The development of a consensus-based nutritional pathway for infants with CHD before surgery using a modified Delphi process.

IntroductionDespite improvements in the medical and surgical management of infants with CHD, growth failure before surgery in many infants continues to be a significant concern. A nutritional pathway was developed, the aim of which was to provide a structured approach to nutritional care for infants with CHD awaiting surgery.Materials and methodsThe modified Delphi process was development of a nutritional pathway; initial stakeholder meeting to finalise draft guidelines and develop questions; round 1 anonymous online survey; round 2 online survey; regional cardiac conference and pathway revision; and final expert meeting and pathway finalisation. RESULTS: Paediatric Dietitians from all 11 of the paediatric cardiology surgical centres in the United Kingdom contributed to the guideline development. In all, 33% of participants had 9 or more years of experience working with infants with CHD. By the end of rounds 1 and 2, 76 and 96% of participants, respectively, were in agreement with the statements. Three statements where consensus was not achieved by the end of round 2 were discussed and agreed at the final expert group meeting. CONCLUSIONS: Nutrition guidelines were developed for infants with CHD awaiting surgery, using a modified Delphi process, incorporating the best available evidence and expert opinion with regard to nutritional support in this group.

Protecting the public interests: issues in contracting managed behavioral health.

In recent years, state governments have begun contracting out behavioral health care to large managed case for-profit organizations. This approach to mental health service delivery has resulted in realignment in roles for both state agencies and the managed care organizations. Overnight state agencies have been transformed into contract managers of multi-million dollar capitated health plans, Management care companies, in turn, moving into the public-sector market must adjust their service delivery to include key concepts of public interest involvement such as consumer input, public comment, and outreach. This article analyzes three public-sector transitions. Common issues in these transformations are used as a springboard for identifying key concerns which states need to monitor when developing managed care contracts.