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Berkalieva A, Kelly NR, Fisher A, Hohmann SF, Abul-Husn NS, Greally JM, Horowitz CR, Wasserstein MP, Kenny EE, Gelb BD, Ferket BS. Physician and informal care use explained by the Pediatric Quality of Life Inventory (PedsQL) in children with suspected genetic disorders. Qual Life Res 2024:10.1007/s11136-024-03677-1. [PMID: 38743313 DOI: 10.1007/s11136-024-03677-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE To examine associations between Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales and PedsQL Infant Scales with formal health care resource utilization (HCRU) and informal caregiver burden. METHODS We studied a pediatric cohort of 837 patients (median age: 8.4 years) with suspected genetic disorders enrolled January 2019 through July 2021 in the NYCKidSeq program for diagnostic sequencing. Using linked ~ nine-month longitudinal survey and physician claims data collected through May 2022, we modeled the association between baseline PedsQL scores and post-baseline HCRU (median follow-up: 21.1 months) and informal care. We also assessed the longitudinal change in PedsQL scores with physician services using linear mixed-effects models. RESULTS Lower PedsQL total and physical health scores were independently associated with increases in 18-month physician services, encounters, and weekly informal care. Comparing low vs. median total scores, increases were 10.6 services (95% CI: 1.0-24.6), 3.3 encounters (95% CI: 0.5-6.8), and $668 (95% CI: $350-965), respectively. For the psychosocial domain, higher scores were associated with decreased informal care. Based on adjusted linear mixed-effects modeling, every additional ten physician services was associated with diminished improvement in longitudinal PedsQL total score trajectories by 1.1 point (95% confidence interval: 0.6-1.6) on average. Similar trends were observed in the physical and psychosocial domains. CONCLUSION PedsQL scores were independently associated with higher utilization of physician services and informal care. Moreover, longitudinal trajectories of PedsQL scores became less favorable with increased physician services. Adding PedsQL survey instruments to conventional measures for improved risk stratification should be evaluated in further research.
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Affiliation(s)
- Asem Berkalieva
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029-6574, USA
| | - Nicole R Kelly
- Division of Pediatric Genetic Medicine, Department of Pediatrics, Children's Hospital at Montefiore/Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ashley Fisher
- Center for Advanced Analytics, Vizient, Chicago, IL, USA
| | | | - Noura S Abul-Husn
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- 23andMe Inc, Sunnyvale, CA, USA
- Division for Genomic Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John M Greally
- Division of Genomics, Department of Genetics, Children's Hospital at Montefiore/Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Carol R Horowitz
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Melissa P Wasserstein
- Division of Pediatric Genetic Medicine, Department of Pediatrics, Children's Hospital at Montefiore/Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Eimear E Kenny
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division for Genomic Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bruce D Gelb
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bart S Ferket
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029-6574, USA.
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Schiavoni KH, Flom M, Blumenthal KJ, Orav EJ, Hefferon M, Maher E, Boudreau AA, Giuliano CP, Chambers B, Mandell MH, Vienneau M, Mendu ML, Vogeli C. Cost, Utilization, and Patient and Family Experience With ACO-Based Pediatric Care Management. Pediatrics 2023; 152:e2022058268. [PMID: 38013488 DOI: 10.1542/peds.2022-058268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Children and Youth with Special Health Care Needs have high healthcare utilization, fragmented care, and unmet health needs. Accountable Care Organizations (ACOs) increasingly use pediatric care management to improve quality and reduce unnecessary utilization. We evaluated effects of pediatric care management on total medical expense (TME) and utilization; perceived quality of care coordination, unmet needs, and patient and family experience; and differential impact by payor, risk score, care manager discipline, and behavioral health diagnosis. METHODS Mixed-methods analysis including claims using quasi-stepped-wedge design pre and postenrollment to estimate difference-in-differences, participant survey, and semistructured interviews. Participants included 1321 patients with medical, behavioral, or social needs, high utilization, in Medicaid or commercial ACOs, and enrolled in multidisciplinary, primary care-embedded care management. RESULTS TME significantly declined 1 to 6 months postenrollment and continued through 19 to 24 months (-$645.48 per member per month, P < .001). Emergency department and inpatient utilization significantly decreased 7 to 12 months post-enrollment and persisted through 19 to 24 months (-29% emergency department, P = .012; -82% inpatient, P < .001). Of respondents, 87.2% of survey respondents were somewhat or very satisfied with care coordination, 56.1% received education coordination when needed, and 81.5% had no unmet health needs. Emergency department or inpatient utilization decreases were consistent across payors and care manager disciplines, occurred sooner with behavioral health diagnoses, and were significant among children with above-median risk scores. Satisfaction and experience were equivalent across groups, with more unmet needs and frustration with above-median risk scores. CONCLUSIONS Pediatric care management in multipayor ACOs may effectively reduce TME and utilization and clinically provide high-quality care coordination, including education and family stress, with high participant satisfaction.
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Affiliation(s)
- Katherine H Schiavoni
- Mass General Brigham, Population Health Management, Somerville, Massachusetts
- Departments of Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Megan Flom
- Mass General Brigham, Population Health Management, Somerville, Massachusetts
| | - Karen J Blumenthal
- Mass General Brigham, Population Health Management, Somerville, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - E John Orav
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Margaret Hefferon
- Mass General Brigham, Population Health Management, Somerville, Massachusetts
| | - Erin Maher
- Mass General Brigham, Population Health Management, Somerville, Massachusetts
| | - Alexy Arauz Boudreau
- Mass General Brigham, Population Health Management, Somerville, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Christopher P Giuliano
- Mass General Brigham, Population Health Management, Somerville, Massachusetts
- Affiliated Pediatric Practices, Dedham, Massachusetts
- Mass General Brigham Community Physicians Organization, Somerville, Massachusetts
| | - Barbara Chambers
- Mass General Brigham, Population Health Management, Somerville, Massachusetts
- Mass General Brigham Community Physicians Organization, Somerville, Massachusetts
| | - Mark H Mandell
- Mass General Brigham, Population Health Management, Somerville, Massachusetts
- Pediatric Associates of Greater Salem, Salem, Massachusetts
| | - Maryann Vienneau
- Mass General Brigham, Population Health Management, Somerville, Massachusetts
| | - Mallika L Mendu
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Renal Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christine Vogeli
- Mass General Brigham, Population Health Management, Somerville, Massachusetts
- The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts
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Walsby A, O'Connor L, Best S, Williams SJ. Evaluation of a family liaison officer role introduced during the COVID-19 pandemic: A mixed methods study. J Eval Clin Pract 2023; 29:998-1007. [PMID: 37021355 DOI: 10.1111/jep.13843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 04/07/2023]
Abstract
RATIONALE The restrictions to hospital visiting for carers and relatives during the pandemic were unprecedented. To ensure patients could stay in touch with their relatives and carers new liaison roles were introduced. AIMS AND OBJECTIVES The aim of this study is to report on the evaluation of a Family Liaison Officer (FLO) role to understand the rationale for introducing the role along with the challenges and benefits of its implementation. METHODS A concurrent mixed methods design was used, triangulating both semi structured interviews and online surveys. Data were collected during 2021 from postholders, patients/relatives and key stakeholders. RESULTS The family liaison officer role occupies a key brokering role between clinical teams and patients/relatives. All participants agreed the importance of the role particularly in relation to communication. Postholders noted issues around clarity of scope of practice. Patients reported the social benefits of the FLOs particularly in relation to technology. There was also key learning in terms of induction, training and line management of this nonprofessional role. CONCLUSION There is limited research that evaluates emerging nonprofessional roles that connect clinical teams and patients/relatives. This evaluation study although limited to one organisation provides important insights to the strategic and operational learning to introducing a family liaison officer role during the COVID-19 pandemic.
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Affiliation(s)
- Alex Walsby
- Hywel Dda University Health Board, Carmarthen, Wales, UK
- School of Health & Social Care, Swansea University, Swansea, Wales, UK
| | | | - Stephanie Best
- Peter MacCallum Cancer Centre, Melbourne, Australia and Health & Social Care, Swansea University, Swansea, Wales, UK
| | - Sharon J Williams
- School of Health & Social Care, Swansea University, Swansea, Wales, UK
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Kukafka R, Eysenbach G, Wang J, Mao F, Wu L, Huang Y, Sun J, Cao F. Effectiveness of Digital Guided Self-help Mindfulness Training During Pregnancy on Maternal Psychological Distress and Infant Neuropsychological Development: Randomized Controlled Trial. J Med Internet Res 2023; 25:e41298. [PMID: 36763452 PMCID: PMC9960047 DOI: 10.2196/41298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/17/2022] [Accepted: 01/09/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Maternal psychological distress during pregnancy is associated with unfavorable outcomes in infants. Mindfulness-based interventions (MBIs) can effectively alleviate psychological distress, but there are often barriers to the access of face-to-face interventions. OBJECTIVE This study aimed to investigate the effectiveness of a digital guided self-help (GSH) MBI (GSH-MBI) in reducing maternal psychological distress and improving infant neuropsychological performance. METHODS This was a randomized controlled trial. We recruited 160 women who were 12 to 20 weeks pregnant and exhibited psychological distress. We randomized them into a digital GSH-MBI group and a control group (usual perinatal care). The digital GSH-MBI consisted of a 6-week intervention through a WeChat mini program, with a daily reminder sent to the participants by a research assistant via WeChat. The primary outcomes consisted of maternal psychological distress, including depression, anxiety, and pregnancy-related anxiety symptoms, which were assessed at 6 time points from baseline to 6 months post partum (only pregnancy-related anxiety symptoms were assessed 3 times during pregnancy). The secondary outcomes were infant neuropsychological outcomes, including temperament and developmental behaviors, which were assessed at 6 weeks and 6 months post partum. RESULTS Compared with the control group, the digital GSH-MBI group showed a significant reduction in depression, anxiety, and pregnancy-related anxiety symptoms. In addition, the scores of the digital GSH-MBI group were lower than those of the control group for the 3 types of infant temperament at 6 weeks post partum, including quality of mood, distractibility, and adaptability. CONCLUSIONS Digital GSH-MBIs are effective in alleviating psychological distress among pregnant women and protecting infant outcomes. TRIAL REGISTRATION Chinese Clinical Trial Register ChiCTR2000040717; https://www.chictr.org.cn/showproj.aspx?proj=65376.
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Affiliation(s)
| | | | - Juan Wang
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Fangxiang Mao
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Liuliu Wu
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Yongqi Huang
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Jiwei Sun
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fenglin Cao
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
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Carter HE, Waugh J, Chang AB, Shelton D, David M, Weir KA, Levitt D, Carty C, Frakking TT. Cost-Effectiveness of Care Coordination for Children With Chronic Noncomplex Medical Conditions: Results From a Multicenter Randomized Clinical Trial. Value Health 2022; 25:S1098-3015(22)02063-0. [PMID: 35871140 DOI: 10.1016/j.jval.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/02/2022] [Accepted: 06/03/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To assess the cost-effectiveness of care coordination, compared with standard care, for children with chronic noncomplex medical conditions. METHODS A total of 81 children aged between 2 and 15 years newly diagnosed with a noncomplex chronic condition were randomized to either care coordination or standard care as part of a multicenter randomized controlled trial. Families receiving care coordination were provided access to an Allied Health Liaison Officer, who facilitated family-centered healthcare access across hospital, education, primary care, and community sectors. Costs were estimated over a 12-month period from the perspective of the Australian health system. Health outcomes were valued as quality-adjusted life-years (QALYs). Caregiver productivity costs were included in an alternative base-case analysis, and key assumptions were tested in a series of one-way sensitivity analyses. A probabilistic sensitivity analysis was conducted to investigate the overall impact of uncertainty in the data. RESULTS Children in the intervention arm incurred an average of $17 in additional health system costs (95% confidence interval -3861 to 1558) and gained an additional 0.031 QALYs (95% confidence interval -0.29 to 0.092) over 12 months, producing an incremental cost-effectiveness ratio of $548 per QALY. When uncertainty was considered, there was a 73% likelihood that care coordination was cost-effective from a health system perspective, assuming a willingness to pay of $50 000 per QALY. This increased to 78% when caregiver productivity costs were included. CONCLUSIONS Care coordination is likely to be a cost-effective intervention for children with chronic noncomplex medical conditions in the Australian healthcare setting.
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Affiliation(s)
- Hannah E Carter
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia.
| | - John Waugh
- Department of Paediatrics, Caboolture Hospital, Queensland Health, Caboolture, QLD, Australia; School of Clinical Medicine, The University of Queensland, Herston, QLD, Australia
| | - Anne B Chang
- Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane, QLD, Australia; Child Health Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia; Australian Centre for Health Services Innovation, Queensland University of Technology, South Brisbane, QLD, Australia
| | - Doug Shelton
- Department of Paediatrics, Gold Coast University Hospital, Queensland Health, Southport, QLD, Australia
| | - Michael David
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia; The Daffodil Centre, The University of Sydney, A Joint Venture With Cancer Council NSW
| | - Kelly A Weir
- School of Health Sciences and Social Work and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia; Allied Health Research, Gold Coast Health, Southport, QLD, Australia
| | - David Levitt
- Department of Paediatrics, Queensland Children's Hospital, Children's Health Queensland, South Brisbane, QLD, Australia
| | - Christopher Carty
- Research Development Unit, Caboolture Hospital, Queensland Health, Caboolture, QLD, Australia; Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Thuy T Frakking
- Research Development Unit, Caboolture Hospital, Queensland Health, Caboolture, QLD, Australia; Centre for Clinical Research, School of Medicine, The University of Queensland, Herston, QLD, Australia; Speech Pathology Department, Gold Coast University Hospital, Southport, QLD, Australia
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