PCOR: Brave new world meets old institutional policies
PCOR: Brave new world meets old institutional policies
A recent article by PROKids team member Jessica Chung, et al., discusses the tensions between the engagement of patient stakeholders in research and the institutional and legal framework governing that engagement. Patient engagement during all stages of research has become increasingly common. Yet institutional policies, often intended to protect patients and research participants, are evolving to meet this new reality.
Chung, et al. lays out these tensions using examples from trial funded by the Patient-Centered Outcomes Institute and led by Dr. Elizabeth Cox, Director of PROKids. Quandaries arose when the values or preferences of patient stakeholders conflicted with institutional policies about background checks, letters about privacy breaches, and study reminders.
A family-centered rounds checklist, family engagement, and patient safety
A family-centered rounds checklist, family engagement, and patient safety
In a recent randomized clinical trial led by Dr. Elizabeth Cox, implementing a checklist during family-centered rounds increased family engagement and the safety of hospitalized children from the perspective of the families. The checklist was developed with input from the hospital staff and families of hospitalized children, and two items were found to significantly increase family engagement: when hospital staff read back orders, families engaged in more decision-making and provided more information, and families were also more engaged when the team talked about goals for discharge. The materials needed to implement the family-centered rounds checklist in are available in a free toolkit here.
Strategies to reduce hospitalizations of children with medical complexity through complex care
Strategies to reduce hospitalizations of children with medical complexity through complex care
In this article, Dr. Ryan Coller et al. describe the process used by a complex care medical home program to develop intervention strategies aiming to reduce hospitalizations within their population. They used (a) semi-structured interviews of caregivers of children with medical complexity that were experienceing acute, unscheduled hospitalizations, and (b) conducted a literature review on preventing hospitalizations among children with medical complexity to link intervention strategies to key drivers for lowering hospital utilization. An expert panel then rated each model for effectiveness in ultimately reducing hospitalizations, and the complex care program applied those findings in their selection of a final set of feasible intervention strategies to implement.
Discharge handoff communication and pediatric readmissions
Discharge handoff communication and pediatric readmissions
In this article, Dr. Ryan Coller et al. characterized common handoff practices between hospitals & primary care providers after pediatric hospitalizations. Using data abstracted from administrative, caregiver, and PCP questionnaires, the authors used logistic regression to asseess the relationship between 30-day unplanned readmissions and 11 handoff communication practices. They found that communication practices varied widely and that PCPs were only notified of half of the admissions that occurred. Unplanned readmissions to the hospital were unrelated to most handoff practices, and having PCP follow-up appoinments scheduled prior to discharge was associated with more readmissions.
"They're younger… it's harder." Primary providers' perspectives on hypertension management in young adults
"They're younger… it's harder." Primary providers' perspectives on hypertension management in young adults
Dr. Heather Johnson and team conducted a multicenter qualitative study to explore PCP perspectives on barriers to diagnosing, treating, and controlling hypertension among young adults with regular primary care. They found altered self-identity, greater blood pressure variability, and unintended consequences of medication initiation were barriers to hypertension control.
MyHEART: A non-randomized feasibility study of a young adult hypertension intervention
MyHEART: A non-randomized feasibility study of a young adult hypertension intervention
This study led by Dr. Heather Johnson sought to examine the feasibility of the MyHEART program, a telephone-based health coach self-management intervention for young adults with high blood pressure. The study team found MyHEART to be feasible and acceptable to young adults with uncontrolled hypertension. More patients reported blood pressure monitoring after the study, all coach-patient encounters were documented in the EHR for PCP review, and surveys indicate that patients had a positive experience with the intervention.
Medical complexity among children with special health care needs
Medical complexity among children with special health care needs
In this article, Dr. Ryan Coller et al. sought to identify subgroups of U.S. children with special health care needs and characterize key health outcomes by subgroup. They used a latent class analysis to identify 4 unique subgroups: (1) broad functional impairment with extensive health care, (2) broad functional impairment alone, (3) predominant physical impairment requiring family-delivered care, and (4) physical impairment alone. Children from class 1 had the highest ED visit rates and hospitalization odds, and the lowest odds of having a medical home. Despite having more shared decision making and medical home attributes, children in class 3 had more ED visits and missed school than children in class 2. However, children in class 2 experienced more cost-related difficulties, care delays, and parents needing to stop work.
The medical home and hospital readmissions
The medical home and hospital readmissions
Despite the fact that primary care medical homes have received considerable attention, little is known about the degree to which they influence early post-discharge utilization. In this article, Dr. Ryan Coller et al. examined whether patients with medical homes were less likely to have early post-discharge hospital or emergency department encounters. In a prospective cohort study of patients who had an acute hospitalization at a children's hospital, the authors found that more than 65% of patients enrolled in the study did not have a medical home and that patients who had a "usual source of sick and well care" had fewer readmissions than those without. Readmissions were higher among patients who had parents with less confidence in avoiding a readmission, subspecialist primary care providers, longer length of index hospital stay, and more hospitalizations in the last year.