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Paget SP, Mcintyre S, Schneuer FJ, Martin T, Sellars L, Burnett H, Price S, Nassar N. Outpatient encounters, continuity of care, and unplanned hospital care for children and young people with cerebral palsy. Dev Med Child Neurol 2024; 66:733-743. [PMID: 37946594 DOI: 10.1111/dmcn.15800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 09/19/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023]
Abstract
AIM To describe the relationships between outpatient encounters, continuity of care, and unplanned hospital care in children/young people with cerebral palsy (CP). METHOD In this population-based data-linkage cohort study we included children/young people with CP identified in the New South Wales/Australian Capital Territory CP Register (birth years 1994-2018). We measured the frequency of outpatient encounters and unplanned hospital care, defined as presentations to emergency departments and/or urgent hospital admissions (2015-2020). Continuity of outpatient care was measured using the Usual Provider of Care Index (UPCI). RESULTS Of 3267 children/young people with CP, most (n = 2738, 83.8%, 57.6% male) had one or more outpatient encounters (123 463 total encounters, median six outpatient encounters per year during childhood). High UPCI was more common in children/young people with mild CP (Gross Motor Function Classification System levels I-III, with no epilepsy or no intellectual disability), residing in metropolitan and areas of least socioeconomic disadvantage. Low UPCI was associated with four or more emergency department presentations (adjusted odds ratio [aOR] 2.34; 95% confidence interval [CI] 1.71-3.19) and one or more urgent hospital admissions (aOR 2.02; 95% CI 1.57-2.61). INTERPRETATION Children/young people with CP require frequent outpatient services. Improving continuity of care, particularly for those residing in regional/remote areas, may decrease need for unplanned hospital care. WHAT THIS PAPER ADDS Many children with cerebral palsy use multiple and frequent outpatient services. Better continuity of care is associated with living in metropolitan and less socioeconomically disadvantaged areas. Outpatient service utilization reduces at the time of transition to adult services. High outpatient utilization is associated with unplanned hospital care. Decreased continuity of care is associated with unplanned hospital care.
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Affiliation(s)
- Simon P Paget
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, The University of Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Sarah Mcintyre
- Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Francisco J Schneuer
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, The University of Sydney, New South Wales, Australia
| | - Tanya Martin
- School of Nursing and Midwifery, The University of Sydney, Sydney, New South Wales, Australia
| | - Louise Sellars
- Agency for Clinical Innovation, NSW Health, Sydney, New South Wales, Australia
| | - Heather Burnett
- HNEkidsHealth, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Sophie Price
- Agency for Clinical Innovation, NSW Health, Sydney, New South Wales, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, The University of Sydney, New South Wales, Australia
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Stewart NH, Kaiksow FA. Continuity for medical students in the hospital setting: A work in progress. J Hosp Med 2024; 19:442-443. [PMID: 38566338 DOI: 10.1002/jhm.13358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/11/2024] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Nancy H Stewart
- Department of Medicine, The University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Farah A Kaiksow
- Department of Medicine, The University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Ehrhardt MJ, Friedman DN, Hudson MM. Health Care Transitions Among Adolescents and Young Adults With Cancer. J Clin Oncol 2024; 42:743-754. [PMID: 38194608 DOI: 10.1200/jco.23.01504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/06/2023] [Accepted: 11/01/2023] [Indexed: 01/11/2024] Open
Abstract
Survivors of adolescent and young adult (AYA) cancers, defined as individuals diagnosed with a primary malignancy between age 15 and 39 years, are a growing population with unique developmental, psychosocial, and health-related needs. These individuals are at excess risk of developing a wide range of chronic comorbidities compared with the general population and, therefore, require lifelong, risk-based, survivorship care to optimize long-term health outcomes. The health care needs of survivors of AYA cancers are particularly complicated given the often heterogeneous and sometimes fragmented care they receive throughout the cancer care continuum. For example, AYA survivors are often treated in disparate settings (pediatric v adult) on dissimilar protocols that include different recommendations for longitudinal follow-up. Specialized tools and techniques are needed to ensure that AYA survivors move seamlessly from acute cancer care to survivorship care and, in many cases, from pediatric to adult clinics while still remaining engaged in long-term follow-up. Systematic, age-appropriate transitional practices involving well-established clinical models of care, survivorship care plans, and survivorship guidelines are needed to facilitate effective transitions between providers. Future studies are necessary to enhance and optimize the clinical effectiveness of transition processes in AYA cancer survivors.
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Affiliation(s)
- Matthew J Ehrhardt
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | - Danielle Novetsky Friedman
- Department of Pediatrics, Division of General Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Melissa M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
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Ostojic K, Karem I, Paget SP, Berg A, Dee-Price BJ, Lingam R, Dale RC, Eapen V, Woolfenden S. Social determinants of health for children with cerebral palsy and their families. Dev Med Child Neurol 2024; 66:32-40. [PMID: 37179527 DOI: 10.1111/dmcn.15640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/15/2023] [Accepted: 04/13/2023] [Indexed: 05/15/2023]
Abstract
Social determinants of health (SDH) influence health and social outcomes in positive and negative ways. Understanding the impact of SDH on children with cerebral palsy (CP) is essential to improve health equity, optimize health outcomes, and support children with CP and their families to thrive in society. In this narrative review, we summarize the landscape of SDH impacting children with CP and their families worldwide. In high-income countries, children from poorer neighbourhoods are more likely to have severe comorbidities, present with spastic bilateral CP, and report lower frequency of participation in community activities. In low- and middle-income countries, socioeconomic disadvantage is associated with increased risk of malnutrition, living in poorer housing conditions, not having access to proper sanitation, and living below the poverty line. Low maternal education is associated with increased likelihood of the child with CP experiencing increased severity of gross motor and bimanual functioning challenges, and poorer academic performance. Lower parental education is also associated with reduced child autonomy. On the other hand, higher parental income is a protective factor, associated with greater diversity of participation in day-to-day activities. A better physical environment and better social support are associated with higher participation in daily activities. Clinicians, researchers, and the community should be aware of these key challenges and opportunities. Then adopt a range of approaches that target adverse SDH/social needs and foster positive SDH in the clinical setting. WHAT THIS PAPER ADDS: Understanding how social determinants of health influence health and social outcomes is a critical step towards improving health equity and outcomes. Approaches are required that target the impact of adverse SDH on access to health care for children with cerebral palsy and that work towards ensuring equity of access for all.
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Affiliation(s)
- Katarina Ostojic
- Population Child Health Research Group, Discipline of Paediatrics and Child Health, University of New South Wales, Sydney, NSW, Australia
| | - Isra Karem
- Population Child Health Research Group, Discipline of Paediatrics and Child Health, University of New South Wales, Sydney, NSW, Australia
| | - Simon P Paget
- Kids Rehab, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Faculty of Medicine and Health, The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Alison Berg
- Kids Rehab, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Betty-Jean Dee-Price
- Southgate Institute for Health Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Raghu Lingam
- Population Child Health Research Group, Discipline of Paediatrics and Child Health, University of New South Wales, Sydney, NSW, Australia
| | - Russell C Dale
- Faculty of Medicine and Health, The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
- Neurology Department, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Valsamma Eapen
- Population Child Health Research Group, Discipline of Paediatrics and Child Health, University of New South Wales, Sydney, NSW, Australia
- South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Sue Woolfenden
- Population Child Health Research Group, Discipline of Paediatrics and Child Health, University of New South Wales, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
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Sabater-Gárriz Á, Gaya-Morey FX, Buades-Rubio JM, Manresa-Yee C, Montoya P, Riquelme I. Automated facial recognition system using deep learning for pain assessment in adults with cerebral palsy. Digit Health 2024; 10:20552076241259664. [PMID: 38846372 PMCID: PMC11155325 DOI: 10.1177/20552076241259664] [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] [Received: 01/09/2024] [Accepted: 05/07/2024] [Indexed: 06/09/2024] Open
Abstract
Objective Assessing pain in individuals with neurological conditions like cerebral palsy is challenging due to limited self-reporting and expression abilities. Current methods lack sensitivity and specificity, underlining the need for a reliable evaluation protocol. An automated facial recognition system could revolutionize pain assessment for such patients.The research focuses on two primary goals: developing a dataset of facial pain expressions for individuals with cerebral palsy and creating a deep learning-based automated system for pain assessment tailored to this group. Methods The study trained ten neural networks using three pain image databases and a newly curated CP-PAIN Dataset of 109 images from cerebral palsy patients, classified by experts using the Facial Action Coding System. Results The InceptionV3 model demonstrated promising results, achieving 62.67% accuracy and a 61.12% F1 score on the CP-PAIN dataset. Explainable AI techniques confirmed the consistency of crucial features for pain identification across models. Conclusion The study underscores the potential of deep learning in developing reliable pain detection systems using facial recognition for individuals with communication impairments due to neurological conditions. A more extensive and diverse dataset could further enhance the models' sensitivity to subtle pain expressions in cerebral palsy patients and possibly extend to other complex neurological disorders. This research marks a significant step toward more empathetic and accurate pain management for vulnerable populations.
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Affiliation(s)
- Álvaro Sabater-Gárriz
- Department of Research and Training, Balearic ASPACE Foundation, Marratxí, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma de Mallorca, Spain
- Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Palma de Mallorca, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - F Xavier Gaya-Morey
- Department of Mathematics and Computer Science, University of the Balearic Islands, Palma de Mallorca, Spain
| | - José María Buades-Rubio
- Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Palma de Mallorca, Spain
- Department of Mathematics and Computer Science, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Cristina Manresa-Yee
- Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Palma de Mallorca, Spain
- Department of Mathematics and Computer Science, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Pedro Montoya
- Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Palma de Mallorca, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
| | - Inmaculada Riquelme
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma de Mallorca, Spain
- Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Palma de Mallorca, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
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Thanalingam Y, Langridge F, Gordon I, Russell J, Muir C, Hamm LM. Strategies and tools to aid the transition between paediatric and adult health services for young adults with neurodevelopmental disorders: a scoping review protocol. BMJ Open 2022; 12:e065138. [PMID: 36446454 PMCID: PMC9710347 DOI: 10.1136/bmjopen-2022-065138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The transition from paediatric to adult healthcare comes with risk and vulnerability for young adults with neurodevelopmental disorders and their carers. Deficits in health, social and disability systems and the fragmentation of services exacerbate problems during the transition period, leaving young people and their carers feeling disconnected with existing services. With advances in healthcare, the number of young adults with neurodevelopmental disorders requiring transition services is increasing. This scoping review aims to summarise the strategies and tools that help ease the transition to adult services for young adults with neurodevelopmental disorders. METHODS AND ANALYSIS Systematic searches of MEDLINE, EMBASE and PsychInfo on the OVID platform were performed on 28/05/2022. Studies that describe tools or strategies designed to ease the transition from child-centred to adult-orientated healthcare for young adults with neurodevelopmental disorders will be included. Two authors will independently review titles, abstracts and full-text articles against the inclusion criteria to determine eligibility. Data will be extracted and synthesised using descriptive stats and thematic analysis. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines will be followed. CONCLUSION This scoping review will synthesise the published literature describing strategies and tools to improve the transition of young adults with neurodevelopmental disorders to adult services. The findings of the review may inform areas of future research to improve care for all involved in the transition process. ETHICS AND DISSEMINATION This review will include published data; as such, ethics approval is not required. We will publish our findings in an open-access, peer-reviewed journal and summarise the results for dissemination to the wider community of clinicians, allied healthcare professionals, teaching professionals, policymakers, non-governmental organisations, impacted youth and parents.
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Affiliation(s)
- Yattheesh Thanalingam
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Fiona Langridge
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Iris Gordon
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jin Russell
- Department of Developmental Paediatrics, Starship Children's Health, Auckland, Auckland, New Zealand
- Centre for Longitudinal Research-He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Colette Muir
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Department of Developmental Paediatrics, Starship Children's Health, Auckland, Auckland, New Zealand
| | - Lisa Marie Hamm
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
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Nicolet A, Al-Gobari M, Perraudin C, Wagner J, Peytremann-Bridevaux I, Marti J. Association between continuity of care (COC), healthcare use and costs: what can we learn from claims data? A rapid review. BMC Health Serv Res 2022; 22:658. [PMID: 35578226 PMCID: PMC9112559 DOI: 10.1186/s12913-022-07953-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 04/08/2022] [Indexed: 01/07/2023] Open
Abstract
Objective To describe how longitudinal continuity of care (COC) is measured using claims-based data and to review its association with healthcare use and costs. Research design Rapid review of the literature. Methods We searched Medline (PubMed), EMBASE and Cochrane Central, manually checked the references of included studies, and hand-searched websites for potentially additional eligible studies. Results We included 46 studies conducted in North America, East Asia and Europe, which used 14 COC indicators. Most reported studies (39/46) showed that higher COC was associated with lower healthcare use and costs. Most studies (37/46) adjusted for possible time bias and discussed causality between the outcomes and COC, or at least acknowledged the lack of it as a limitation. Conclusions Whereas a wide range of indicators is used to measure COC in claims-based data, associations between COC and healthcare use and costs were consistent, showing lower healthcare use and costs with higher COC. Results were observed in various population groups from multiple countries and settings. Further research is needed to make stronger causal claims. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07953-z.
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Affiliation(s)
- Anna Nicolet
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Biopôle 2 SV-A, Route de la Corniche 10, CH-1010, Lausanne, Switzerland.
| | - Muaamar Al-Gobari
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Biopôle 2 SV-A, Route de la Corniche 10, CH-1010, Lausanne, Switzerland
| | - Clémence Perraudin
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Biopôle 2 SV-A, Route de la Corniche 10, CH-1010, Lausanne, Switzerland
| | - Joël Wagner
- Department of Actuarial Science, Faculty of Business and Economics (HEC), and Swiss Finance Institute, University of Lausanne, Lausanne, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Biopôle 2 SV-A, Route de la Corniche 10, CH-1010, Lausanne, Switzerland
| | - Joachim Marti
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Biopôle 2 SV-A, Route de la Corniche 10, CH-1010, Lausanne, Switzerland
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Snyder DA, Schuller J, Ameen Z, Toth C, Kemper AR. Improving Patient-Provider Continuity in a Large Urban Academic Primary Care Network. Acad Pediatr 2022; 22:305-312. [PMID: 34780999 DOI: 10.1016/j.acap.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/04/2021] [Accepted: 11/06/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Although patient-provider continuity improves care delivery and satisfaction, poor continuity with primary care providers (PCP) often exists in academic centers. We aimed to increase patient empanelment from 0% to 90% and then increase the percent of well-child care (WCC) visits scheduled with the PCP from 25.6% to 50%, without decreasing timely access that might result if patients waited for PCP availability. METHODS Nationwide Children's Hospital Primary Care Network cares for >120,000 mostly Medicaid-enrolled patients across 13 offices. Before 2017, patients were empaneled to an office, not individual PCPs. We empaneled patients to PCPs, reduced provider floating, implemented continuity-promoting scheduling guidelines, scheduled future WCC visits for patients ≤15 months during check-in for their current one, and encouraged online scheduling. We tracked the percentage of all WCC visits that were scheduled with the patient's PCP and the percentage of subsequent WCC visits for patients ≤15 months that were scheduled during the current visit, and provided feedback to schedulers. We followed emergency department (ED) utilization and visit show rates. WCC visit completion rates were tracked using HEDIS metrics. RESULTS Patient empanelment increased from 0% to >90% (P < .001). Patient-provider WCC continuity increased from 25.6% to 54.7% (P < .001). A 20.5% decrease in ED utilization rate was associated with continuity project initiation. Empaneled patients demonstrated higher show rates (76.9%) versus unempaneled patients (71.4%; P < .001). WCC completion rates increased from 52.6% to 60.7%. CONCLUSIONS WCC continuity more than doubled after interventions and was associated with decreased ED utilization, higher show rates, and increased timely WCC completion.
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Affiliation(s)
- Dane A Snyder
- Division of Primary Care Pediatrics, Nationwide Children's Hospital (DA Synder, J Schuller, Z Ameen, and AR Kemper), Columbus, Ohio.
| | - Jonathon Schuller
- Division of Primary Care Pediatrics, Nationwide Children's Hospital (DA Synder, J Schuller, Z Ameen, and AR Kemper), Columbus, Ohio
| | - Zeenath Ameen
- Division of Primary Care Pediatrics, Nationwide Children's Hospital (DA Synder, J Schuller, Z Ameen, and AR Kemper), Columbus, Ohio
| | - Christina Toth
- Quality Improvement Services, Nationwide Children's Hospital (C Toth), Columbus, Ohio
| | - Alex R Kemper
- Division of Primary Care Pediatrics, Nationwide Children's Hospital (DA Synder, J Schuller, Z Ameen, and AR Kemper), Columbus, Ohio
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Paget S, Ostojic K, Goldsmith S, Nassar N, McIntyre S. Determinants of hospital-based health service utilisation in cerebral palsy: a systematic review. Arch Phys Med Rehabil 2021; 103:1628-1637. [PMID: 34968439 DOI: 10.1016/j.apmr.2021.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/25/2021] [Accepted: 12/01/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To systematically review and synthesize evidence of determinants associated with hospital-based health service utilisation among individuals with cerebral palsy (CP). DATA SOURCES Electronic databases MEDLINE, Embase, APA Psycinfo were searched from January 2000 to April 2020. STUDY SELECTION Observational studies were included that described people with CP, reported quantitative measures of hospital-based health service utilisation (inpatient, outpatient, emergency department), and based in high-income countries. We excluded studies that included only subsets of people with CP, or those that only reported therapy service utilisation. DATA EXTRACTION After initial screen, two reviewers reviewed full texts for inclusion and performed data extraction and risk of bias assessment using the Newcastle Ottawa scale. Determinants of health service utilisation were identified and categorised using the Andersen Behavioural Model. DATA SYNTHESIS Seventeen studies met inclusion criteria. Study quality was high. Twenty-six determinants were reported across eight Andersen Model characteristics. Individual predisposing factors such as sex showed no difference in health service utilisation; inpatient admissions decreased with increasing age during childhood and was lower in adults. Increased health service utilisation was associated with "individual need" including severe gross motor disability, epilepsy, developmental/ intellectual disability and gastrostomy-use across inpatient, outpatient and emergency department settings. There was little information reported on socio-demographic and health system contextual determinants. CONCLUSIONS CP health service utilisation was associated with age, severity and comorbidities. Improved understanding of determinants of health service utilisation can support health service access for people with CP.
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Affiliation(s)
- Simon Paget
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Kids Rehab, the Children's Hospital at Westmead, Westmead NSW Australia.
| | - Katarina Ostojic
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
| | - Shona Goldsmith
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
| | - Natasha Nassar
- Child Population and Translational Health, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Sarah McIntyre
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
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