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Kelly MM, Kieren MQ, Coller RJ, Pitt MB, Smith CA. Pediatric Open Notes: Caregiver Experiences Since the 21st Century Cures Act. Acad Pediatr 2024; 24:556-558. [PMID: 37793607 PMCID: PMC10985041 DOI: 10.1016/j.acap.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/27/2023] [Accepted: 10/01/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Michelle M Kelly
- Department of Pediatrics (MM Kelly, MQ Kieren, and RJ Coller), University of Wisconsin School of Medicine and Public Health, Madison, Wis.
| | - Madeline Q Kieren
- Department of Pediatrics (MM Kelly, MQ Kieren, and RJ Coller), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Ryan J Coller
- Department of Pediatrics (MM Kelly, MQ Kieren, and RJ Coller), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Michael B Pitt
- Department of Pediatrics (MB Pitt), University of Minnesota Medical School, Minneapolis, Minn
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Kelly MM, Martin-Peters T, Farber JS. Secondary Data Analysis: Using existing data to answer new questions. J Pediatr Health Care 2024:S0891-5245(24)00053-1. [PMID: 38556962 DOI: 10.1016/j.pedhc.2024.03.005] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/11/2024] [Accepted: 03/16/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Secondary data analysis is a cost-effective, accessible, and efficient means of utilizing existing data to answer new research questions. METHOD The manuscript provides an overview of the secondary data analysis process, as well as benefits and limitations inherent in the research method. RESULTS An exemplar of pediatric focused research using a publicly available dataset is presented to facilitate understanding of the process. DISCUSSION Novice and experienced researchers benefit from exploring the quantitative and qualitative secondary data analysis options available.
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Webber S, Semia S, Nacht CL, Garcia S, Kloster H, Vellardita L, Kieren MQ, Kelly MM. Physician Work-Personal Intersection: A Scoping Review of Terms, Definitions, and Measures. Acad Med 2024; 99:331-339. [PMID: 38039978 DOI: 10.1097/acm.0000000000005579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
PURPOSE A substantial body of evidence describes the multidimensional relationship between the intersection of physicians' work and personal lives and health care quality and costs, workforce sustainability, and workplace safety culture. However, there is no clear consensus on the terms, definitions, or measures used in physician work-personal intersection (WPI) research. In this scoping review, the authors aimed to describe the terms and definitions used by researchers to describe physician WPI, summarize the measurement tools used, and formulate a conceptual model of WPI that can inform future research. METHOD The authors searched PubMed, CINAHL, Scopus, and Web of Science for studies that investigated U.S. practicing physicians' WPI and measured WPI as an outcome from January 1990 to March 2022. The authors applied thematic analysis to all WPI terms, definitions, and survey questions or prompts in the included studies to create a conceptual model of physician WPI. RESULTS Ultimately, 102 studies were included in the final analysis. The most commonly used WPI terms were work-life balance, work-life integration, and work-home or work-life conflict(s). There was no consistency in the definition of any terms across studies. There was heterogeneity in the way WPI was measured, and only 8 (7.8%) studies used a validated measurement tool. The authors identified 6 key driver domains of WPI: work and personal demands; colleague and institutional support and resources; personal identity, roles, health, and values; work schedule and flexibility; partner and family support; and personal and professional strategies. CONCLUSIONS The authors found significant variability in the terms, definitions, and measures used to study physician WPI. They offer a conceptual model of the WPI construct that can be used to more consistently study physician WPI in the future. Future work should further investigate the validity of this model and generate consensus around WPI terms, definitions, and measures.
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Nacht CL, Jacobson N, Shiyanbola O, Smith CA, Hoonakker PL, Coller RJ, Dean SM, Sklansky DJ, Smith W, Sprackling CM, Kelly MM. Perception of Physicians' Notes Among Parents of Different Health Literacy Levels. Hosp Pediatr 2024; 14:108-115. [PMID: 38173406 PMCID: PMC10823185 DOI: 10.1542/hpeds.2023-007240] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
OBJECTIVES To explore the benefits and challenges of accessing physicians' notes during pediatric hospitalization across parents of different health literacy levels. METHODS For this secondary analysis, we used semi-structured interviews conducted with 28 parents on their impressions of having access to their child's care team notes on a bedside table. Three researchers used thematic analysis to develop a codebook, coded interview data, and identified themes. Parent interviews and respective themes were then dichotomized into proficient or limited health literacy groups and compared. RESULTS Nine themes were identified in this secondary analysis: 6 benefits and 3 challenges. All parents identified more benefits than challenges, including that the notes served as a recap of information and memory aid and increased autonomy, empowerment, and advocacy for their child. Both groups disliked receiving bad news in notes before face-to-face communication. Parents with proficient literacy reported that notes allowed them to check information accuracy, but that notes may not be as beneficial for parents with lower health literacy. Parents with limited literacy uniquely identified limited comprehension of medical terms but indicated that notes facilitated their understanding of their child's condition, increased their appreciation for their health care team, and decreased their anxiety, stress, and worry. CONCLUSIONS Parents with limited health literacy uniquely reported that notes improved their understanding of their child's care and decreased (rather than increased) worry. Reducing medical terminology may be one equitable way to increase note accessibility for parents across the health literacy spectrum.
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Affiliation(s)
- Carrie L. Nacht
- School of Public Health, San Diego State University, San Diego, California
| | - Nora Jacobson
- Institute for Clinical and Translational Research and School of Nursing
| | | | | | - Peter L.T. Hoonakker
- Wisconsin Institute for Health Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Ryan J. Coller
- Department of Pediatrics, University of WisconsinSchool of Medicine and Public Health, Madison, Wisconsin
| | | | - Daniel J. Sklansky
- Department of Pediatrics, University of WisconsinSchool of Medicine and Public Health, Madison, Wisconsin
| | | | - Carley M. Sprackling
- Department of Pediatrics, University of WisconsinSchool of Medicine and Public Health, Madison, Wisconsin
| | - Michelle M. Kelly
- Department of Pediatrics, University of WisconsinSchool of Medicine and Public Health, Madison, Wisconsin
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Wooldridge AR, Carayon P, Hoonakker P, Hose BZ, Shaffer DW, Brazelton T, Eithun B, Rusy D, Ross J, Kohler J, Kelly MM, Springman S, Gurses AP. Team Cognition in Handoffs: Relating System Factors, Team Cognition Functions and Outcomes in Two Handoff Processes. Hum Factors 2024; 66:271-293. [PMID: 35658721 PMCID: PMC11022309 DOI: 10.1177/00187208221086342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study investigates how team cognition occurs in care transitions from operating room (OR) to intensive care unit (ICU). We then seek to understand how the sociotechnical system and team cognition are related. BACKGROUND Effective handoffs are critical to ensuring patient safety and have been the subject of many improvement efforts. However, the types of team-level cognitive processing during handoffs have not been explored, nor is it clear how the sociotechnical system shapes team cognition. METHOD We conducted this study in an academic, Level 1 trauma center in the Midwestern United States. Twenty-eight physicians (surgery, anesthesia, pediatric critical care) and nurses (OR, ICU) participated in semi-structured interviews. We performed qualitative content analysis and epistemic network analysis to understand the relationships between system factors, team cognition in handoffs and outcomes. RESULTS Participants described three team cognition functions in handoffs-(1) information exchange, (2) assessment, and (3) planning and decision making; information exchange was mentioned most. Work system factors influenced team cognition. Inter-professional handoffs facilitated information exchange but included large teams with diverse backgrounds communicating, which can be inefficient. Intra-professional handoffs decreased team size and role diversity, which may simplify communication but increase information loss. Participants in inter-professional handoffs reflected on outcomes significantly more in relation to system factors and team cognition (p < 0.001), while participants in intra-professional handoffs discussed handoffs as a task. CONCLUSION Handoffs include team cognition, which was influenced by work system design. Opportunities for handoff improvement include a flexibly standardized process and supportive tools/technologies. We recommend incorporating perspectives of the patient and family in future work.
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Affiliation(s)
- Abigail R. Wooldridge
- Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign
| | - Pascale Carayon
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin–Madison
- Department of Industrial and Systems Engineering, University of Wisconsin – Madison
| | - Peter Hoonakker
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin–Madison
| | - Bat-Zion Hose
- Department of Anesthesiology and Critical Care at the Perelman School of Medicine, University of Pennsylvania
| | | | - Tom Brazelton
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ben Eithun
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Deborah Rusy
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Joshua Ross
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Michelle M. Kelly
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Scott Springman
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ayse P. Gurses
- Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Schools of Medicine, Bloomberg School of Public Health and Whiting School of Engineering, Johns Hopkins University, Baltimore, MD
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Sprackling CM, Kieren MQ, Nacht CL, Moreno MA, Wooldridge A, Kelly MM. Adolescent Access to Clinicians' Notes: Adolescent, Parent, and Clinician Perspectives. J Adolesc Health 2024; 74:155-160. [PMID: 37831050 PMCID: PMC10842681 DOI: 10.1016/j.jadohealth.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE In 2021, federal guidelines mandated that health-care organizations share clinicians' notes with patients to increase information transparency. While findings indicate advantages for adult patients, less is known about note-sharing from the viewpoint of adolescents. This study aims to identify adolescent, parent, and clinician perspectives on the anticipated benefits and concerns of giving adolescents access to clinicians' notes and strategies to support note-sharing in this population. METHODS We conducted six focus groups with adolescents, parents, and clinicians at a children's hospital from May to October 2021. A semistructured facilitator guide captured participant perspectives of note-sharing benefits, concerns, and strategies. Two researchers independently coded and analyzed transcript data using thematic analysis; a third researcher reconciled discrepancies. RESULTS 38 stakeholders (17 adolescents, 10 parents, and 11 clinicians) described four benefits, three concerns, and four implementation strategies regarding adolescent note-sharing. Potential benefits included adolescents using notes to remember and reinforce the visit, gaining knowledge about their health, strengthening the adolescent-clinician relationship, and increasing agency in health care decisions. Concerns included notes leading to a breach in confidentiality, causing negative emotions, and becoming less useful for clinicians. Strategies included making note-sharing more secure, optimizing note layout and content, setting clear expectations, and having a portion of the note for clinician use only. DISCUSSION Stakeholders suggest multiple strategies to optimize the implementation of note-sharing to support adolescent patients, parents, and clinicians as hospitals work to comply with federal regulations. These strategies may reinforce the potential benefits and mitigate the challenges of sharing notes with adolescent patients.
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Affiliation(s)
- Carley M Sprackling
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Madeline Q Kieren
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Carrie L Nacht
- School of Public Health, San Diego State University, San Diego, California
| | - Megan A Moreno
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Abigail Wooldridge
- Department of Industrial and Enterprise Systems Engineering, University of Illinois Urbana-Champaign, Champaign, Illinois
| | - Michelle M Kelly
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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Griffith PB, Mariani B, Kelly MM. Diagnostic Reasoning Competency and Accuracy by Nurse Practitioner Students Following the Use of Structured Reflection in Simulation: A Mixed-Methods Experiment. Nurs Educ Perspect 2023; 44:E18-E24. [PMID: 37404060 DOI: 10.1097/01.nep.0000000000001158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
AIM The aim of this study was to examine the effect of structured reflection used during a simulated patient's diagnostic workup on diagnostic reasoning competency and accuracy and explore participants' cognitive bias experience and perceived utility of structured reflection. BACKGROUND Reasoning flaws may lead to diagnostic errors. Medical learners who used structured reflection demonstrated improved diagnosis accuracy. METHOD Embedded mixed-methods experiment examined diagnostic reasoning competency and accuracy of nurse practitioner students who did and did not use structured reflection. Cognitive bias experience and perceptions of structured reflection's utility were explored. RESULTS Diagnostic Reasoning Assessment mean competency scores and categories were not changed. Accuracy trended toward improvement with structured reflection. The theme, diagnostic verification, prompted diagnosis change by both structured reflection users and control participants. CONCLUSION Despite no changes in quantitative outcomes, explicit users of structured reflection believed that this strategy is helpful to their reasoning, and control participants used the strategy's components with the same noted benefits.
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Affiliation(s)
- Patricia B Griffith
- About the Authors Patricia B. Griffith, PhD, CRNP, ACNP-BC, is advanced senior lecturer, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania. Bette Mariani, PhD, RN, ANEF, FAAN, is vice dean of academic affairs and a professor, Villanova University M. Louise Fitzpatrick College of Nursing, Villanova, Pennsylvania. Michelle M. Kelly, PhD, CRNP, CNE, FAANP, is associate professor, Villanova University M. Louise Fitzpatrick College of Nursing. Dr. Mariani, Research Briefs editor for Nursing Education Perspectives , had no role in the review or selection of this article. This work was supported by the National League for Nursing Education Scholarship and the Pennsylvania Higher Education Nursing Schools Association Nursing Education Research funding. For more information, contact Dr. Griffith at
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Luo BT, Barton HJ, Wooldridge AR, Kelly MM. Human Factors Engineering for the Pediatric Hospitalist. Hosp Pediatr 2023; 13:e365-e370. [PMID: 37885421 PMCID: PMC10680139 DOI: 10.1542/hpeds.2023-007258] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
As pediatrics hospitalists, we care for a diverse population of hospitalized children with increasing acuity and complexity in large, multidisciplinary medical teams. In this Method/ology paper, we summarize how human factors engineering (HFE) can provide a framework and tools to help us understand and improve our complex care processes and resulting outcomes. First, we define and discuss the 3 domains of HFE (ie, physical, cognitive, and organizational) and offer examples of HFE's application to pediatric hospital medicine. Next, we highlight an HFE-based framework, the Systems Engineering for Patient Safety model, which conceptualizes how our work system shapes health care processes and outcomes. We provide tools for leveraging this model to better understand the context in which our work is done, which, consequently, informs how we design our systems and processes to improve the quality and safety of care. Finally, we outline the basics of human-centered design and highlight a case study of a project completed in a pediatric hospital setting focused on making rounds more family-centered. In addition, we provide resources for those interested in learning more about HFE.
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Affiliation(s)
- Brooke T Luo
- Section of Pediatric Hospital Medicine
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hanna J Barton
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Abigail R Wooldridge
- Department of Industrial and Enterprise Systems Engineering, University of Illinois Urbana-Champaign, Urbana, Illinois
| | - Michelle M Kelly
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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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 DOI: 10.1016/j.acap.2023.06.008] [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] [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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Hose BZ, Carayon P, Hoonakker PLT, Brazelton TB, Dean SM, Eithun BL, Kelly MM, Kohler JE, Ross JC, Rusy DA. Work system barriers and facilitators of a team health information technology. Appl Ergon 2023; 113:104105. [PMID: 37541103 PMCID: PMC10530583 DOI: 10.1016/j.apergo.2023.104105] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 07/23/2023] [Accepted: 07/26/2023] [Indexed: 08/06/2023]
Abstract
Designing health IT aimed at supporting team-based care and improving patient safety is difficult. This requires a work system (i.e., SEIPS) evaluation of the technology by care team members. This study aimed to identify work system barriers and facilitators to the use of a team health IT that supports care transitions for pediatric trauma patients. We conducted an analysis on 36 interviews - representing 12 roles - collected from a scenario-based evaluation of T3. We identified eight dimensions with both barriers and facilitators in all five work system elements: person (experience), task (task performance, workload/efficiency), technology (usability, specific features of T3), environment (space, location), and organization (communication/coordination). Designing technology that meets every role's needs is challenging; in particular, when trade-offs need to be managed, e.g., additional workload for one role or divergent perspectives regarding specific features. Our results confirm the usefulness of a continuous work system approach to technology design and implementation.
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Affiliation(s)
- Bat-Zion Hose
- Department of Anesthesiology and Critical Care at the Perelman School of Medicine, University of Pennsylvania, USA.
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, USA; Wisconsin Institute for Health Systems Engineering, University of Wisconsin-Madison, USA
| | - Peter L T Hoonakker
- Wisconsin Institute for Health Systems Engineering, University of Wisconsin-Madison, USA
| | - Thomas B Brazelton
- American Family Children's Hospital, UW Health, USA; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, USA
| | | | | | - Michelle M Kelly
- American Family Children's Hospital, UW Health, USA; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, USA
| | | | - Joshua C Ross
- American Family Children's Hospital, UW Health, USA; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, USA; Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, USA
| | - Deborah A Rusy
- American Family Children's Hospital, UW Health, USA; Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, USA
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Mauskar S, Ngo T, Haskell H, Mallick N, Mercer AN, Baird J, Bardsley K, Berry JG, Copp K, Humphrey K, Kelly MM, Landrigan CP, Matherson S, McGeachey A, Pinkham A, Rogers JE, Khan A. In their own words: Safety and quality perspectives from families of hospitalized children with medical complexity. J Hosp Med 2023; 18:777-786. [PMID: 37559415 DOI: 10.1002/jhm.13178] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/30/2023] [Accepted: 07/17/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Children with medical complexity (CMC) experience adverse events due to multiorgan impairment, frequent hospitalizations, subspecialty care, and dependence on multiple medications/equipment. Their families are well-versed in care and can help identify safety/quality gaps to inform improvements. Although previous studies have shown families identify important safety/quality gaps in hospitals, studies of inpatient safety/quality experience of CMC and their families are limited. To address this gap and identify otherwise unrecognized, family-prioritized areas for improving safety/quality of CMC, we conducted a secondary qualitative analysis of safety reporting surveys among families of CMC. OBJECTIVE Explore safety reports from families of hospitalized CMC to identify areas to improve safety/quality. DESIGNS, SETTINGS AND PARTICIPANTS We analyzed free-text responses from predischarge safety reporting surveys administered to families of CMC at a quaternary children's hospital from April 2018 to November 2020. Using a qualitative descriptive approach, we categorized responses into standard clinical categories. Three team members inductively generated an initial codebook to apply iteratively to responses. Reviewers coded responses collaboratively, resolved discrepancies through consensus, and generated themes. MAIN OUTCOME AND MEASURES Outcomes: family-reported areas of safety/quality improvement. MEASURES pre-discharge family surveys. RESULTS Two hundred and eight/two hundred and thirty-seven (88%) families completed surveys; 83 families offered 138 free-text safety responses about medications, feeds, cares, and other categories. Themes included unmet expectations of hospital care/environment, lack of consistency, provider-patient communication lapses, families' expertise about care, and the value of transparency. CONCLUSION To improve care of CMC and their families, hospitals can manage expectations about hospital limitations, improve consistency of care/communication, acknowledge family expertise, and recognize that family-observed quality concerns can have safety implications. Soliciting family input can help hospitals improve care in meaningful, otherwise unrecognized ways.
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Affiliation(s)
- Sangeeta Mauskar
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Tiffany Ngo
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Helen Haskell
- Mothers Against Medical Error, Columbia, South Carolina, USA
| | - Nandini Mallick
- Family Advisory Council, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Alexandra N Mercer
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jennifer Baird
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Kristin Bardsley
- Department of Nursing, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jay G Berry
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Katherine Copp
- School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kate Humphrey
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle M Kelly
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Christopher P Landrigan
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Departments of Medicine and Neurology, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Susan Matherson
- Department of Nursing, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Amanda McGeachey
- Maine Children's Cancer Program, The Barbara Bush Children's Hospital at Maine Medical Center, Scarborough, Portland, Maine, USA
| | - Amy Pinkham
- Department of Nursing, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jayne E Rogers
- Department of Nursing, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Alisa Khan
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Coller RJ, Kelly MM, Eickhoff J, Johnson SB, Zhao Q, Warner G, Katz B, Butteris SM, Ehlenbach ML, Koval S, Howell KD, DeMuri GP. School Attendance Decisions for Children With Medical Complexity During COVID-19. Pediatrics 2023; 152:e2022060352K. [PMID: 37394510 PMCID: PMC10312281 DOI: 10.1542/peds.2022-060352k] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVE School attendance by children with medical complexity (CMC) may be influenced by parent perceptions of their child's risk for coronavirus disease 2019 (COVID-19). The authors of this study aimed to quantify in-person school attendance and identify attendance predictors. METHODS From June to August 2021, surveys were collected from English- and Spanish-speaking parents of children aged 5 to 17 years with ≥1 complex chronic condition who received care at an academic tertiary children's hospital in the Midwestern United States and who attended school prepandemic. The outcome, in-person attendance, was defined dichotomously as any in-person attendance versus none. We evaluated parent-perceived school attendance benefits, barriers, motivation, and cues, COVID-19 severity and susceptibility using survey items derived from the health belief model (HBM). Latent HBM constructs were estimated with exploratory factor analysis. Associations between the outcome and the HBM were evaluated with multivariable logistic regression and structural equation models. RESULTS Among 1330 families (response rate 45%), 19% of CMC were not attending in-person school. Few demographic and clinical variables predicted school attendance. In adjusted models, family-perceived barriers, motivation, and cues predicted in-person attendance, whereas benefits, susceptibility, and severity did not. The predicted probability (95% confidence interval) of attendance ranged from 80% (70% to 87%) for high perceived barriers to 99% (95% to 99%) for low perceived barriers. Younger age (P <.01) and previous COVID-19 infection (P = .02) also predicted school attendance. CONCLUSIONS Overall, 1 in 5 CMC did not attend school at the end of the 2020 to 2021 academic year. Family perceptions of schools' mitigation policies and encouragement of attendance may be promising avenues to address this disparity.
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Affiliation(s)
| | | | - Jens Eickhoff
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Qianqian Zhao
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | | | | | | | - Shawn Koval
- Healthy Kids Collaborative, UW Health, Madison, Wisconsin
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Griffith PB, Mariani BA, Kelly MM. The Effect of Structured Reflection on Nurse Practitioner Students’ Diagnostic Reasoning Within Simulation: Qualitative Outcomes of a Mixed Methods Experiment. Clin Simul Nurs 2023. [DOI: 10.1016/j.ecns.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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15
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Bourne MJ, Smeltzer SC, Kelly MM, Mariani B. ADAPTATION AND TESTING OF THE DEVELOPMENTAL DISABILITY ATTITUDES IN NURSING CARE INSTRUMENT. J Nurs Meas 2023; 31:96-108. [PMID: 36941040 DOI: 10.1891/jnm-2021-0015] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and Purpose: Individuals with developmental disability (DD) often experience poor health outcomes, potentiated by healthcare inequities. Nurses have the potential to reduce these inequities through the quality of care provided. The quality of care provided by nursing students, the future generation of nurses, is affected by the attitudes of their clinical nursing faculty. The purpose of this study was to adapt and test an instrument to specifically measure the attitudes of clinical nursing faculty toward providing care to people with DD. Methods: The Disability Attitudes in Health Care (DAHC) instrument was adapted to create the new Developmental Disability Attitudes in Nursing Care (DDANC) instrument. Results: Content experts reviewed the DDANC for content validity (CVI = 0.88), followed by testing for internal consistency reliability (Cronbach's alpha = 0.7). The study respondents had overall positive attitudes toward the care of people with DD. Conclusions: The DDANC is an acceptably valid and reliable instrument to assess attitudes of clinical nursing faculty toward providing care to people with DD.
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Affiliation(s)
- Melissa J Bourne
- PhD Student, M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, United States
- Visiting Assistant Professor, Wegmans School of Nursing, St. John Fisher College, Rochester, NY, United States
| | - Suzanne C Smeltzer
- The Richard and Marianne Kreider Endowed Professor in Nursing for Vulnerable Populations, M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, United States
| | - Michelle M Kelly
- Associate Professor, M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, United States
| | - Bette Mariani
- Vice Dean for Academic Affairs, Associate Professor of Nursing, M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, United States
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16
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Kelly MM, Arcoleo K, D’Agata AL, Sullivan MC. A test of differential susceptibility in behavior trajectories of preterm infants from preschool to adulthood. Res Nurs Health 2023; 46:80-92. [PMID: 36316209 PMCID: PMC9839493 DOI: 10.1002/nur.22275] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 09/25/2022] [Accepted: 10/14/2022] [Indexed: 11/07/2022]
Abstract
Preterm birth predisposes children to internalizing and externalizing behaviors that may persist into adolescence resulting in adult mental health conditions. Social and caregiving contexts, particularly for vulnerable infants born preterm, influence long-term outcomes, but mechanisms are not clearly understood. Healthcare teams caring for those born preterm face difficulty predicting who will be most affected by risk, who will most benefit, and the optimal timing of intervention. Differential susceptibility theory offers an alternative to the traditional risk-only assessments and theories by positing that individuals may be more, or less, susceptible to environmental influences. A sample of preterm- and term-born infants were followed from birth to 23 years of age. Mixed model repeated measures analyses of internalizing and externalizing behaviors were utilized for the comparison groups (N = 214; observations = 1070). Environmental contexts were indexed as proximal protection (low, moderate, high) and medical risk (low, moderate, high). Personal characteristic covariates of sex, race, socioeconomic status, and cognition were modeled. Internalizing behavior trajectories varied significantly over time. Early proximal protective environments conferred a sustained positive influence on behaviors. There is partial support for differential susceptibility theory suggesting that prematurity, as a malleability characteristic enables absorption of both the positive and negative influences of the environment, with greater intensity that those without malleability. The current analyses suggest lasting effects of the preschool age proximal environment on internalizing and externalizing behaviors in young adulthood for those born preterm. Understanding these nuances may aid healthcare professionals in the promotion and timing of interventions to support the child and family. The current manuscript reflects ongoing analyses of longitudinal data. No patient or public contribution to the analyses were required for testing the differential susceptibility theory. The authors would solicit patient or public contribution when implementing practice or policy changes based on the results.
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Affiliation(s)
- Michelle M. Kelly
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania, USA
- College of Nursing, University of Rhode Island, Providence, Rhode Island, USA
| | - Kimberly Arcoleo
- College of Nursing, University of Rhode Island, Providence, Rhode Island, USA
| | - Amy L. D’Agata
- College of Nursing, University of Rhode Island, Providence, Rhode Island, USA
| | - Mary C. Sullivan
- College of Nursing, University of Rhode Island, Providence, Rhode Island, USA
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17
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Hose BZ, Carayon P, Hoonakker PLT, Ross JC, Eithun BL, Rusy DA, Kohler JE, Brazelton TB, Dean SM, Kelly MM. Managing multiple perspectives in the collaborative design process of a team health information technology. Appl Ergon 2023; 106:103846. [PMID: 35985249 PMCID: PMC10024924 DOI: 10.1016/j.apergo.2022.103846] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/29/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
We need to design technologies that support the work of health care teams; designing such solutions should integrate different clinical roles. However, we know little about the actual collaboration that occurs in the design process for a team-based care solution. This study examines how multiple perspectives were managed in the design of a team health IT solution aimed at supporting clinician information needs during pediatric trauma care transitions. We focused our analysis on four co-design sessions that involved multiple clinicians caring for pediatric trauma patients. We analyzed design session transcripts using content analysis and process coding guided by Détienne's (2006) co-design framework. We expanded upon Détienne (2006) three collaborative activities to identify specific themes and processes of collaboration between care team members engaged in the design process. The themes and processes describe how team members collaborated in a team health IT design process that resulted in a highly usable technology.
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Affiliation(s)
- Bat-Zion Hose
- Department of Anesthesiology and Critical Care at the Perelman School of Medicine, University of Pennsylvania, USA.
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, USA; Wisconsin Institute for Health Systems Engineering, University of Wisconsin-Madison, USA
| | - Peter L T Hoonakker
- Wisconsin Institute for Health Systems Engineering, University of Wisconsin-Madison, USA
| | - Joshua C Ross
- American Family Children's Hospital, UW Health, USA; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, USA
| | | | - Deborah A Rusy
- American Family Children's Hospital, UW Health, USA; Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, USA
| | | | - Thomas B Brazelton
- American Family Children's Hospital, UW Health, USA; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, USA
| | | | - Michelle M Kelly
- American Family Children's Hospital, UW Health, USA; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, USA
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18
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Kelly MM, Hoonakker PLT, Nacht CL, Smith CA, Dean SM, Sklansky DJ, Smith W, Sprackling CM, Zellmer BM, Coller RJ. Parent Perspectives on Sharing Pediatric Hospitalization Clinical Notes. Pediatrics 2023; 151:e2022057756. [PMID: 36450655 PMCID: PMC9998186 DOI: 10.1542/peds.2022-057756] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Federal guidelines mandate that hospitals provide patients and caregivers with free, online access to their physician's clinical notes. This study sought to identify parent perceptions of the benefits and challenges of real-time note access during their child's hospitalization and strategies to optimize note-sharing at the bedside. METHODS This qualitative study was conducted with parents of children aged <12 years admitted to a pediatric hospitalist service in April 2019. Parents were given access to their child's admission and daily progress notes on a bedside tablet (iPad), and interviewed upon discharge. In-depth, 60-minute interviews were audio-recorded and transcribed. Two researchers developed and refined a codebook and coded data inductively and deductively with validation by a third researcher. Thematic analysis was used to identify emergent themes. RESULTS The 28 interviewed parents described 6 benefits of having note access, which: provided a recap and improved their knowledge about their child's care plan, enhanced communication, facilitated empowerment, increased autonomy, and incited positive emotions. Potential challenges included that notes: caused confusion, hindered communication with the health care team, highlighted problems with note content, and could incite negative emotions. Parents recommended 4 strategies to support sharing: provide preemptive communication about expectations, optimize the note release process, consider parent-friendly note template modifications, and offer informational resources for parents. CONCLUSIONS Findings provide a framework for operationalizing note-sharing with parents during hospitalization. These results have important implications for hospitals working to comply with federal regulations and researchers assessing the effects of increased information transparency in the inpatient setting.
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Affiliation(s)
- Michelle M Kelly
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Carrie L Nacht
- School of Public Health, San Diego State University, San Diego, California
| | | | - Shannon M Dean
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Daniel J Sklansky
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Carley M Sprackling
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Benjamin M Zellmer
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ryan J Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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19
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Coller RJ, Kelly MM, Howell KD, Warner G, Butteris SM, Ehlenbach ML, Werner N, Katz B, McBride JA, Kieren M, Koval S, DeMuri GP. In-Home COVID-19 Testing for Children With Medical Complexity: Feasibility and Association With School Attendance and Safety Perceptions. Am J Public Health 2022; 112:S878-S882. [PMID: 36108256 PMCID: PMC9707728 DOI: 10.2105/ajph.2022.306971] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2022] [Indexed: 01/29/2023]
Abstract
The REstarting Safe Education and Testing program for children with medical complexity was implemented in May 2021 at the University of Wisconsin to evaluate the feasibility of in-home rapid antigen COVID-19 testing among neurocognitively affected children. Parents or guardians administered BinaxNOW rapid antigen self-tests twice weekly for three months and changed to symptom and exposure testing or continued surveillance. In-home testing was feasible: nearly all (92.5%) expected tests were conducted. Symptomatic testing identified seven of nine COVID-19 cases. School safety perceptions were higher among those opting for symptom testing. Clinical Trials.gov identifier: NCT04895085. (Am J Public Health. 2022;112(S9):S878-S882. https://doi.org/10.2105/AJPH.2022.306971).
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Affiliation(s)
- Ryan J Coller
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Michelle M Kelly
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Kristina Devi Howell
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Gemma Warner
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Sabrina M Butteris
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Mary L Ehlenbach
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Nicole Werner
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Barbara Katz
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Joseph A McBride
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Madeline Kieren
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Shawn Koval
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
| | - Gregory P DeMuri
- Ryan J. Coller, Michelle M. Kelly, Kristina Devi Howell, Gemma Warner, Sabrina M. Butteris, Mary L. Ehlenbach, Joseph A. McBride, Madeline Kieren, and Gregory P. DeMuri are with the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison. Nicole Werner is with the Department of Industrial and Systems Engineering, University of Wisconsin-Madison. Barbara Katz is with Family Voices of Wisconsin, Madison. Shawn Koval is with the Health Kids Collaborative, UW Health, Madison, WI
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Kelly MM, Dean SM. Improving transparency in hospitals: perspectives on implementing an inpatient portal. Future Healthc J 2022; 9:326-329. [PMID: 36561822 PMCID: PMC9761469 DOI: 10.7861/fhj.2021-0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Michelle M Kelly
- AUniversity of Wisconsin School of Medicine and Public Health, Madison, USA,Address for correspondence: Dr Michelle M Kelly, University of Wisconsin School of Medicine and Public Health, H4/4 CSC, 600 Highland Avenue, Madison, WI 53792, USA. Twitter: @MichelleKellys
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21
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Griffith PB, Mariani B, Kelly MM. Diagnostic Reasoning Outcomes in Nurse Practitioner Education: A Scoping Review. J Nurs Educ 2022; 61:579-586. [DOI: 10.3928/01484834-20220803-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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22
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Jolliff A, Werner NE, Barton HJ, Howell KD, Kelly MM, Morgen M, Ehlenbach M, Warner G, Katz B, Kieren M, DeMuri G, Coller RJ. Caregiver perceptions of in-home COVID-19 testing for children with medical complexity: a qualitative study. BMC Pediatr 2022; 22:533. [PMID: 36076181 PMCID: PMC9452877 DOI: 10.1186/s12887-022-03550-5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/05/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND In-home direct antigen rapid testing (DART) plays a major role in COVID-19 mitigation and policy. However, perceptions of DART within high-risk, intellectually impaired child populations are unknown. This lack of research could negatively influence DART uptake and utility among those who stand to benefit most from DART. The purpose of this study was to describe caregivers' perceptions of an in-home COVID-19 DART regimen in children with medical complexity, including the benefits and limitations of DART use. METHODS This qualitative study was a subproject of the NIH Rapid Acceleration of Diagnostics Underserved Populations research program at the University of Wisconsin. We combined survey data and the thematic analysis of semi-structured interview data to understand caregivers' perceptions of in-home COVID-19 testing and motivators to perform testing. Caregivers of children with medical complexity were recruited from the Pediatric Complex Care Program at the University of Wisconsin (PCCP). Data were collected between May and August 2021. RESULTS Among n = 20 caregivers, 16/20 (80%) of their children had neurologic conditions and 12/20 (60%) used home oxygen. Survey data revealed that the largest caregiver motivators to test their child were to get early treatment if positive (18/20 [90%] of respondents agreed) and to let the child's school know if the child was safe to attend (17/20 [85%] agreed). Demotivators to testing included that the child could still get COVID-19 later (7/20 [35%] agreed), and the need for officials to reach out to close contacts (6/20 [30%] agreed). From interview data, four overarching themes described perceptions of in-home COVID-19 testing: Caregivers perceived DART on a spectrum of 1) benign to traumatic and 2) simple to complex. Caregivers varied in the 3) extent to which DART contributed to their peace of mind and 4) implications of test results for their child. CONCLUSIONS Although participants often described DART as easy to administer and contributing to peace of mind, they also faced critical challenges and limitations using DART. Future research should investigate how to minimize the complexity of DART within high-risk populations, while leveraging DART to facilitate safe school attendance for children with medical complexity and reduce caregiver burden.
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Affiliation(s)
- Anna Jolliff
- grid.411377.70000 0001 0790 959XDepartment of Health and Wellness Design, Indiana University School of Public Health-Bloomington, 1025 E 7th St, Bloomington, IN 47405 USA
| | - Nicole E. Werner
- grid.411377.70000 0001 0790 959XDepartment of Health and Wellness Design, Indiana University School of Public Health-Bloomington, 1025 E 7th St, Bloomington, IN 47405 USA
| | - Hanna J. Barton
- grid.14003.360000 0001 2167 3675Department of Industrial and Systems Engineering, University of Wisconsin – Madison, 1550 Engineering Drive, Madison, WI 53706 USA
| | - Kristina Devi Howell
- grid.14003.360000 0001 2167 3675Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, USA
| | - Michelle M. Kelly
- grid.14003.360000 0001 2167 3675Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, USA
| | - Makenzie Morgen
- grid.14003.360000 0001 2167 3675Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, USA
| | - Mary Ehlenbach
- grid.14003.360000 0001 2167 3675Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, USA
| | - Gemma Warner
- grid.14003.360000 0001 2167 3675Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, USA
| | | | - Madeline Kieren
- grid.14003.360000 0001 2167 3675Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, USA
| | - Gregory DeMuri
- grid.14003.360000 0001 2167 3675Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, USA
| | - Ryan J. Coller
- grid.14003.360000 0001 2167 3675Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, USA
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23
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Grebely J, Dore GJ, Altice FL, Conway B, Litwin AH, Norton BL, Dalgard O, Gane EJ, Shibolet O, Nahass R, Luetkemeyer AF, Peng CY, Iser D, Gendrano IN, Kelly MM, Hwang P, Asante-Appiah E, Haber BA, Barr E, Robertson MN, Platt H. Reinfection and Risk Behaviors After Treatment of Hepatitis C Virus Infection in Persons Receiving Opioid Agonist Therapy : A Cohort Study. Ann Intern Med 2022; 175:1221-1229. [PMID: 35939812 DOI: 10.7326/m21-4119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) reinfection after successful treatment may reduce the benefits of cure among people who inject drugs. OBJECTIVE To evaluate the rate of HCV reinfection for 3 years after successful treatment among people receiving opioid agonist therapy (OAT). DESIGN A 3-year, long-term, extension study of persons enrolled in the CO-STAR (Hepatitis C Patients on Opioid Substitution Therapy Antiviral Response) study (ClinicalTrials.gov: NCT02105688). SETTING 55 clinical trial sites in 13 countries. PATIENTS Aged 18 years and older with chronic HCV infection with genotypes 1, 4, or 6 receiving stable OAT. INTERVENTION No treatments were administered. MEASUREMENTS Serum samples were assessed for HCV reinfection. Urine drug screening was performed. RESULTS Among 296 participants who received treatment, 286 were evaluable for reinfection and 199 were enrolled in the long-term extension study. The rate of HCV reinfection was 1.7 [95% CI, 0.8 to 3.0] per 100 person-years; 604 person-years of follow-up). A higher rate of reinfection was seen among people with recent injecting drug use (1.9 [95% CI, 0.5 to 4.8] per 100 person-years; 212 person-years). Ongoing drug use and injecting drug use were reported by 59% and 21% of participants, respectively, at the 6-month follow-up visit and remained stable during 3 years of follow-up. LIMITATIONS Participants were required to be 80% adherent to OAT at baseline and may represent a population with higher stability and lower risk for HCV reinfection. Rate of reinfection may be underestimated because all participants did not continue in the long-term extension study; whether participants who discontinued were at higher risk for reinfection is unknown. CONCLUSION Reinfection with HCV was low but was highest in the first 24 weeks after treatment completion and among people with ongoing injecting drug use and needle-syringe sharing. PRIMARY FUNDING SOURCE Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.
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Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia (J.G., G.J.D.)
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia (J.G., G.J.D.)
| | | | - Brian Conway
- Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada (B.C.)
| | - Alain H Litwin
- Prisma Health/University of South Carolina School of Medicine Greenville, and Clemson University, Greenville, South Carolina (A.H.L., B.L.N.)
| | - Brianna L Norton
- Prisma Health/University of South Carolina School of Medicine Greenville, and Clemson University, Greenville, South Carolina (A.H.L., B.L.N.)
| | - Olav Dalgard
- Institute of Clinical Medicine, Akershus University, Oslo, Norway (O.D.)
| | - Edward J Gane
- Auckland City Hospital, Auckland, New Zealand (E.J.G.)
| | - Oren Shibolet
- Liver Unit, Department of Gastroenterology, Tel Aviv Medical Center and Tel Aviv University, Tel Aviv, Israel (O.S.)
| | | | - Anne F Luetkemeyer
- University of California San Francisco, San Francisco, California (A.F.L.)
| | - Cheng-Yuan Peng
- China Medical University Hospital, Taichung, Taiwan (C.Y.P.)
| | - David Iser
- The Alfred Hospital, Melbourne, Victoria, Australia (D.I.)
| | - Isaias Noel Gendrano
- Merck & Co., Inc., Rahway, New Jersey (I.N.G., M.M.K., P.H., E.A.A., B.A.H., E.B., M.N.R., H.P.)
| | - Michelle M Kelly
- Merck & Co., Inc., Rahway, New Jersey (I.N.G., M.M.K., P.H., E.A.A., B.A.H., E.B., M.N.R., H.P.)
| | - Peggy Hwang
- Merck & Co., Inc., Rahway, New Jersey (I.N.G., M.M.K., P.H., E.A.A., B.A.H., E.B., M.N.R., H.P.)
| | - Ernest Asante-Appiah
- Merck & Co., Inc., Rahway, New Jersey (I.N.G., M.M.K., P.H., E.A.A., B.A.H., E.B., M.N.R., H.P.)
| | - Barbara A Haber
- Merck & Co., Inc., Rahway, New Jersey (I.N.G., M.M.K., P.H., E.A.A., B.A.H., E.B., M.N.R., H.P.)
| | - Eliav Barr
- Merck & Co., Inc., Rahway, New Jersey (I.N.G., M.M.K., P.H., E.A.A., B.A.H., E.B., M.N.R., H.P.)
| | - Michael N Robertson
- Merck & Co., Inc., Rahway, New Jersey (I.N.G., M.M.K., P.H., E.A.A., B.A.H., E.B., M.N.R., H.P.)
| | - Heather Platt
- Merck & Co., Inc., Rahway, New Jersey (I.N.G., M.M.K., P.H., E.A.A., B.A.H., E.B., M.N.R., H.P.)
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24
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Howell KD, Kelly MM, DeMuri GP, McBride JA, Katz B, Edmonson MB, Sklansky DJ, Shadman KA, Ehlenbach ML, Butteris SM, Warner G, Zhao Q, Coller RJ. COVID-19 Vaccination Intentions for Children With Medical Complexity. Hosp Pediatr 2022; 12:e295-e302. [PMID: 36039687 PMCID: PMC10039457 DOI: 10.1542/hpeds.2022-006544] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The chronic conditions and functional limitations experienced by children with medical complexity (CMC) place them at disproportionate risk for COVID-19 transmission and poor outcomes. To promote robust vaccination uptake, specific constructs associated with vaccine hesitancy must be understood. Our objective was to describe demographic, clinical, and vaccine perception variables associated with CMC parents' intention to vaccinate their child against COVID-19. METHODS We conducted a cross-sectional survey (June-August 2021) for primary caregivers of CMC between ages 5 to 17 at an academic medical center in the Midwest. Multivariable logistic regression examined associations between vaccination intent and selected covariates. RESULTS Among 1330 families, 65.8% indicated vaccination intent. In multivariable models, demographics had minimal associations with vaccination intent; however, parents of younger children (<12 years) had significantly lower adjusted odds of vaccination intent (adjusted odds ratio [95% confidence interval]: 0.26 [0.17-0.3]) compared to parents of older children (≥12 years). CMC with higher severity of illness, ie, those with ≥1 hospitalization in the previous year (versus none) or >1 complex chronic condition (vs 1), had higher adjusted odds of vaccination intent (1.82 [1.14-2.92] and 1.77 [1.16-2.71], respectively). Vaccine perceptions associated with vaccine intention included "My doctor told me to get my child a COVID-19 vaccine" (2.82 [1.74-4.55]); and "I'm concerned about my child's side effects from the vaccine" (0.18 [0.12-0.26]). CONCLUSIONS One-third of CMC families expressed vaccine hesitation; however, constructs strongly associated with vaccination intent are potentially modifiable. Pediatrician endorsement of COVID-19 vaccination and careful counseling on side effects might be promising strategies to encourage uptake.
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Affiliation(s)
- Kristina Devi Howell
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Michelle M. Kelly
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Gregory P. DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Joseph A. McBride
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - M. Bruce Edmonson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Daniel J. Sklansky
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kristin A. Shadman
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Mary L. Ehlenbach
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sabrina M. Butteris
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Gemma Warner
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Qianqian Zhao
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ryan J. Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Dalgard O, Litwin AH, Shibolet O, Grebely J, Nahass R, Altice FL, Conway B, Gane EJ, Luetkemeyer AF, Peng CY, Iser D, Gendrano IN, Kelly MM, Haber BA, Platt H, Puenpatom A. Health-related quality of life in people receiving opioid agonist treatment and treatment for hepatitis C virus infection. J Addict Dis 2022:1-12. [PMID: 35920743 DOI: 10.1080/10550887.2022.2088978] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND In people with chronic hepatitis C virus (HCV) infection, viral eradication is associated with improved health-related quality of life (HRQOL). OBJECTIVE To assess changes in HRQOL among participants receiving opioid agonist therapy undergoing treatment for HCV infection. METHODS COSTAR (NCT02251990) was a randomized, double-blind, placebo-controlled study. Adults with HCV infection on opioid agonist therapy received elbasvir (50 mg)/grazoprevir (100 mg) or placebo for 12 weeks. HRQOL was evaluated using the Medical Outcomes Study 36-Item Short Form Health Survey version 2 (SF-36v2) Acute Form. Participants remained blinded until 4 weeks after end of treatment. RESULTS Overall, 201 participants received elbasvir/grazoprevir and 100 participants received placebo. Treatment difference mean change from baseline scores (elbasvir/grazoprevir minus placebo) indicated an improvement in HRQOL at 4 weeks after end of treatment in participants receiving elbasvir/grazoprevir versus those receiving placebo, driven by declining HRQOL in those receiving placebo and improved HRQOL in certain domains among participants receiving elbasvir/grazoprevir. Notable differences in SF-36v2 scores were evident in the general health (mean treatment difference [MTD], 6.00; 95% CI, 1.37-10.63), vitality (MTD, 6.81; 95% CI, 1.88-11.75), and mental health (MTD, 5.17; 95% CI, 0.52-9.82) domains and in the mental component summary score (mean, 2.83; 95% CI, 0.29-5.37). No notable between-treatment differences were evident at treatment weeks 4 or 12. CONCLUSION HRQOL in patients receiving medication for opioid dependence was improved following treatment for HCV infection with elbasvir/grazoprevir, suggesting that eradication of HCV infection with direct-acting antivirals is associated with improved HRQOL. TRIAL REGISTRATION NUMBER ClinicalTrials.gov, NCT02251990.
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Affiliation(s)
- Olav Dalgard
- Institute of Clinical Medicine, Akershus University, Oslo, Norway
| | - Alain H Litwin
- Prisma Health/University of South Carolina School of Medicine Greenville, Clemson University, Greenville, SC, USA
| | - Oren Shibolet
- Liver Unit, Department of Gastroenterology, Tel Aviv Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | | | - Brian Conway
- Vancouver Infectious Diseases Centre, Vancouver, BC, Canada
| | | | | | | | - David Iser
- The Alfred Hospital, Melbourne, VIC, Australia
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26
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Barton HJ, Werner NE, Morgen M, DeMuri GP, Kelly MM, Wald ER, Warner G, Katz B, Coller RJ. Task Analysis of In-Home SARS-CoV-2 Rapid Antigen Testing by Families. Pediatrics 2022; 150:188098. [PMID: 35610754 PMCID: PMC9677708 DOI: 10.1542/peds.2022-056681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hanna J. Barton
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Nicole E. Werner
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | | | | | | | - Ellen R. Wald
- Department of Pediatrics, University of Wisconsin-Madison
| | - Gemma Warner
- Department of Pediatrics, University of Wisconsin-Madison
| | | | - Ryan J. Coller
- Department of Pediatrics, University of Wisconsin-Madison
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27
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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; 150:188486. [PMID: 35791784 DOI: 10.1542/peds.2021-055098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [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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Tiedt K, Webber S, Babal J, Nackers KAM, Allen A, Nacht CL, Coller RJ, Eickhoff J, Sklansky DJ, Kieren M, Shadman KA, Kelly MM. Gender Difference in Teaching Evaluation Scores of Pediatric Faculty. Acad Pediatr 2022; 23:564-568. [PMID: 35914732 DOI: 10.1016/j.acap.2022.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/07/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate associations between faculty gender and milestone-based teaching assessment scores assigned by residents. METHODS We performed a retrospective cohort study of milestone-based clinical teaching assessments of pediatric faculty completed by pediatric residents at a mid-sized residency program from July 2016 to June 2019. Assessments included 3 domains (Clinical Interactions, Teaching Skills, Role Modeling/Professionalism) comprised of a total of 11 sub-competency items. We used multilevel logistic regression accounting for repeat measures and clustering to evaluate associations between faculty gender and assessment scores in the 1) top quartile, 2) bottom quartile, or 3) top-box (highest score). Findings were adjusted for faculty rank and academic track, and resident year and gender. RESULTS Over 3 years, 2889 assessments of 104 faculty were performed by 91 residents. Between assessments of women and men faculty, there were no significant differences in the odds of receiving a score in the top quartile for the 3 domains (Clinical aOR 0.99, P = .86; Teaching aOR 0.99, P = .93; Role Modeling aOR 0.87, P = .089). However, assessments of women were more likely to receive a score in the bottom quartile in both Teaching (aOR 1.23, P = .019) and Role Modeling (aOR 1.26, P = .008). Assessments of women also had lower odds of receiving the highest score in 6 of 11 sub-competencies. CONCLUSION Results suggest that gender bias may play a role in resident assessments of pediatric faculty. Future studies are needed to determine if findings are replicated in other settings and to identify opportunities to reduce the gender gap in pediatric academic medicine.
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Affiliation(s)
- Kristin Tiedt
- Departments of Pediatrics (K Tiedt, S Webber, J Babal, KAM Nackers, A Allen, CL Nacht, RJ Coller, DJ Sklansky, M Kieren, KA Shadman, and MM Kelly), University of Wisconsin School of Medicine and Public Health, Madison, Wis.
| | - Sarah Webber
- Departments of Pediatrics (K Tiedt, S Webber, J Babal, KAM Nackers, A Allen, CL Nacht, RJ Coller, DJ Sklansky, M Kieren, KA Shadman, and MM Kelly), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Jessica Babal
- Departments of Pediatrics (K Tiedt, S Webber, J Babal, KAM Nackers, A Allen, CL Nacht, RJ Coller, DJ Sklansky, M Kieren, KA Shadman, and MM Kelly), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Kirstin A M Nackers
- Departments of Pediatrics (K Tiedt, S Webber, J Babal, KAM Nackers, A Allen, CL Nacht, RJ Coller, DJ Sklansky, M Kieren, KA Shadman, and MM Kelly), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Ann Allen
- Departments of Pediatrics (K Tiedt, S Webber, J Babal, KAM Nackers, A Allen, CL Nacht, RJ Coller, DJ Sklansky, M Kieren, KA Shadman, and MM Kelly), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Carrie L Nacht
- Departments of Pediatrics (K Tiedt, S Webber, J Babal, KAM Nackers, A Allen, CL Nacht, RJ Coller, DJ Sklansky, M Kieren, KA Shadman, and MM Kelly), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Ryan J Coller
- Departments of Pediatrics (K Tiedt, S Webber, J Babal, KAM Nackers, A Allen, CL Nacht, RJ Coller, DJ Sklansky, M Kieren, KA Shadman, and MM Kelly), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Jens Eickhoff
- Departments of Biostatistics (J Eickhoff), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Daniel J Sklansky
- Departments of Pediatrics (K Tiedt, S Webber, J Babal, KAM Nackers, A Allen, CL Nacht, RJ Coller, DJ Sklansky, M Kieren, KA Shadman, and MM Kelly), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Madeline Kieren
- Departments of Pediatrics (K Tiedt, S Webber, J Babal, KAM Nackers, A Allen, CL Nacht, RJ Coller, DJ Sklansky, M Kieren, KA Shadman, and MM Kelly), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Kristin A Shadman
- Departments of Pediatrics (K Tiedt, S Webber, J Babal, KAM Nackers, A Allen, CL Nacht, RJ Coller, DJ Sklansky, M Kieren, KA Shadman, and MM Kelly), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Michelle M Kelly
- Departments of Pediatrics (K Tiedt, S Webber, J Babal, KAM Nackers, A Allen, CL Nacht, RJ Coller, DJ Sklansky, M Kieren, KA Shadman, and MM Kelly), University of Wisconsin School of Medicine and Public Health, Madison, Wis
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29
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Werner NE, Fleischman A, Warner G, Barton HJ, Kelly MM, Ehlenbach ML, Wagner T, Finesilver S, Katz BJ, Howell KD, Nacht CL, Scheer N, Coller RJ. Feasibility Testing of Tubes@HOME: A Mobile Application to Support Family-Delivered Enteral Care. Hosp Pediatr 2022; 12:663-673. [PMID: 35670137 DOI: 10.1542/hpeds.2022-006532] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Assistance from medical devices is common for children with medical complexity (CMC) but introduces caregiving challenges. We tested the feasibility of "Tubes@HOME," a mobile application supporting CMC family-delivered care using enteral care as a model. METHODS Caregivers of CMC with enteral tubes participated in a 30-day feasibility study of Tubes@HOME November 2020 through January 2021. Tubes@HOME was available on mobile devices and designed to support collaborative care and tracking over time. Key features include child profile, caregiving network management, care routines, feedback loop, and action plans. Care routines delineated nutrition, medication, and procedural tasks needed for the child: frequencies, completions, and reminders. Metadata summarized feature use among users. Feasibility was evaluated with postuse questionnaires and interviews. Measures of Tubes@HOME's usability and usefulness included the NASA Task Load Index (TLX), System Usability Scale (SUS), and Acceptability and Use of Technology Questionnaire (AUTQ). RESULTS Among n = 30 children, there were 30 primary (eg, parent) and n = 22 nonprimary caregivers using Tubes@HOME. Children had a median (IQR) 10 (5.5-13) care routines created. For care routines created, 93% were marked complete at least once during the study period, with participants engaging with routines throughout study weeks 2 to 4. Results (mean [SD]) indicated low mental workload (TLX) 30.9 (12.2), good usability (SUS) 75.4 (14.7), and above-average usefulness (AUTQ) 4.0 (0.7) associated with Tubes@HOME, respectively. Interviews contextualized usefulness and suggested improvements. CONCLUSIONS Longitudinal use of Tubes@HOME among caregiving networks appeared feasible. Efficacy testing is needed, and outcomes could include reliability of care delivered in home and community.
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Affiliation(s)
| | - Alyssa Fleischman
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Gemma Warner
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Michelle M Kelly
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Mary L Ehlenbach
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Teresa Wagner
- American Family Children's Hospital, UW Health, Madison, Wisconsin; and
| | - Sara Finesilver
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Kristina D Howell
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Carrie L Nacht
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Nora Scheer
- Department of Industrial and Systems Engineering and
| | - Ryan J Coller
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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Edmonson MB, Zhao Q, Francis DO, Kelly MM, Sklansky DJ, Shadman KA, Coller RJ. Association of Patient Characteristics With Postoperative Mortality in Children Undergoing Tonsillectomy in 5 US States. JAMA 2022; 327:2317-2325. [PMID: 35727278 PMCID: PMC9214584 DOI: 10.1001/jama.2022.8679] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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] [Indexed: 01/17/2023]
Abstract
IMPORTANCE The rate of postoperative death in children undergoing tonsillectomy is uncertain. Mortality rates are not separately available for children at increased risk of complications, including young children (aged <3 y) and those with sleep-disordered breathing or complex chronic conditions. OBJECTIVE To estimate postoperative mortality following tonsillectomy in US children, both overall and in relation to recognized risk factors for complications. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study based on longitudinal analysis of linked records in state ambulatory surgery, inpatient, and emergency department discharge data sets distributed by the Healthcare Cost and Utilization Project for 5 states covering 2005 to 2017. Participants included 504 262 persons younger than 21 years for whom discharge records were available to link outpatient or inpatient tonsillectomy with at least 90 days of follow-up. EXPOSURES Tonsillectomy with or without adenoidectomy. MAIN OUTCOME AND MEASURES Postoperative death within 30 days or during a surgical stay lasting more than 30 days. Modified Poisson regression with sample weighting was used to estimate postoperative mortality per 100 000 operations, both overall and in relation to age group, sleep-disordered breathing, and complex chronic conditions. RESULTS The 504 262 children in the cohort underwent a total of 505 182 tonsillectomies (median [IQR] patient age, 7 [4-12] years; 50.6% females), of which 10.1% were performed in young children, 28.9% in those with sleep-disordered breathing, and 2.8% in those with complex chronic conditions. There were 36 linked postoperative deaths, which occurred a median (IQR) of 4.5 (2-20.5) days after surgical admission, and most of which (19/36 [53%]) occurred after surgical discharge. The unadjusted mortality rate was 7.04 (95% CI, 4.97-9.98) deaths per 100 000 operations. In multivariable models, neither age younger than 3 years nor sleep-disordered breathing was significantly associated with mortality, but children with complex chronic conditions had significantly higher mortality (16 deaths/14 299 operations) than children without these conditions (20 deaths/490 883 operations) (117.22 vs 3.87 deaths per 100 000 operations; adjusted rate difference, 113.55 [95% CI, 51.45-175.64] deaths per 100 000 operations; adjusted rate ratio, 29.39 [95% CI, 13.37-64.62]). Children with complex chronic conditions accounted for 2.8% of tonsillectomies but 44% of postoperative deaths. Most deaths associated with complex chronic conditions occurred in children with neurologic/neuromuscular or congenital/genetic disorders. CONCLUSIONS AND RELEVANCE Among children undergoing tonsillectomy, the rate of postoperative death was 7 per 100 000 operations overall and 117 per 100 000 operations among children with complex chronic conditions. These findings may inform decision-making for pediatric tonsillectomy.
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Affiliation(s)
- M. Bruce Edmonson
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Qianqian Zhao
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison
| | - David O. Francis
- Division of Otolaryngology, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
| | - Michelle M. Kelly
- Division of Hospital Medicine, Department of Pediatrics, University of Wisconsin, Madison
| | - Daniel J. Sklansky
- Division of Hospital Medicine, Department of Pediatrics, University of Wisconsin, Madison
| | - Kristin A. Shadman
- Division of Hospital Medicine, Department of Pediatrics, University of Wisconsin, Madison
| | - Ryan J. Coller
- Division of Hospital Medicine, Department of Pediatrics, University of Wisconsin, Madison
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Khan A, Baird J, Kelly MM, Blaine K, Chieco D, Haskell H, Lopez K, Ngo T, Mercer A, Quiñones-Pérez B, Schuster MA, Singer SJ, Viswanath K, Landrigan CP, Williams D, Luff D. Family Safety Reporting in Medically Complex Children: Parent, Staff, and Leader Perspectives. Pediatrics 2022; 149:188129. [PMID: 35615941 DOI: 10.1542/peds.2021-053913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite compelling evidence that patients and families report valid and unique safety information, particularly for children with medical complexity (CMC), hospitals typically do not proactively solicit patient or family concerns about patient safety. We sought to understand parent, staff, and hospital leader perspectives about family safety reporting in CMC to inform future interventions. METHODS This qualitative study was conducted at 2 tertiary care children's hospitals with dedicated inpatient complex care services. A research team conducted approximately 60-minute semistructured, individual interviews with English and Spanish-speaking parents of CMC, physicians, nurses, and hospital leaders. Audio-recorded interviews were translated, transcribed, and verified. Two researchers coded data inductively and deductively developed and iteratively refined the codebook with validation by a third researcher. Thematic analysis allowed for identification of emerging themes. RESULTS We interviewed 80 participants (34 parents, 19 nurses and allied health professionals, 11 physicians, and 16 hospital leaders). Four themes related to family safety reporting were identified: (1) unclear, nontransparent, and variable existing processes, (2) a continuum of staff and leadership buy-in, (3) a family decision-making calculus about whether to report, and (4) misaligned staff and parent priorities and expectations. We also identified potential strategies for engaging families and staff in family reporting. CONCLUSIONS Although parents were deemed experts about their children, buy-in about the value of family safety reporting among staff and leaders varied, staff and parent priorities and expectations were misaligned, and family decision-making around reporting was complex. Strategies to address these areas can inform design of family safety reporting interventions attuned to all stakeholder groups.
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Affiliation(s)
- Alisa Khan
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Departments of Pediatrics
| | - Jennifer Baird
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California
| | - Michelle M Kelly
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kevin Blaine
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California
| | - Deanna Chieco
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Mount Sinai School of Medicine, New York, New York
| | - Helen Haskell
- Mothers Against Medical Error, Columbia, South Carolina
| | - Kelleen Lopez
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California
| | - Tiffany Ngo
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Alexandra Mercer
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Bianca Quiñones-Pérez
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Departments of Pediatrics
| | - Mark A Schuster
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Sara J Singer
- Department of Medicine, Stanford University School of Medicine, Stanford, California.,Organizational Behavior, Stanford Graduate School of Business, Stanford, California
| | - K Viswanath
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,McGraw-Patterson Center for Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Christopher P Landrigan
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Departments of Pediatrics.,Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - David Williams
- Orthopedic Surgery.,Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts
| | - Donna Luff
- Anesthesia, Harvard Medical School, Boston, Massachusetts
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Affiliation(s)
- Jessica C. Babal
- All authors are with the University of Wisconsin School of Medicine and Public Health
- Jessica C. Babal, MD, is Assistant Professor (CHS), Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine
| | - Sarah Webber
- All authors are with the University of Wisconsin School of Medicine and Public Health
- Sarah Webber, MD, is Assistant Professor (CHS), Department of Pediatrics, Division of Hospital Medicine, and Department of Pediatrics Well-Being Director
| | - Carrie L. Nacht
- All authors are with the University of Wisconsin School of Medicine and Public Health
- Carrie L. Nacht, MPH, is Research Specialist, Department of Pediatrics, Division of Hospital Medicine
| | - Kirstin A.M. Nackers
- All authors are with the University of Wisconsin School of Medicine and Public Health
- Kirstin A.M. Nackers, MD, is Associate Professor (CHS), Department of Pediatrics, Division of Hospital Medicine, and Director for Medical Student Education
| | - Kristin Tiedt
- All authors are with the University of Wisconsin School of Medicine and Public Health
- Kristin Tiedt, MD, is Assistant Professor (CHS), Department of Pediatrics, Division of Hospital Medicine
| | - Ann Allen
- All authors are with the University of Wisconsin School of Medicine and Public Health
- Ann Allen, MD, is Assistant Professor (CHS), Department of Pediatrics, Division of Hospital Medicine, Medical Director of Community Pediatric Hospital Medicine, and Program Director, Pediatric Hospital Medicine Fellowship
| | - Brittany J. Allen
- All authors are with the University of Wisconsin School of Medicine and Public Health
- Brittany J. Allen, MD, is Associate Professor (CHS), Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, and Co-Medical Director, Pediatric and Transgender Health (PATH) Clinic, American Family Children's Hospital
| | - Michelle M. Kelly
- All authors are with the University of Wisconsin School of Medicine and Public Health
- Michelle M. Kelly, MD, MS, is Associate Professor (CHS), Department of Pediatrics, Division of Hospital Medicine
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Khan S, Jones CD, Kelly MM. Trust during care transitions: Building the relationship between hospitalists and outpatient clinicians. J Hosp Med 2022; 17:322-323. [PMID: 35403336 DOI: 10.1002/jhm.12821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Sarah Khan
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christine D Jones
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VHA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Michelle M Kelly
- Division of Hospital Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Smith CA, Kelly MM. Open Notes, a digital transformation of pediatric inpatient care: Focus groups of parents and other stakeholders (Preprint). J Particip Med 2022; 14:e37759. [PMID: 35635743 PMCID: PMC9153906 DOI: 10.2196/37759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/24/2022] [Accepted: 04/27/2022] [Indexed: 11/21/2022] Open
Abstract
Background Patient portals are a health information technology that allows patients and their proxies, such as caregivers and family members, to access designated portions of their electronic health record using mobile devices and web browsers. The Open Notes initiative in the United States, which became federal law in April 2021, has redrawn and expanded the boundaries of medical records. Only a few studies have focused on sharing notes with parents or caregivers of pediatric patients. Objective This study aimed to investigate the anticipated impact of increasing the flow of electronic health record information, specifically physicians’ daily inpatient progress notes, via a patient portal to parents during their child’s acute hospital stay—an understudied population and an understudied setting. Methods A total of 5 in-person focus groups were conducted with 34 stakeholders most likely impacted by sharing of physicians’ inpatient notes with parents of hospitalized children: hospital administrators, hospitalist physicians, interns and resident physicians, nurses, and the parents themselves. Results Distinct themes identified as benefits of pediatric inpatient Open Notes for parents emerged from all the 5 focus groups. These themes were communication, recapitulation and reinforcement, education, stress reduction, quality control, and improving family-provider relationships. Challenges identified included burden on provider, medical jargon, communication, sensitive content, and decreasing trust. Conclusions Providing patients and, in the case of pediatrics, caregivers with access to medical records via patient portals increases the flow of information and, in turn, their ability to participate in the discourse of their care. Parents in this study demonstrated not only that they act as monitors and guardians of their children’s health but also that they are observers of the clinical processes taking place in the hospital and at their child’s bedside. This includes the clinical documentation process, from the creation of notes to the reading and sharing of the notes. Parents acknowledge not only the importance of notes in the clinicians’ workflow but also their collaboration with providers as part of the health care team.
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Affiliation(s)
| | - Michelle M Kelly
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
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Carayon P, Hose BZ, Wooldridge A, Brazelton TB, Dean SM, Eithun BL, Kelly MM, Kohler JE, Ross J, Rusy DA, Hoonakker PLT. Human-centered design of team health IT for pediatric trauma care transitions. Int J Med Inform 2022; 162:104727. [PMID: 35305517 PMCID: PMC9437147 DOI: 10.1016/j.ijmedinf.2022.104727] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Received: 09/01/2021] [Revised: 01/20/2022] [Accepted: 02/21/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND As problems of acceptance, usability and workflow integration continue to emerge with health information technologies (IT), it is critical to incorporate human factors and ergonomics (HFE) methods and design principles. Human-centered design (HCD) provides an approach to integrate HFE and produce usable technologies. However, HCD has been rarely used for designing team health IT, even though team-based care is expanding. OBJECTIVE To describe the HCD process used to develop a usable team health IT (T3 or Teamwork Transition Technology) that provides cognitive support to pediatric trauma care teams during transitions from the emergency department to the operating room and the pediatric intensive care unit. METHODS The HCD process included seven steps in three phases of analysis, design activities and feedback. RESULTS The HCD process involved multiple perspectives and clinical roles that were engaged in inter-related activities, leading to design requirements, i.e., goals for the technology, a set of 47 information elements, and a list of HFE design principles applied to T3. Results of the evaluation showed a high usability score for T3. CONCLUSIONS HFE can be integrated in the HCD process through a range of methods and design principles. That design process can produce a usable technology that provides cognitive support to a large diverse team involved in pediatric trauma care transitions. Future research should continue to focus on HFE-based design of team health IT.
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Affiliation(s)
- Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States; Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, United States.
| | - Bat-Zion Hose
- Department of Anesthesiology and Critical Care at the Perelman School of Medicine, University of Pennsylvania, United States
| | - Abigail Wooldridge
- Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, United States
| | - Thomas B Brazelton
- American Family Children's Hospital, UW Health, United States; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, United States
| | - Shannon M Dean
- Department of Pediatric Medicine, St Jude's Hospital, United States
| | - Ben L Eithun
- American Family Children's Hospital, UW Health, United States
| | - Michelle M Kelly
- American Family Children's Hospital, UW Health, United States; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, United States
| | | | - Joshua Ross
- American Family Children's Hospital, UW Health, United States; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, United States; Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, United States
| | - Deborah A Rusy
- American Family Children's Hospital, UW Health, United States; Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, United States
| | - Peter L T Hoonakker
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, United States
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36
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Kelly MM, DeMuri GP, Barton HJ, Nacht CL, Butteris SM, Katz B, Burns R, Koval S, Ehlenbach ML, Stanley J, Wald ER, Warner G, Wilson LF, Myrah GE, Parker DE, Coller RJ. Priorities for Safer In-Person School for Children With Medical Complexity During COVID-19. Pediatrics 2022; 149:184886. [PMID: 35199167 PMCID: PMC9647557 DOI: 10.1542/peds.2021-054434] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To establish statewide consensus priorities for safer in-person school for children with medical complexity (CMC) during the coronavirus disease 2019 (COVID-19) pandemic using a rapid, replicable, and transparent priority-setting method. METHODS We adapted the Child Health and Nutrition Research Initiative Method, which allows for crowdsourcing ideas from diverse stakeholders and engages technical experts in prioritizing these ideas using predefined scoring criteria. Crowdsourcing surveys solicited ideas from CMC families, school staff, clinicians and administrators through statewide distribution groups/listservs using the prompt: "It is safe for children with complex health issues and those around them (families, teachers, classmates, etc.) to go to school in-person during the COVID-19 pandemic if/when…" Ideas were aggregated and synthesized into a unique list of candidate priorities. Thirty-four experts then scored each candidate priority against 5 criteria (equity, impact on COVID-19, practicality, sustainability, and cost) using a 5-point Likert scale. Scores were weighted and predefined thresholds applied to identify consensus priorities. RESULTS From May to June 2021, 460 stakeholders contributed 1166 ideas resulting in 87 candidate priorities. After applying weighted expert scores, 10 consensus CMC-specific priorities exceeded predetermined thresholds. These priorities centered on integrating COVID-19 safety and respiratory action planning into individualized education plans, educating school communities about CMC's unique COVID-19 risks, using medical equipment safely, maintaining curricular flexibility, ensuring masking and vaccination, assigning seats during transportation, and availability of testing and medical staff at school. CONCLUSIONS Priorities for CMC, identified by statewide stakeholders, complement and extend existing recommendations. These priorities can guide implementation efforts to support safer in-person education for CMC.
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Affiliation(s)
- Michelle M. Kelly
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin,Address correspondence to Michelle M. Kelly, MD, MS Department of Pediatrics, University of Wisconsin, H4/419 CSC, 600 Highland Ave., Madison, WI 53792. E-mail:
| | - Gregory P. DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Hanna J. Barton
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Carrie L. Nacht
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Sabrina M. Butteris
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Rebecca Burns
- Children and Youth with Special Health Care Needs, State of Wisconsin Department of Health Services, Madison, Wisconsin
| | - Shawn Koval
- Children and Youth with Special Health Care Needs, State of Wisconsin Department of Health Services, Madison, Wisconsin
| | - Mary L. Ehlenbach
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Julia Stanley
- Healthy Kids Collaborative, UW Health, Madison, Wisconsin
| | - Ellen R. Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Gemma Warner
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Gary E. Myrah
- Wisconsin Council of Administrators and Special Services, Wisconsin
| | | | - Ryan J. Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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37
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Shadman KA, Edmonson MB, Coller RJ, Sklansky DJ, Nacht CL, Zhao Q, Kelly MM. US Hospital Stays in Children and Adolescents With Acetaminophen Poisoning. Hosp Pediatr 2022; 12:e60-e67. [PMID: 35048104 DOI: 10.1542/hpeds.2021-005816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Acetaminophen poisoning occurs in all age groups; however, hospital-based outcomes of children with these poisonings were not well characterized. Our objectives were to describe the incidence, characteristics, and outcomes of hospital stays in children with acetaminophen poisoning and evaluate the contribution of intentionality. METHODS We used the 2016 Kids' Inpatient Database and validated International Classification of Diseases, 10th Revision diagnostic codes to identify hospitalizations of children aged 0 to 19 years for acetaminophen poisoning. We used standard survey methods to generate weighted population estimates and describe characteristics and outcomes, both overall and stratified by intentionality. RESULTS There were 9935 (95% confidence interval [CI], 9252-10 619) discharges from acute care hospitals for acetaminophen poisoning in U.S. children aged 0 to 19 years during 2016, corresponding to a population rate of 12.1 (95% CI, 11.3-12.9) hospitalizations per 100 000 children. Most hospitalizations for both intentional and unintentional acetaminophen poisoning occurred in females, with a strongly age-related sex distribution. Median length of stay was 2 days (interquartile range, 1-4 days); however, nearly half of discharges were subsequently transferred to another type of facility (eg, psychiatric hospital). Median hospital charges for acute care were $14 379 (interquartile range, $9162-$23 114), totaling $204.7 million (95% CI, $187.4-$221.9) in aggregate. Of 31 632 hospital discharges associated with self-harm medication poisoning in children aged 0 to 19 years, acetaminophen was the single most commonly implicated agent. CONCLUSIONS Acetaminophen poisoning was the most common cause of U.S. hospital stays associated with medication self-harm poisoning. More effective acetaminophen poisoning prevention strategies are needed, which may reduce the burden of this common adolescent malady.
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Affiliation(s)
| | | | | | | | | | - Qianqian Zhao
- Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health
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Nacht CL, Kelly MM, Edmonson MB, Sklansky DJ, Shadman KA, Kind AJH, Zhao Q, Barreda CB, Coller RJ. Association Between Neighborhood Disadvantage and Pediatric Readmissions. Matern Child Health J 2022; 26:31-41. [PMID: 35013884 PMCID: PMC8982848 DOI: 10.1007/s10995-021-03310-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Although individual-level social determinants of health (SDH) are known to influence 30-day readmission risk, contextual-level associations with readmission are poorly understood among children. This study explores associations between neighborhood disadvantage measured by Area Deprivation Index (ADI) and pediatric 30-day readmissions. METHODS This retrospective cohort study included discharges of patients aged < 20 years from Maryland's 2013-2016 all-payer dataset. The ADI, which quantifies 17 indicators of neighborhood socioeconomic disadvantage within census block groups, is used as a proxy for contextual-level SDH. Readmissions were identified with the 30-day Pediatric All-Condition Readmissions measure. Associations between ADI and readmission were identified with generalized estimating equations adjusted for patient demographics and clinical severity (Chronic Condition Indicator [CCI], Pediatric Medical Complexity Algorithm [PMCA], Index Hospital All Patients Refined Diagnosis Related Groups [APR-DRG]), and hospital discharge volume. RESULTS Discharges (n = 138,998) were mostly female (52.7%), publicly insured (55.1%), urban-dwelling (93.0%), with low clinical severity levels (0-1 CCIs [82.3%], minor APR-DRG severity [48.4%]). Overall readmission rate was 4.0%. Compared to the least disadvantaged ADI quartile, readmissions for the most disadvantaged quartile were significantly more likely (aOR 1.19, 95% CI 1.09-1.30). After adjustment, readmissions were associated with public insurance and indicators of medical complexity (higher number of CCIs, complex-chronic disease PMCA, and APR-DRG severity). CONCLUSION In this all-payer, statewide sample, living in the most socioeconomically disadvantaged neighborhoods independently predicted pediatric readmission. While the relative magnitude of neighborhood disadvantage was modest compared to medical complexity, disadvantage is modifiable and thus represents an important consideration for prevention and risk stratification efforts.
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Affiliation(s)
- Carrie L. Nacht
- University of Wisconsin School of Medicine and Public Health, Department of Pediatrics, Madison, Wisconsin
| | - Michelle M. Kelly
- University of Wisconsin School of Medicine and Public Health, Department of Pediatrics, Madison, Wisconsin
| | - M Bruce Edmonson
- University of Wisconsin School of Medicine and Public Health, Department of Pediatrics, Madison, Wisconsin
| | - Daniel J. Sklansky
- University of Wisconsin School of Medicine and Public Health, Department of Pediatrics, Madison, Wisconsin
| | - Kristin A. Shadman
- University of Wisconsin School of Medicine and Public Health, Department of Pediatrics, Madison, Wisconsin
| | - Amy J. H. Kind
- Madison VA Hospital Geriatrics Research Education and Clinical Center (GRECC),University of Wisconsin School of Medicine and Public Health, Department of Medicine
| | - Qianqian Zhao
- University of Wisconsin School of Medicine and Public Health, Department of Biostatistics and Medical Informatics, Madison, Wisconsin
| | - Christina B. Barreda
- University of Wisconsin School of Medicine and Public Health, Department of Pediatrics, Madison, Wisconsin
| | - Ryan J. Coller
- University of Wisconsin School of Medicine and Public Health, Department of Pediatrics, Madison, Wisconsin
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Wooldridge AR, Carayon P, Hoonakker P, Hose BZ, Schroeer K, Brazelton T, Eithun B, Rusy D, Ross J, Kohler J, Kelly MM, Dean S, Springman S, Rahal R, Gurses AP. Care transition of trauma patients: Processes with articulation work before and after handoff. Appl Ergon 2022; 98:103606. [PMID: 34638036 PMCID: PMC10373374 DOI: 10.1016/j.apergo.2021.103606] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/23/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]
Abstract
While care transitions influence quality of care, less work studies transitions between hospital units. We studied care transitions from the operating room (OR) to pediatric and adult intensive critical care units (ICU) using Systems Engineering Initiative for Patient Safety (SEIPS)-based process modeling. We interviewed twenty-nine physicians (surgery, anesthesia, pediatric critical care) and nurses (OR, ICU) and administered the AHRQ Hospital Survey on Patient Safety Culture items about handoffs, care transitions and teamwork. Care transitions are complex, spatio-temporal processes and involve work during the transition (i.e., handoff and transport) and preparation and follow up activities (i.e., articulation work). Physicians defined the transition as starting earlier and ending later than nurses. Clinicians in the OR to adult ICU transition without a team handoff reported significantly less information loss and better cooperation, despite positive interview data. A team handoff and supporting articulation work should increase awareness, improving quality and safety of care transitions.
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Affiliation(s)
- Abigail R Wooldridge
- Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - Pascale Carayon
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin, Madison, USA; Department of Industrial and Systems Engineering, University of Wisconsin, Madison, USA
| | - Peter Hoonakker
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin, Madison, USA
| | - Bat-Zion Hose
- Department of Anesthesiology and Critical Care at the Perelman School of Medicine, University of Pennsylvania, USA
| | - Katherine Schroeer
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin, Madison, USA; Department of Industrial and Systems Engineering, University of Wisconsin, Madison, USA
| | - Tom Brazelton
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ben Eithun
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Deborah Rusy
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Joshua Ross
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Michelle M Kelly
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Shannon Dean
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Scott Springman
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Rima Rahal
- Vituity, Mercy General Hospital and Sutter Medical Center, Sacramento, CA, USA
| | - Ayse P Gurses
- Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Schools of Medicine, Bloomberg School of Public Health and Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
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Hoonakker PLT, Hose BZ, Carayon P, Eithun BL, Rusy DA, Ross JC, Kohler JE, Dean SM, Brazelton TB, Kelly MM. Scenario-Based Evaluation of Team Health Information Technology to Support Pediatric Trauma Care Transitions. Appl Clin Inform 2022; 13:218-229. [PMID: 35139563 PMCID: PMC8828456 DOI: 10.1055/s-0042-1742368] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/21/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Clinicians need health information technology (IT) that better supports their work. Currently, most health IT is designed to support individuals; however, more and more often, clinicians work in cross-functional teams. Trauma is one of the leading preventable causes of children's death. Trauma care by its very nature is team based but due to the emergent nature of trauma, critical clinical information is often missed in the transition of these patients from one service or unit to another. Teamwork transition technology can help support these transitions and minimize information loss while enhancing information gathering and storage. In this study, we created a large screen technology to support shared situational awareness across multiple clinical roles and departments. OBJECTIVES This study aimed to examine if the Teamwork Transition Technology (T3) supports teams and team cognition. METHODS We used a scenario-based mock-up methodology with 36 clinicians and staff from the different units and departments who are involved in pediatric trauma to examine T3. RESULTS Results of the evaluation show that most participants agreed that the technology helps achieve the goals set out in the design phase. Respondents thought that T3 organizes and presents information in a different way that was helpful to them. CONCLUSION In this study, we examined a health IT (T3) that was designed to support teams and team cognition. The results of our evaluation show that participants agreed that T3 does support them in their work and increases their situation awareness.
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Affiliation(s)
- Peter L. T. Hoonakker
- Wisconsin Institute for Health Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Bat-Zion Hose
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Perelman School of Medicine, Philadelphia, United States
| | - Pascale Carayon
- Wisconsin Institute for Health Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, United States
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Ben L. Eithun
- American Family Children's Hospital, Madison, Wisconsin, United States
| | - Deborah A. Rusy
- Department of Anesthesiology, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, United States
| | - Joshua C. Ross
- Department of Emergency Medicine, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, United States
| | - Jonathan E. Kohler
- Department of Surgery, UC Davis Children's Hospital, Sacramento, California, United States
| | - Shannon M. Dean
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, United States
| | - Tom B. Brazelton
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, United States
| | - Michelle M. Kelly
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, United States
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Golden BP, Kelly MM, Olson APJ. Defining the gold standard: What is success in electronic health record documentation? J Hosp Med 2022; 17:71-72. [PMID: 35504587 DOI: 10.1002/jhm.2737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Blair P Golden
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Michelle M Kelly
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Andrew P J Olson
- Departments of Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Abstract
CONTEXT Artificial intelligence (AI) technologies are increasingly used in pediatrics and have the potential to help inpatient physicians provide high-quality care for critically ill children. OBJECTIVE We aimed to describe the use of AI to improve any health outcome(s) in neonatal and pediatric intensive care. DATA SOURCE PubMed, IEEE Xplore, Cochrane, and Web of Science databases. STUDY SELECTION We used peer-reviewed studies published between June 1, 2010, and May 31, 2020, in which researchers described (1) AI, (2) pediatrics, and (3) intensive care. Studies were included if researchers assessed AI use to improve at least 1 health outcome (eg, mortality). DATA EXTRACTION Data extraction was conducted independently by 2 researchers. Articles were categorized by direct or indirect impact of AI, defined by the European Institute of Innovation and Technology Health joint report. RESULTS Of the 287 publications screened, 32 met inclusion criteria. Approximately 22% (n = 7) of studies revealed a direct impact and improvement in health outcomes after AI implementation. Majority were in prototype testing, and few were deployed into an ICU setting. Among the remaining 78% (n = 25) AI models outperformed standard clinical modalities and may have indirectly influenced patient outcomes. Quantitative assessment of health outcomes using statistical measures, such as area under the receiver operating curve (56%; n = 18) and specificity (38%; n = 12), revealed marked heterogeneity in metrics and standardization. CONCLUSIONS Few studies have revealed that AI has directly improved health outcomes for pediatric critical care patients. Further prospective, experimental studies are needed to assess AI's impact by using established implementation frameworks, standardized metrics, and validated outcome measures.
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Affiliation(s)
- Claudette O Adegboro
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Avishek Choudhury
- Division of Engineering Management, School of Systems and Enterprise, Stevens Institute of Technology, Hoboken, New Jersey
| | - Onur Asan
- Division of Engineering Management, School of Systems and Enterprise, Stevens Institute of Technology, Hoboken, New Jersey
| | - Michelle M Kelly
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
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Abstract
The preterm birth rate in the United States is 10%, with 8% being born between 36 and 32 weeks of gestation, and the remaining 2% born less than 31 weeks of gestation. The global preterm birth rate varies from 5% to 18%, with varying survival rates. These percentages signify a population of people that will receive health care across the life course without ever being asked about a preterm birth history. With a steady rise in the survival rate of preterm infants being discharged home from the neonatal intensive care unit, with limited referrals for neonatal or developmental follow up, it is essential adult care providers ask the right questions and identify risk factors for this vulnerable population. This review describes the recently published, evidence-based recommendations for addressing preterm history across the life course. A robust review of the literature has demonstrated that the long-term sequelae of being born preterm can adversely affect health and quality of life. The following will offer preterm birth history recommendations based on assessment and diagnosis, prevention and management and referral and treatment. The goal of the recommendations is to create awareness among adult health providers in acknowledging a past medical history of preterm birth and providing appropriate preventive care, therefore shifting the paradigm of care from reactive intervention to proactive care.
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Affiliation(s)
- Michelle M Kelly
- Villanova University, Fitzpatrick College of Nursing, United States of America; University of Rhode Island, College of Nursing, Research Fellow, United States of America.
| | - Jane Tobias
- Thomas Jefferson University, Jefferson College of Nursing, United States of America
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Bourne MJ, Smeltzer SC, Kelly MM. Healthcare inequities among adults with developmental disability: An integrative review with implications for nursing education. Nurse Educ Pract 2021; 57:103225. [PMID: 34649127 DOI: 10.1016/j.nepr.2021.103225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/23/2021] [Accepted: 09/29/2021] [Indexed: 11/29/2022]
Abstract
AIM This integrative review synthesized research on the healthcare inequities experienced by adults with developmental disability in the United States and discussed implications for nursing education. BACKGROUND Individuals with developmental disability are living longer with chronic comorbidities and experience healthcare inequities. METHOD Application of inclusion criteria to database and ancestry searches resulted in 26 articles that were assessed for quality and analyzed thematically. RESULTS Three categories of inequity were identified: knowledge deficits, communication challenges and poor quality of care. Knowledge deficits and communication challenges can lead to frustration, errors and unmet needs. Poor quality of care encompasses the decreased availability and access to services, limited health promotion participation and higher rates of hospitalizations and complications for adults with developmental disability. CONCLUSION Healthcare inequities may be reduced by targeting patient and provider knowledge. Inclusion of developmental disability content and clinical experiences in nursing education may improve care and reduce inequities for this underserved population.
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Affiliation(s)
- Melissa J Bourne
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA.
| | - Suzanne C Smeltzer
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA.
| | - Michelle M Kelly
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA.
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Williams BS, Nacht C, Fiore MC, Kelly MM. Smoke Exposure Disclosure: Parental Perspectives of Screening in the Inpatient Setting. Hosp Pediatr 2021; 11:e210-e217. [PMID: 34507976 DOI: 10.1542/hpeds.2021-005808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Current screening questions for pediatric tobacco smoke exposure are suboptimal. Factors influencing screening accuracy, particularly in the pediatric inpatient setting, are unknown. Our objective was to identify facilitators of and barriers to parental disclosure of smoke exposure when screened during their child's hospitalization and strategies to promote accurate disclosure. METHODS This qualitative study was conducted with a convenience sample of parents of children admitted to the medical and surgical unit of a Midwest tertiary care children's hospital. Eligible parents included those with documented disclosure of smoke exposure in the child's electronic health record. A researcher trained in qualitative methods conducted semistructured, in-depth interviews with parents regarding their experiences with smoke exposure screening in the inpatient pediatric setting. Two researchers independently identified concepts directed at barriers, facilitators, and strategies for effective screening, which were compared and reconciled by a third researcher. RESULTS Facilitators of disclosing their child's smoke exposure included the following: (1) the caregiver's internal characteristic(s) promoting disclosure, (2) perceived relevance of the screening question to the child's health, and (3) the questioner being viewed positively. Barriers included the following: (1) fear of negative consequences, (2) a vague question, (3) lack of knowledge, (4) guilt, and (5) unconducive environment and timing. The strategies parents suggested to improve screening for smoke exposure included the following: (1) communicate preemptively, (2) provide specific exposure examples, (3) improve questioner-caregiver rapport, and (4) improve screening environment and timing. CONCLUSIONS Parents identified various mechanisms to improve tobacco smoke exposure screening. The facilitators, barriers, and strategies provide opportunities to improve the inpatient pediatric screening process.
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Affiliation(s)
- Brian S Williams
- Departments of Pediatrics .,Medicine, School of Medicine and Public Health.,Center for Tobacco Research and Intervention, University of Wisconsin-Madison
| | | | - Michael C Fiore
- Medicine, School of Medicine and Public Health.,Center for Tobacco Research and Intervention, University of Wisconsin-Madison
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Kelly MM, Coller RJ, Hoonakker PLT, Nacht CL, Dean SM. Provider Experiences With Offering Families Bedside Health Record Access Across a Children's Hospital. Hosp Pediatr 2021; 10:1002-1005. [PMID: 33109520 DOI: 10.1542/hpeds.2020-0044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Evaluate provider experiences with a bedside tablet inpatient portal application given to hospitalized patients and families across a children's hospital. METHODS In this cross-sectional study, English-speaking parents of children <12 years old and adolescents ≥12 years admitted between February and June 2017 to a 111-bed tertiary children's hospital were given an inpatient portal application (MyChart Bedside; Epic Systems Corporation, Verona, WI) on a tablet (iPad) to use during their stay. The portal included real-time vital signs, test results, medication and problem lists, a daily schedule, educational materials, and provider names and photographs. Portal use was described from electronic health record data, and provider (physician, nurse, and pharmacist) experiences were assessed from surveys. RESULTS Of 1892 admissions given a tablet over 5 months, 1502 (79.4%) logged in to view their inpatient health record at least once during their hospital stay. No tablets were lost or stolen. Of 101 providers, 96 completed the survey (a response rate of 95%). They reported that patients and/or parents asked them questions about information they found, including laboratory results (45% of respondents), medications (13%), diagnoses (13%), and errors and/or mistakes in care (3%). Few perceived spending more time answering questions related to portal use (8%) or that it increased their workload (11%). In all, 92% of providers wanted patients and parents to continue to be able to use the portal. CONCLUSIONS Almost 80% of hospitalized patients and parents given a tablet accessed real-time information from the inpatient health record. The portal facilitated communication about test results, diagnoses, and medications and providers overwhelmingly supported its ongoing use.
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Affiliation(s)
- Michelle M Kelly
- Department of Pediatrics, School of Medicine and Public Health and .,Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin
| | - Ryan J Coller
- Department of Pediatrics, School of Medicine and Public Health and
| | - Peter L T Hoonakker
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin
| | - Carrie L Nacht
- Department of Pediatrics, School of Medicine and Public Health and
| | - Shannon M Dean
- Department of Pediatrics, School of Medicine and Public Health and
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Barton HJ, Coller RJ, Loganathar S, Singhe N, Ehlenbach ML, Katz B, Warner G, Kelly MM, Werner NE. Medical Device Workarounds in Providing Care for Children With Medical Complexity in the Home. Pediatrics 2021; 147:peds.2020-019513. [PMID: 33926988 PMCID: PMC8085995 DOI: 10.1542/peds.2020-019513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Children with medical complexity (CMC) are commonly assisted by medical devices, which family caregivers are responsible for managing and troubleshooting in the home. Optimizing device use by maximizing the benefits and minimizing the complications is a critical goal for CMC but is relatively unexplored. In this study, we sought to identify and describe workarounds families have developed to optimize medical device use for their needs. METHODS We conducted 30 contextual inquiry interviews with families of CMC in homes. Interviews were recorded, transcribed, and analyzed for barriers and workarounds specific to medical device usage through a directed content analysis. We used observation notes and photographs to confirm and elaborate on interview findings. RESULTS We identified 4 barriers to using medical devices in the home: (1) the quantity and type of devices allotted do not meet family needs, (2) the device is not designed to be used in locations families require, (3) device use is physically or organizationally disruptive to the home, and (4) the device is not designed to fit the user. We also identified 11 categories of workarounds to the barriers. CONCLUSIONS Families face many barriers in using medical devices to care for CMC. Our findings offer rich narrative and photographic data revealing the ways in which caregivers work around these barriers. Future researchers should explore the downstream effects of these ubiquitous, necessary workarounds on CMC outcomes toward developing interventions that optimize device use for families.
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Affiliation(s)
| | - Ryan J. Coller
- Pediatrics, University of Wisconsin–Madison, Madison, Wisconsin; and
| | | | - Nawang Singhe
- Departments of Industrial and Systems Engineering and
| | - Mary L. Ehlenbach
- Pediatrics, University of Wisconsin–Madison, Madison, Wisconsin; and
| | | | - Gemma Warner
- Pediatrics, University of Wisconsin–Madison, Madison, Wisconsin; and
| | - Michelle M. Kelly
- Pediatrics, University of Wisconsin–Madison, Madison, Wisconsin; and
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48
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Kelly MM, Tobias J, Griffith PB. Addressing Preterm Birth History With Clinical Practice Recommendations Across the Life Course. J Pediatr Health Care 2021; 35:e5-e20. [PMID: 33637388 DOI: 10.1016/j.pedhc.2020.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/12/2020] [Accepted: 12/18/2020] [Indexed: 12/19/2022]
Abstract
Preterm birthrates, coupled with excellent preterm birth survival rates, guarantee that every health care provider, regardless of specialty, is caring for patients who were born preterm. Patients and families may not share a preterm birth history however, eliciting this information is important for mitigating potential risk. Long-term health outcomes research supports health implications associated with preterm birth throughout the life course. Through an in-depth review of literature and validation from health care experts in pediatric and adult care, recommendations for primary care providers were developed. The aim was to enhance the identification of those born prematurely, empower health care providers to employ familiar screening strategies, and advocate for mitigations strategies with anticipatory guidance and health promotion. These recommendations advocate a paradigm shift toward proactive intervention, rather than the reactive practice of waiting for children to fail to meet specific milestones or begin to show comorbid tendencies.
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49
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Zellmer BM, Nacht CL, Coller RJ, Hoonakker PLT, Smith CA, Sklansky DJ, Dean SM, Smith W, Sprackling CM, Ehlenfeldt BD, Kelly MM. BedsideNotes: Sharing Physicians' Notes With Parents During Hospitalization. Hosp Pediatr 2021; 11:503-508. [PMID: 33795371 DOI: 10.1542/hpeds.2020-005447] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Physicians increasingly share ambulatory visit notes with patients to meet new federal requirements, and evidence suggests patient experiences improve without overburdening physicians. Whether sharing inpatient notes with parents of hospitalized children yields similar outcomes is unknown. In this pilot study, we evaluated parent and physician perceptions of sharing notes with parents during hospitalization. METHODS Parents of children aged <12 years admitted to a hospitalist service at a tertiary children's hospital in April 2019 were offered real-time access to their child's admission and daily progress notes on a bedside inpatient portal (MyChart Bedside). Upon discharge, ambulatory OpenNotes survey items assessed parent and physician (attendings and interns) perceptions of note sharing. RESULTS In all, 25 parents and their children's discharging attending and intern physicians participated. Parents agreed that the information in notes was useful and helped them remember their child's care plan (100%), prepare for rounds (96%), and feel in control (91%). Although many physicians (34%) expressed concern that notes would confuse parents, no parent reported that notes were confusing. Some physicians perceived that they spent more time writing and/or editing notes (28%) or that their job was more difficult (15%). Satisfaction with sharing was highest among parents (100%), followed by attendings (81%) and interns (35%). CONCLUSIONS Parents all valued having access to physicians' notes during their child's hospital stay; however, some physicians remained concerned about the potential negative consequences of sharing. Comparative effectiveness studies are needed to evaluate the effect of note sharing on outcomes for hospitalized children, families, and staff.
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Affiliation(s)
| | - Carrie L Nacht
- Department of Pediatrics, School of Medicine and Public Health
| | - Ryan J Coller
- Department of Pediatrics, School of Medicine and Public Health
| | | | | | | | - Shannon M Dean
- Department of Pediatrics, School of Medicine and Public Health.,University of Wisconsin Health, Madison, Wisconsin
| | - Windy Smith
- University of Wisconsin Health, Madison, Wisconsin
| | | | | | - Michelle M Kelly
- Department of Pediatrics, School of Medicine and Public Health, .,Center for Quality and Productivity Improvement, and
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Bourne MJ, Smeltzer SC, Kelly MM. Clinical teacher self-efficacy: A concept analysis. Nurse Educ Pract 2021; 52:103029. [PMID: 33780834 DOI: 10.1016/j.nepr.2021.103029] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 11/15/2022]
Abstract
Self-efficacy is a well-researched concept and a key component of Bandura's Social Cognitive Theory. Teacher self-efficacy is widely researched within education; it affects student achievement and motivation as well as teacher performance and commitment. Minimal information exists on teacher self-efficacy within clinical settings of practice professions which likely affects patient outcomes. This paper provides background on self-efficacy and teacher self-efficacy; it then addresses clinical teacher self-efficacy using the Walker and Avant (2005) method for concept analysis. Assumptions, definitions, characteristics, antecedents and consequences of the concept of clinical teacher self-efficacy are discussed and represented visually, and exemplified as cases within nursing education. Implications and recommendations are suggested for the applicability of clinical teacher self-efficacy within clinician education and practice.
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Affiliation(s)
- Melissa J Bourne
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, 19085, United States.
| | - Suzanne C Smeltzer
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, 19085, United States.
| | - Michelle M Kelly
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, 19085, United States.
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