Impact of Children’s Feeding/Swallowing Problems: Validation of a New Caregiver Instrument

Lefton‐Greif, Maureen A.; Okelo, Sande O.; Wright, Jennifer M.; Collaco, Joseph M.; McGrath‐Morrow, Sharon A.; Eakin, Michelle N.

doi:10.1007/s00455-014-9560-7

Cited by 76 publications

(55 citation statements)

References 31 publications

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“…Subjective health measures the patients' perspective of their disease state. The validated pediatric Feeding/Swallowing Impact Survey (FSIS), an 18‐question survey, was administered to the parents of the patient on a tablet device while they waited to meet their providers at each appointment . The subjective health calculation is as follows:

S = 100 - (\frac{100}{n} * (\sum \frac{x_{i}}{5})), n = # q u e s t i o n s, x_{i} = F S I S v a l u e s .

…”

Section: Methodsmentioning

confidence: 99%

A pilot study assessing clinic value in pediatric pharyngeal dysphagia: The OPPS/cost method

et al. 2018

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Objectives/Hypothesis: Given the costs of healthcare, capitation, and desires for quality improvement (QI), there is a need to better assess healthcare value. Time-driven activity-based costing and the Quadruple Aim have evaluated value by assessing health outcomes and provider experiences relative to costs. The proposed OPPS/Cost method expands on this to examine value for aerodigestive clinic treatment of pediatric persistent pharyngeal dysphagia: O + P 1 + P 2 + S/Cost (O = objective health [video-fluoroscopic swallow study results], P 1 = patient/family experience [Consumer Assessment of Healthcare Providers and Systems], P 2 = provider experience [Copenhagen Burnout Inventory {CBI}], S = subjective health [Feeding/Swallowing-Impact Survey], C = cost [time-driven activity-based costing]).Study Design: Use of QI time data, surveys, and retrospective chart review for 56 patient encounters. Methods: Staff interviews were used to develop process maps, and monetary values were assigned to activities. OPPS/ Cost outcomes were normalized amongst variables, and composite values were calculated. Comparisons were made using a Student t test for pre-and postclinic relocation over a 14-month period.Results: Time reductions were check-in (13 minutes/patient), rooming (21 minutes/patient), and providers (4 minutes/patient). Patient in-room wait time increased (4 minutes/patient). The CBI identified burnout as an area for improvement. OPPS/Cost composite values increased by 14%, with a 1.7% cost reduction, improvement in objective and subjective health outcomes of 47.4% (P < .05) and 7.3%, respectively, and stable patient/family experience.Conclusions: OPPS/Cost is feasible in an interdisciplinary clinic and helped evaluate value during a clinic relocation. The QI opportunities identified are indicative of the potential of OPPS/Cost.

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S = 100 - (\frac{100}{n} * (\sum \frac{x_{i}}{5})), n = # q u e s t i o n s, x_{i} = F S I S v a l u e s .

…”

Section: Methodsmentioning

confidence: 99%

A pilot study assessing clinic value in pediatric pharyngeal dysphagia: The OPPS/cost method

et al. 2018

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“…[13][14][15][16] Nonetheless, 40% of children with feeding/swallowing disorders are reported to have histories of preterm birth. 17 Much of the attention to feeding/swallowing disorders in these pediatric populations has focused on preterm infants in neonatal intensive care unit (NICU) settings and during follow-up after hospital discharge. Critical to the care of these infants is increased recognition that they comprise a heterogeneous population, with differing causes of preterm births and a wide range of phenotypic variations.…”

Section: Swallowing Disorders In Infants and Childrenmentioning

confidence: 99%

Pediatric Feeding/Swallowing: Yesterday, Today, and Tomorrow

Lefton‐Greif

Arvedson

2016

Semin Speech Lang

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Speech-language pathologists (SLPs) have played primary roles in the evaluation and management of children with feeding/swallowing disorders for more than five decades. Medical, surgical, and technological advances have improved the survival of young fragile infants and children, many of whom will present with feeding/swallowing problems. Regardless of their underlying etiologies, many of these children are at risk for aspiration-induced lung disease, undernutrition or malnutrition, developmental deficits, and stressful interactions with their caregivers. Unfortunately, our understanding of the physiology/pathophysiology of swallowing and its maturation, the development of standardized and efficacious evaluation and therapy tools, and identification of functional outcomes have not kept pace with our ability to identify children who are at increased risk for dysphagia and the associated sequelae. Given this paucity of evidence to guide practice in pediatrics, clinicians rely upon a combination of data extrapolated from adults with dysphagia, anecdotal reports, and institution-specific guidelines. This article focuses on updates in population demographics and advances in evaluation and treatment over the past decade and identifies future directions that may enable us to meet the needs of the children who are in our care to attain functional outcomes.

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“…(2) Prematurity negatively impacts attainment of feeding milestones,(3, 4) as 40% of infants referred to feeding clinics were born preterm. (5) Infections, growth failure, bronchopulmonary dysplasia, necrotizing enterocolitis, and neurological sequelae in the neonatal intensive care unit (NICU) are associated with neurodevelopmental and feeding dysfunctions in later childhood. (6–9) The relationship between concurrent post-discharge childhood feeding behaviors and neurodevelopmental status has been assessed.…”

mentioning

confidence: 99%

Feeding Methods at Discharge Predict Long-Term Feeding and Neurodevelopmental Outcomes in Preterm Infants Referred for Gastrostomy Evaluation

Jadcherla

Khot

Moore

et al. 2017

The Journal of Pediatrics

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Objective To test the hypothesis that oral (PO) feeding at first neonatal intensive care unit (NICU) discharge is associated with less neurodevelopmental impairment and better feeding milestones, as compared with discharge with a gastrostomy tube (g-tube). Study design We studied outcomes for a retrospective cohort of 194 neonates < 37 weeks gestation referred for evaluation and management of feeding difficulties between July 2006–July 2012. Discharge milestones, length of hospitalization, and Bayley Scales of Infant Development scores at 18–24 months were examined. Chi-Square, Mann-Whitney U, or t-tests and multivariable logistic regression models were used. Results 60% (n=117) of infants were discharged on PO feedings; of these, 96% remained PO-fed at 1-year. The remaining 40% (n=77) were discharged on g-tube feedings; of these, 31 (40%) remained g-tube dependent, 17 (22%) became PO-fed, and 29 (38%) were on PO and g-tube feedings at one year. Infants discharged on a g-tube had lower cognitive (p<0.01), communication (p=0.03), and motor (p<0.01) composite scores. The presence of a g-tube, younger gestation, bronchopulmonary dysplasia, or intraventricular hemorrhage was significantly associated with neurodevelopmental delay. Conclusions For infants referred for feeding concerns, g-tube evaluations and feeding management, the majority did not require a g-tube. Full PO feeding at first NICU discharge was associated with superior feeding milestones and less long-term neurodevelopmental impairment, relative to full or partial g-tube feeding. Evaluation and feeding management before and after g-tube placement may improve long-term feeding and neurodevelopmental outcomes.

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Impact of Children’s Feeding/Swallowing Problems: Validation of a New Caregiver Instrument

Cited by 76 publications

References 31 publications

A pilot study assessing clinic value in pediatric pharyngeal dysphagia: The OPPS/cost method

A pilot study assessing clinic value in pediatric pharyngeal dysphagia: The OPPS/cost method

Pediatric Feeding/Swallowing: Yesterday, Today, and Tomorrow

Feeding Methods at Discharge Predict Long-Term Feeding and Neurodevelopmental Outcomes in Preterm Infants Referred for Gastrostomy Evaluation

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