Caregiving and Confidence to Avoid Hospitalization for Children with Medical Complexity.

OBJECTIVE: To test associations between parent-reported confidence to avoid hospitalization and caregiving strain, activation, and health-related quality of life (HRQOL). STUDY DESIGN: In this prospective cohort study, enrolled parents of children with medical complexity (n = 75) from 3 complex care programs received text messages (at random times every 2 weeks for 3 months) asking them to rate their confidence to avoid hospitalization in the next month. Low confidence, as measured on a 10-point Likert scale (1 = not confident; 10 = fully confident), was defined as a mean rating <5. Caregiving measures included the Caregiver Strain Questionnaire, Family Caregiver Activation in Transition (FCAT), and caregiver HRQOL (Medical Outcomes Study Short Form 12 [SF12]). Relationships between caregiving and confidence were assessed with a hierarchical logistic regression and classification and regression trees (CART) model. RESULTS: The parents were mostly mothers (77%) and were linguistically diverse (20% spoke Spanish as their primary language), and 18% had low confidence on average. Demographic and clinical variables had weaker associations with confidence. In regression models, low confidence was associated with higher caregiver strain (aOR, 3.52; 95% CI, 1.45-8.54). Better mental HRQOL was associated with lower likelihood of low confidence (aOR, 0.89; 95% CI, 0.80-0.97). In the CART model, higher strain similarly identified parents with lower confidence. In all models, low confidence was not associated with caregiver activation (FCAT) or physical HRQOL (SF12) scores. CONCLUSIONS: Parents of children with medical complexity with high strain and low mental HRQOL had low confidence in the range in which intervention to avoid hospitalization would be warranted. Future work could determine how adaptive interventions to improve confidence and prevent hospitalizations should account for strain and low mental HRQOL.

Linking Parent Confidence and Hospitalization through Mobile Health: A Multisite Pilot Study.

OBJECTIVE: To evaluate the associations between parent confidence in avoiding hospitalization and subsequent hospitalization in children with medical complexity (CMC); and feasibility/acceptability of a texting platform, Assessing Confidence at Times of Increased Vulnerability (ACTIV), to collect repeated measures of parent confidence. STUDY DESIGN: This prospective cohort study purposively sampled parent-child dyads (n = 75) in 1 of 3 complex care programs for demographic diversity to pilot test ACTIV for 3 months. At random days/times every 2 weeks, parents received text messages asking them to rate confidence in their child avoiding hospitalization in the next month, from 1 (not confident) to 10 (fully confident). Unadjusted and adjusted generalized estimating equations with repeated measures evaluated associations between confidence and hospitalization in the next 14 days. Post-study questionnaires and focus groups assessed ACTIV's feasibility/acceptability. RESULTS: Parents were 77.3% mothers and 20% Spanish-speaking. Texting response rate was 95.6%. Eighteen hospitalizations occurred within 14 days after texting, median (IQR) 8 (2-10) days. When confidence was <5 vs ≥5, adjusted odds (95% CI) of hospitalization within 2 weeks were 4.02 (1.20-13.51) times greater. Almost all (96.8%) reported no burden texting, one-third desired more frequent texts, and 93.7% were very likely to continue texting. Focus groups explored the meaning of responses and suggested ACTIV improvements. CONCLUSIONS: In this demographically diverse multicenter pilot, low parent confidence predicted impending CMC hospitalization. Text messaging was feasible and acceptable. Future work will test efficacy of real-time interventions triggered by parent-reported low confidence.

Efeito de um programa cinesioterapêutico de grupo, aliado à escola de postura, na lombalgia crônica / Effect of group program of kinesiotherapy with Back School for chronic low back pain

INTRODUÇÃO: A dor lombar, considerada importante problema de saúde pública, pode ser tratada com cinesioterapia aliada à "Escola de Postura"; entretanto, ainda não está definido o papel desta associação como alternativa de tratamento para lombalgias crônicas. OBJETIVO: Avaliar a efetividade de um programa cinesioterapêutico de grupo aliado à Escola de Postura, sobre a dor e a capacidade funcional, em indivíduos com lombalgia crônica. MATERIAIS E MÉTODOS: Trata-se de um estudo clínico transversal, realizado com 24 indivíduos que apresentavam dor lombar, de ambos os gêneros, com média de idade de 55,3 ± 6,3 anos, pertencentes à área de abrangência da Unidade de Saúde Bairro Novo (Curitiba, PR). Foram realizados 12 atendimentos de um programa de cinesioterapia e educação postural, com frequência de uma vez por semana, durante três meses. Foram avaliadas dor (Escala Visual Analógica - EVA) e capacidade funcional (questionário de Rolland Morris) antes e após o período de intervenção. RESULTADOS: Na EVA observou-se diminuição significativa da dor (p < 0,05) do primeiro dia de intervenção (atendimento de 1h30min) para a EVA inicial de pré e pós-intervenção (programa de três meses). Também houve melhora na capacidade funcional no período de três meses de intervenção (p < 0,05). CONCLUSÃO: O programa de cinesioterapia em grupo mostrou-se favorável na melhora da dor e da capacidade funcional de pacientes com lombalgia.

INTRODUCTION: Low back pain is significant public health problem and can be treated with kinesiotherapy allied to "Back School", however, is not yet defined the role of this association as an alternative treatment for chronic back pain. OBJECTIVE: To evaluate the effectiveness program of a exercise group training allied to the Back School on the pain and functional capacity in individuals with chronic low back pain. MATERIALS AND METHODS: It is a cross-sectional clinical study, conducted with 24 individuals of both genders, with a mean age of 55.3 ± 6.3 years old, belonging to the area of the Health Unit Bairro Novo (Curitiba, Paraná State) who had low back pain. Were carried out 12 visits to a program kinesiotherapy and postural education, often once a week for three months. We assessed pain (Visual Analogue Scale - VAS) and functional capacity (Rolland Morris questionnaire) before and after the intervention period. RESULTS: VAS showed a significant decrease in pain (p < 0.05) for the first day of intervention (care 1h30m) and EVA for initial pre and post intervention (program three months). There was also improvement in functional capacity within three months of intervention (p < 0.05). CONCLUSIONS: The program of a group kinesiotherapy was favorable in improving pain and functional capacity of patients with low back pain.

Predictors of 30-day readmission and association with primary care follow-up plans.

OBJECTIVE: To test the hypothesis that missing primary care follow-up plans in the discharge summary is associated with higher 30-day readmissions. STUDY DESIGN: This retrospective cohort study included pediatric patients discharged from Mattel Children's Hospital, University of California, Los Angeles between July 2008 and July 2010. Exclusions included deaths, transfers, neonatal discharges, stays under 24 hours, and patients over 18 years of age. Bivariate and propensity weighted multivariate logistic regressions tested relationships between 30-day readmission and patient demographics, illness severity, and documentation of primary care provider (PCP) follow-up plans at discharge. RESULTS: There were 7794 index discharges (representing 5056 unique patients), with 1457 readmissions within 30 days (18.7%). Average length of stay was 6.3 days. Being 15-18 years old, (OR 1.42 [1.02-1.96]), having public insurance (OR 1.48 [1.20-1.83]), or having higher All-Patient Refined Diagnosis-Related Group severity scores (for severity = 4 vs 1, OR 6.88 [4.99-9.49]) was associated with increased odds of 30-day readmission. After adjusting for insurance status, Asian (OR 1.46 [1.01-2.12]) but not Black or Hispanic, race/ethnicity was associated with greater odds of readmission. Fifteen percent of 172 medical records from a randomly selected month in 2010 documented PCP follow-up plans. After adjusting for demographics, length of stay and severity, documenting PCP follow-up plans was associated with significantly increased odds of 30-day readmission (OR 4.52 [1.01-20.31]). CONCLUSION: Readmission rates are complex quality measures, and documenting primary care follow-up may be associated with higher rather than lower 30-day readmissions. Additional studies are needed to understand the inpatient-outpatient transition.