First name
Margaret
Last name
O'Neill

Title

Clinician Perceptions of the Importance of the Components of Hospital Discharge Care for Children.

Year of Publication

2018

Number of Pages

79-88

Date Published

2018 Mar/Apr

ISSN Number

1945-1474

Abstract

<p><strong>BACKGROUND: </strong>Discharging hospitalized children involves several different components, but their relative value is unknown. We assessed which discharge components are perceived as most and least important by clinicians.</p>

<p><strong>METHODS: </strong>March and June of 2014, we conducted an online discrete choice experiment (DCE) among national societies representing 704 nursing, physician, case management, and social work professionals from 46 states. The DCE consisted of 14 discharge care components randomly presented two at a time for a total of 28 choice tasks. Best-worst scaling of participants' choices generated mean relative importance (RI) scores for each component, which allowed for ranking from least to most important.</p>

<p><strong>RESULTS: </strong>Participants, regardless of field or practice setting, perceived "Discharge Education/Teach-Back" (RI 11.1 [95% confidence interval, CI: 11.0-11.3]) and "Involve the Child's Care Team" (RI 10.6 [95% CI: 10.4-10.8]) as the most important discharge components, and "Information Reconciliation" (RI 4.1 [95% CI: 3.9-4.4]) and "Assigning Roles/Responsibilities of Discharge Care" (RI 2.8 [95% CI: 2.6-3.0]) as least important.</p>

<p><strong>CONCLUSIONS: </strong>A diverse group of pediatric clinicians value certain components of the pediatric discharge care process much more than others. Efforts to optimize the quality of hospital discharge for children should consider these findings.</p>

DOI

10.1097/JHQ.0000000000000084

Alternate Title

J Healthc Qual

PMID

29329135

Title

Postacute Care after Pediatric Hospitalizations for a Primary Mental Health Condition.

Year of Publication

2018

Number of Pages

222-2228.e1.

Date Published

2018 Feb

ISSN Number

1097-6833

Abstract

<p><strong>OBJECTIVES: </strong>To determine the proportion of US children hospitalized for a primary mental health condition who are discharged to postacute care (PAC); whether PAC discharge is associated with demographic, clinical, and hospital characteristics; and whether PAC use varies by state.</p>

<p><strong>STUDY DESIGN: </strong>Retrospective cohort study of a nationally representative sample of US acute care hospitalizations for children ages 2-20 years with a primary mental health diagnosis, using the 2009 and 2012 Kids' Inpatient Databases. Discharge to PAC was used as a proxy for transfer to an inpatient mental health facility. We derived adjusted logistic regression models to assess the association of patient and hospital characteristics with discharge to PAC.</p>

<p><strong>RESULTS: </strong>In 2012, 14.7% of hospitalized children (n = 248 359) had a primary mental health diagnosis. Among these, 72% (n = 178 214) had bipolar disorder, depression, or psychosis, of whom 4.9% (n = 8696) were discharged to PAC. The strongest predictors of PAC discharge were homicidal ideation (aOR, 24.9; 96% CI, 4.1-150.4), suicide and self-injury (aOR, 15.1; 95% CI, 11.7-19.4), and substance abuse-related medical illness (aOR, 5.0; 95% CI, 4.5-5.6). PAC use varied widely by state, ranging from 2.2% to 36.3%.</p>

<p><strong>CONCLUSIONS: </strong>The majority of children hospitalized primarily for a mood disorder or psychosis were not discharged to PAC, and safety-related conditions were the primary drivers of the relatively few PAC discharges. There was substantial state-to-state variation. Target areas for quality improvement include improving access to PAC for children hospitalized for mood disorders or psychosis and equitable allocation of appropriate PAC resources across states.</p>

DOI

10.1016/j.jpeds.2017.09.058

Alternate Title

J. Pediatr.

PMID

29162345

Title

Ways to Identify Children with Medical Complexity and the Importance of Why.

Year of Publication

2015

Number of Pages

229-37

Date Published

08/2015

ISSN Number

1097-6833

DOI

10.1016/j.jpeds.2015.04.068

Alternate Title

J. Pediatr.

PMID

26028285

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