Outpatient Follow-up Care After Hospital Discharge of Children With Complex Chronic Conditions at a Rural Tertiary Care Hospital.

OBJECTIVE: To determine factors associated with completion of recommended outpatient follow-up visits in children with complex chronic conditions (CCCs) following hospital discharge. METHODS: We retrospectively identified children aged 1 to 17 years diagnosed with a CCC who were discharged from our rural tertiary care children's hospital between 2017 and 2018 with a diagnosis meeting published CCC criteria. Patients discharged from the neonatal intensive care unit and patients enrolled in a care coordination program for technology-dependent children were excluded. RESULTS: Of 113 eligible patients, 77 (68%) had outpatient follow-up consistent with discharge instructions. Intensive care unit (ICU) admission (P = .020) and prolonged length of stay (P = .004) were associated with decreased likelihood of completing recommended follow-up. CONCLUSIONS: Among children with CCCs who were not already enrolled in a care coordination program, ICU admission was associated with increased risk of not completing recommended outpatient follow-up. This population could be targeted for expanded care coordination efforts.

Care Coordination Program for Children With Complex Chronic Conditions Discharged From a Rural Tertiary-Care Academic Medical Center.

OBJECTIVES: Hospital discharge offers an opportunity to initiate coordination of follow-up care, preventing readmissions or emergency department (ED) recidivism. We evaluated how revisits and costs of care varied in a 12-month period between children in a care coordination program at our center (enrolled after hospital discharge with a tracheostomy or on a ventilator) and children with complex chronic condition discharges who were not enrolled. METHODS: Children ages 1 to 17 years were retrospectively included if they had a hospital discharge in 2017 with an International Classification of Diseases, 10th Revision code meeting complex chronic condition criteria or if they were in active follow-up with the care coordination program. Revisits and total costs of care were compared over 2018 for included patients. RESULTS: Seventy patients in the program were compared with 56 patients in the control group. On bivariate analysis, the median combined number of hospitalizations and ED visits in 2018 was lower among program participants (0 vs 1; P = .033), and program participation was associated with lower median total costs of care in 2018 ($700 vs $3200; P = .024). On multivariable analysis, care coordination program participation was associated with 59% fewer hospitalizations in 2018 (incidence rate ratio: 0.41; 95% confidence interval: 0.23 to 0.75; P = .004) but was not significantly associated with reduced ED visits or costs. CONCLUSIONS: The care coordination program is a robust service spanning the continuum of patient care. We found program participation to be associated with reduced rehospitalization, which is an important driver of costs for children with medical complexity.

An Initial Evaluation of an Assessment Method for the PEAK Relational System Direct Training Module.

When considering the best available treatment, it is crucial that assessments yield valid and reliable measures to produce effective treatment options. Currently, this research is limited, giving behavior analysis a platform to evaluate the psychometric properties and content validity of assessment tools used across settings. One major issue that practicing behavior analysts face is conducting the most comprehensive assessment within the time constraints put in place by insurance companies. Utilizing a method of assessment that includes indirect and direct descriptive methods and experimental manipulations could aid in cutting down assessment time, especially if those methods have known correspondence with each other. The purpose of the present study was to assess the components of the Promoting the Emergence of Advanced Knowledge Relational Training System: Direct Training Module (PEAK-DT) for children with autism. More specifically, this study evaluated the correspondence between the PEAK indirect assessment (PEAK-IA) and PEAK preassessment (PEAK-PA) for the Direct Training Module. Comparisons were also made to determine which method offers the best predictive validity of actual performance on the PEAK-DT module. Results indicate that PEAK-IA completed by parents and PEAK-PA share moderate correspondence, with the PEAK-PA offering the strongest predictive validity of direct testing outcomes. Implications for behavior-analytic practice, as well as directions for future research, are discussed.

A Pilot Observational Study of an Acupressure/Acupuncture Intervention in Children with Autism Spectrum Disorder.

OBJECTIVES: To determine whether children with autism spectrum disorder (ASD) would tolerate an acupressure/acupuncture intervention and whether parents would adhere to a twice-weekly, 8-week intervention protocol. Second, to further understand best measures to use to capture impact of intervention on behavioral and regulatory functions. DESIGN: This is an observational pilot study with pre-, mid-, and postintervention measures. SETTINGS/LOCATION: The intervention was carried out in a private practice office in a large metropolitan area. SUBJECTS: A total of 10 children of ages 3-10 years with ASD and one of their parents participated. INTERVENTIONS: A total of 16 biweekly treatment sessions of acupressure and/or acupuncture were carried out by a licensed acupuncturist, and a daily home-based acupressure intervention was carried out by a parent. OUTCOME MEASURES: Attendance, tolerance of intervention, parent compliance with home program, and parent compliance in completing daily diary and five standardized measures of behavioral and regulatory functions pre-, mid-, and postintervention were recorded. RESULTS: The 10 children in this observational study, collectively, tolerated the intervention and parents adhered to the 16 sessions, biweekly protocol, and home protocol, as well as completing daily diary and five standardized measures at three different time intervals. The five measurements appeared to be sensitive to behavioral and regulatory functions that may improve with this type of intervention. CONCLUSIONS: The results of this observational pilot study suggest that acupressure/acupuncture is a feasible intervention for children with ASD that merits rigorous evaluation through a randomized controlled trial.

A method for performance evaluation using WeeFIM data collected for the Joint Commission on Accreditation of Healthcare Organizations' ORYX initiative: The 0.5 band control chart analysis.

This article describes the employment of a method of data analysis for detailed internal program evaluation, which we call the 0.5 Band Control Chart Analysis. We describe how the 0.5 Band Control Chart Analysis can be used in conjunction with the data collected and analyzed as part of the Joint Commission on Accreditation of Healthcare Organizations' ORYX initiative to enhance program evaluation. How this procedure helped identify problems and drove performance improvement at our facility is also discussed.

Toward an optimal healing environment in pediatric rehabilitation.

Although recent scientific advances have enabled us to minimize disability and improve the quality of life for people with disabilities and their families, cure is still not possible for many rehabilitation patients. This inability to cure renders the field of rehabilitation medicine particularly well-suited to the philosophy of healing. In contrast to curing, which is aimed at removing or reversing a disease process, both rehabilitation and healing are meant to enhance all aspects of well-being, restore integrity to the person, and facilitate the creation of meaning. Pediatric rehabilitation represents the interface of rehabilitation medicine and pediatrics, and is associated with unique characteristics that provide a natural context for exploring the optimal healing environment. This paper describes those characteristics and argues for the systematic integration and evaluation of healing interventions among children with developmental disabilities and their caregivers (parents, health care practitioners, and teachers). The ultimate aim of these interventions would be to improve all levels of the children's functioning in their homes, schools, and community environments by reducing impairment and increasing activity and participation. The paper concludes with a discussion of research priorities and the challenges imposed by different research strategies.