui Cui
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Nursing Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Shuangzi Li
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Neurology Department of Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Wenjin Chen
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Neurology Department of Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Hengyu Zhou
- School of Nursing, Chongqing Medical University, Chongqing, China
| | - Xianlan Zheng
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Nursing Children's Hospital of Chongqing Medical University, Chongqing, China
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Barton HJ, Pflaster E, Loganathar S, Werner A, Tarfa A, Wilkins D, Ehlenbach ML, Katz B, Coller RJ, Valdez R, Werner NE. What makes a home? Designing home personas to represent the homes of families caring for children with medical complexity. APPLIED ERGONOMICS 2023; 106:103900. [PMID: 36122551 PMCID: PMC10072316 DOI: 10.1016/j.apergo.2022.103900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/22/2022] [Accepted: 09/05/2022] [Indexed: 06/15/2023]
Abstract
Personas are widely recognized as valuable design tools for communicating dimensions of individuals, yet they often lack critical contextual factors. For those people managing chronic health conditions, the home is a critical context of their patient work system (PWS). We propose the development of 'home personas' to convey essential aspects of the home context to those tasked with designing technologies and interventions to fit it. We used an iterative, multi-stakeholder design process to design 'home personas' for a model population, families caring for children with medical complexity. Each of the four resultant home personas-Multi-level, Customized, Ranch, and Rental-has a unique home layout, pain points, and are described on three dimensions that emerged from the data. This study builds on a foundation of work in the emerging field of Patient Ergonomics, describing a mechanism for distilling rich descriptions of the PWS into brief yet informative design tools.
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Affiliation(s)
- Hanna J Barton
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States
| | - Ellen Pflaster
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States
| | - Shanmugapriya Loganathar
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States
| | - Allison Werner
- School of Human Ecology, University of Wisconsin-Madison, United States
| | - Adati Tarfa
- School of Pharmacy, University of Wisconsin-Madison, United States
| | - David Wilkins
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States
| | - Mary L Ehlenbach
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, United States
| | | | - Ryan J Coller
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, United States
| | - Rupa Valdez
- Department of Public Health Sciences and Department of Engineering Systems and Environment, University of Virginia, United States
| | - Nicole E Werner
- Department of Health and Wellness Design, Indiana University School of Public Health-Bloomington, United States.
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Valdez RS, Lyon SE, Wellbeloved-Stone C, Collins M, Rogers CC, Cantin-Garside KD, Gonclaves Fortes D, Kim C, Desai SS, Keim-Malpass J, Kushalnagar R. Engaging the disability community in informatics research: rationales and practical steps. J Am Med Inform Assoc 2022; 29:1989-1995. [PMID: 35972753 PMCID: PMC9552212 DOI: 10.1093/jamia/ocac136] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/25/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
As the informatics community grows in its ability to address health disparities, there is an opportunity to expand our impact by focusing on the disability community as a health disparity population. Although informaticians have primarily catered design efforts to one disability at a time, digital health technologies can be enhanced by approaching disability from a more holistic framework, simultaneously accounting for multiple forms of disability and the ways disability intersects with other forms of identity. The urgency of moving toward this more holistic approach is grounded in ethical, legal, and design-related rationales. Shaped by our research and advocacy with the disability community, we offer a set of guidelines for effective engagement. We argue that such engagement is critical to creating digital health technologies which more fully meet the needs of all disabled individuals.
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Affiliation(s)
- Rupa S Valdez
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
- Department of Engineering Systems and Environment, University of Virginia, Charlottesville, Virginia, USA
- Blue Trunk Foundation, Charlottesville, Virginia, USA
| | - Sophie E Lyon
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | | | - Mary Collins
- Medline Industries, LP, Northfield, Illinois, USA
| | - Courtney C Rogers
- Department of Engineering Systems and Environment, University of Virginia, Charlottesville, Virginia, USA
| | - Kristine D Cantin-Garside
- Global Commercial Data Science Digital Health, Global Commercial Strategy Organization, Janssen Pharmaceuticals, Raritan, New Jersey, USA
| | | | | | - Shaalini S Desai
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | | | - Raja Kushalnagar
- Department of Science, Technology, Accessibility, Mathematics, and Public Health, Gallaudet University, Washington, District of Columbia, USA
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Mercer AN, Mauskar S, Baird J, Berry J, Chieco D, Copp K, Cox ED, Haskell H, Hennessy K, Kelly MM, Mallick N, McGeachey A, Melvin P, Ngo T, Pinkham A, Rogers J, Wickremasinghe W, Williams D, Landrigan CP, Khan A. Family Safety Reporting in Hospitalized Children With Medical Complexity. Pediatrics 2022; 150:e2021055098. [PMID: 35791784 PMCID: PMC11099940 DOI: 10.1542/peds.2021-055098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Hospitalized children with medical complexity (CMC) are at high risk of medical errors. Their families are an underutilized source of hospital safety data. We evaluated safety concerns from families of hospitalized CMC and patient/parent characteristics associated with family safety concerns. METHODS We conducted a 12-month prospective cohort study of English- and Spanish-speaking parents/staff of hospitalized CMC on 5 units caring for complex care patients at a tertiary care children's hospital. Parents completed safety and experience surveys predischarge. Staff completed surveys during meetings and shifts. Mixed-effects logistic regression with random intercepts controlling for clustering and other patient/parent factors evaluated associations between family safety concerns and patient/parent characteristics. RESULTS A total of 155 parents and 214 staff completed surveys (>89% response rates). 43% (n = 66) had ≥1 hospital safety concerns, totaling 115 concerns (1-6 concerns each). On physician review, 69% of concerns were medical errors and 22% nonsafety-related quality issues. Most parents (68%) reported concerns to staff, particularly bedside nurses. Only 32% of parents recalled being told how to report safety concerns. Higher education (adjusted odds ratio 2.94, 95% confidence interval [1.21-7.14], P = .02) and longer length of stay (3.08 [1.29-7.38], P = .01) were associated with family safety concerns. CONCLUSIONS Although parents of CMC were infrequently advised about how to report safety concerns, they frequently identified medical errors during hospitalization. Hospitals should provide clear mechanisms for families, particularly of CMC and those from disadvantaged backgrounds, to share safety concerns. Actively engaging patients/families in reporting will allow hospitals to develop a more comprehensive, patient-centered view of safety.
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Affiliation(s)
| | | | | | | | | | - Katherine Copp
- Division of General Pediatrics, Department of Pediatrics
| | | | - Helen Haskell
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts
| | - Karen Hennessy
- Division of General Pediatrics, Department of Pediatrics
| | - Michelle M Kelly
- Office of Health Equity and Inclusion
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California
| | - Nandini Mallick
- Department of Pediatrics, Mount Sinai School of Medicine, New York, New York
| | - Amanda McGeachey
- Maine Children's Cancer Program, The Barbara Bush Children's Hospital at Maine Medical Center, Scarborough, Maine
| | - Patrice Melvin
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
- Mothers Against Medical Error, Columbia, South Carolina
| | - Tiffany Ngo
- Division of General Pediatrics, Department of Pediatrics
| | - Amy Pinkham
- Division of General Pediatrics, Department of Pediatrics
| | - Jayne Rogers
- Division of General Pediatrics, Department of Pediatrics
| | | | - David Williams
- Department of Pediatrics, University of Wisconsin Health, American Family Children's Hospital, Madison, Wisconsin
- Department of Orthopaedic Surgery
| | - Christopher P Landrigan
- Division of General Pediatrics, Department of Pediatrics
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Alisa Khan
- Division of General Pediatrics, Department of Pediatrics
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Blair L, Vergales J, Peregoy L, Seegal H, Keim-Malpass J. Acceptability of an interstage home monitoring mobile application for caregivers of children with single ventricle physiology: Toward technology-integrated family management. J SPEC PEDIATR NURS 2022; 27:e12372. [PMID: 35365917 DOI: 10.1111/jspn.12372] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/31/2021] [Accepted: 03/02/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Infants with single ventricle physiology experience numerous vulnerable transitions, and the interstage period for shunt-dependent children represents the time of highest risk for morbidity and mortality. Data exchange, physiological monitoring, and communication between clinicians and caregivers through interstage home monitoring are critical. The purpose of this study is to report on the acceptability of a technology-enhanced home monitoring mobile application for interstage family management of children with single ventricle physiology. DESIGN AND METHODS This study employed a qualitative descriptive study design and recruited caregivers that were part of a broader quality improvement project where they were beta users of a mobile health application specifically developed for the interstage home monitoring time period. RESULTS Eleven caregivers were enrolled in this study that was a part of the early phases of beta testing the mobile application from a human-centered design perspective. In general, the participants had a favorable sentiment toward the technology-integrated family management aspects that the mobile application allowed for during the interstage process. The acceptability findings can be organized through the following themes: time needed for mobile application, family as integrated members of care team, connectedness and confidence, and resolving technical issues. CONCLUSIONS Evaluation of the feasibility and acceptability of this technology from the perspective of family/caregivers is a critical component of human-centered design. The integration of technology-facilitated communication shows immense promise for patient populations undergoing vulnerable transitions in care. Future study is needed to determine the role mobile applications have in improved clinical outcomes, enhanced provider clinical-decision support, and family engagement in care.
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Affiliation(s)
- Lisa Blair
- Department of Nursing, College of Nursing, University of Kentucky, Lexington, Kentucky, USA.,Department of Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Jeffrey Vergales
- Department of Pediatric Cardiology, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Leslie Peregoy
- Department of Pediatric Cardiology, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Hallie Seegal
- Department of Acute and Specialty Care, School of Nursing, University of Virginia, Charlottesville, Virginia, USA
| | - Jessica Keim-Malpass
- Department of Pediatric Cardiology, School of Medicine, University of Virginia, Charlottesville, Virginia, USA.,Department of Acute and Specialty Care, School of Nursing, University of Virginia, Charlottesville, Virginia, USA
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