RESUMEN
OBJECTIVE: To overcome obstacles to delivering medication abortion services during the COVID-19 pandemic, clinics and providers implemented new medication abortion service models not requiring in-person care. This study identifies organizational factors that promoted successful implementation of telehealth and adoption of "no test" medication abortion protocols. STUDY DESIGN: We conducted 21 semi-structured, in-depth interviews with health care providers and clinic administrators implementing clinician-supported telehealth abortion during the COVID pandemic. We selected 15 clinical sites to represent 4 different practice settings: independent primary care practices, online medical services, specialty family planning clinics, and primary care clinics within multispecialty health systems. The Consolidated Framework for Implementation Research guided our thematic analysis. RESULTS: Successful implementation of telehealth abortion included access to formal and informal inter-organizational networks, including professional organizations and informal mentorship relationships with innovators in the field; organizational readiness for implementation, such as having clinic resources available for telehealth services like functional electronic health records and options for easy-to-use virtual patient-provider interactions; and motivated and effective clinic champions. CONCLUSIONS: In response to the need to offer remote clinical services, 4 different practice settings types leveraged key operational factors to facilitate successful implementation of telehealth abortion. Information from this study can inform implementation strategies to support the dissemination and adoption of this model. IMPLICATIONS: Examples of successfully implemented telehealth medication abortion services provide a framework that can be used to inform and implement similar patient-centered telehealth models in diverse practice settings.
Asunto(s)
Abortivos/uso terapéutico , Aborto Inducido/métodos , Instituciones de Atención Ambulatoria/organización & administración , Personal de Salud , Atención Primaria de Salud/organización & administración , Telemedicina/organización & administración , COVID-19 , Registros Electrónicos de Salud , Humanos , Ciencia de la Implementación , Innovación Organizacional , Participación del Paciente , SARS-CoV-2 , Telemedicina/métodos , Estados UnidosRESUMEN
OBJECTIVES: Shared care plans play an essential role in coordinating care across health care providers and settings for children with medical complexity (CMC). However, existing care plans often lack shared ownership, are out-of-date, and lack universal accessibility. In this study, we aimed to establish requirements for shared care plans to meet the information needs of caregivers and providers and to mitigate current information barriers when caring for CMC. METHODS: We followed a user-centered design methodology and conducted in-depth semistructured interviews with caregivers and providers of CMC who receive care at a tertiary care children's hospital. We applied inductive, thematic analysis to identify salient themes. Analysis occurred concurrently with data collection; therefore, the interview guide was iteratively revised as new questions and themes emerged. RESULTS: Interviews were conducted with 17 caregivers and 22 providers. On the basis of participant perspectives, we identified 4 requirements for shared care plans that would help meet information needs and mitigate current information barriers when caring for CMC. These requirements included the following: (1) supporting the accessibility of care plans from multiple locations (eg, cloud-based) and from multiple devices, with alert and search features; (2) ensuring the organization is tailored to the specific user; (3) including collaborative functionality such as real-time, multiuser content management and secure messaging; and (4) storing care plans on a secure platform with caregiver-controlled permission settings. CONCLUSIONS: Although further studies are needed to understand the optimal design and implementation strategies, shared care plans that meet these specified requirements could mitigate perceived information barriers and improve care for CMC.
Asunto(s)
Cuidadores/psicología , Servicios de Salud del Niño , Enfermedad Crónica , Nube Computacional , Niños con Discapacidad , Personal de Salud/organización & administración , Adulto , Niño , Servicios de Salud del Niño/organización & administración , Servicios de Salud del Niño/tendencias , Nube Computacional/tendencias , Personal de Salud/tendencias , Humanos , Entrevistas como Asunto , Planificación de Atención al Paciente , Percepción , Relaciones Profesional-Familia , Investigación Cualitativa , Participación de los InteresadosRESUMEN
OBJECTIVE: To develop and test a caregiver-reported experience measure for pediatric hospital-to-home transitions. DATA SOURCES/STUDY SETTING: Primary data were collected between 07/2014 and 05/2015 from caregivers within 2-8 weeks of their child's discharge from a tertiary care children's hospital. STUDY DESIGN/DATA COLLECTION: We used a step-wise approach to developing the measure that included drafting de novo survey items based on caregiver interviews (n = 18), pretesting items using cognitive interviews (n = 18), and pilot testing revised items among an independent sample of caregivers (n = 500). Item reduction statistics and confirmatory factor analysis (CFA) were performed on a test sample of the pilot data to refine the measure, followed by CFA on the validation sample to test the final measure model fit. PRINCIPAL FINDINGS: Of 46 initial survey items, 19 were removed after pretesting and 19 were removed after conducting item statistics and CFA. This resulted in an eight-item measure with two domains: transition preparation (four items) and transition support (four items). Survey items assess the quality of discharge instructions, access to needed support and resources, care coordination, and follow-up care. Practical fit indices demonstrated an acceptable model fit: χ2 = 28.3 (df = 19); root-mean-square error of approximation = 0.04; comparative fit index = 0.99; and Tucker-Lewis index = 0.98. CONCLUSIONS: An eight-item caregiver-reported experience measure to evaluate hospital-to-home transition outcomes in pediatric populations demonstrated acceptable content validity and psychometric properties.
Asunto(s)
Cuidadores/psicología , Continuidad de la Atención al Paciente/organización & administración , Hospitales Pediátricos/organización & administración , Alta del Paciente , Adolescente , Adulto , Cuidados Posteriores/organización & administración , Niño , Preescolar , Análisis Factorial , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Lactante , Recién Nacido , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Factores Socioeconómicos , Adulto JovenRESUMEN
OBJECTIVE: To explore caregiver needs and preferences for achievement of high-quality pediatric hospital to home transitions and to describe similarities and differences in caregiver needs and preferences according to child medical complexity. METHODS: Qualitative study using semistructured telephone interviews of 18 caregivers of patients aged 1 month to 18 years discharged from Seattle Children's Hospital between September 2013 and January 2014. Grounded theory methodology was used to elucidate needs and preferences identified to be important to caregivers. Medical complexity was determined using the Pediatric Medical Complexity Algorithm. Thematic comparisons between medical complexity groups were facilitated using a profile matrix. RESULTS: A multidimensional theoretical framework consisting of 3 domains emerged to represent caregiver needs and preferences for hospital to home transitions. Caregiver self-efficacy for home care management emerged as the central domain in the framework. Caregivers identified several needs to promote their sense of self-efficacy including: support from providers familiar with the child, opportunities to practice home care skills, and written instructions containing contingency plan information. Many needs were consistent across medical complexity groups; however, some needs and preferences were only emphasized by caregivers of children with chronic conditions or caregivers of children with medical complexity. Distinct differences in caregiver preferences for how to meet these needs were also noted on the basis of the child's level of medical complexity. CONCLUSIONS: Caregivers identified several needs and preferences for enhancement of their sense of self-efficacy during hospital to home transitions. These findings inform quality improvement efforts to develop family-centered transition systems of care that address the needs and preferences of broad pediatric populations.