Novel interventions in children’s healthcare for youth hospitalized for chronic pain.

Harris, Michael A.; Wagner, David V.; Wilson, Anna; Spiro, Kim; Heywood, Matthew; Hoehn, Dana

doi:10.1037/cpp0000088

Cited by 13 publications

(8 citation statements)

References 30 publications

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“…55 This includes ensuring capacity to support children and their families once needs are identified. Identifying spheres of need (economic, legal, psychosocial, etc) in pilots such as this study may lead to better allocation of hospital resources tiered by social complexity, such as intensive home-and community-based treatment of patients and their families (eg, Novel Interventions in Children' s Health Care), 41,56,57 medical legal partnerships, social needs navigation programs, social work consultation, and solidifying liaisons with community partners. These interventions would need to be operationalized in tandem with widespread screening.…”

Section: Discussionmentioning

confidence: 99%

Identification of Caregiver-Reported Social Risk Factors in Hospitalized Children

Vaz

Wagner

Ramsey

et al. 2020

Hospital Pediatrics

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Although health systems are increasingly moving toward addressing social determinants of health, social risk screening for hospitalized children is largely unexplored. We sought to determine if inpatient screening was feasible and describe the prevalence of social risk among children and caregivers, with special attention given to children with chronic conditions. METHODS: Caregivers of pediatric patients on the hospitalist service at a children's hospital in the Pacific Northwest completed a social risk survey in 2017. This survey was used to capture items related to caregiver demographics; socioeconomic, psychosocial, and household risks; and adverse childhood experiences (ACEs). Charts were reviewed for child demographics and medical complexity. Results were tabulated as frequency distributions, and analyses compared the association of risk factors with a child's medical complexity by using x 2 tests. RESULTS: A total of 265 out of 304 (87%) caregivers consented to participate. One in 3 families endorsed markers of financial stress (eg, difficulty paying for food, rent, or utilities). Forty percent experienced medical bill or insurance troubles. Caregiver mental health concerns were prevalent, affecting over one-third of all respondents. ACEs were also common, with 38% of children having at least 1 ACE. The presence of any ACE was more likely for children with chronic conditions than those without. CONCLUSIONS: We found that social risk screening in the inpatient setting was feasible; social risk was uniformly common and did not disproportionately affect those with chronic diseases. Knowing the prevalence of social risk may assist in appropriate alignment of interventions tiered by social complexity.

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Section: Discussionmentioning

confidence: 99%

Identification of Caregiver-Reported Social Risk Factors in Hospitalized Children

Vaz

Wagner

Ramsey

et al. 2020

Hospital Pediatrics

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“…Instead, because the overall numbers of readmissions are low (4.3% in our study), and only a fraction of those are potentially preventable (20% in our study), focusing on individual patient populations, mainly those with complex medical conditions, who consume a larger proportion of health care resources and the bulk of readmissions is more likely to be fruitful. 27,[31][32][33][34][35][36] Intensifying efforts around care coordination, 37,38 particularly involving communication between inpatient and outpatient providers, and primary care and subspecialty providers may be beneficial in reducing overall health care use for this patient population.…”

Section: Discussionmentioning

confidence: 99%

Preventability of 7-Day Versus 30-Day Readmissions at an Academic Children’s Hospital

Gardner

Vaz²,

Foster³

et al. 2020

Hospital Pediatrics

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BACKGROUND AND OBJECTIVES: The 30-day readmission rate is a common quality metric used by Medicare for adult patients. However, studies in pediatrics have shown lower readmission rates and potentially less preventability. Therefore, some question the utility of the 30-day readmission time frame in pediatrics. Our objective was to describe the characteristics of patients readmitted within 30 days of discharge over a 1-year period and determine the preventability of readmissions occurring 0 to 7 vs 8 to 30 days after discharge from a pediatric hospitalist service at an academic children's hospital. METHODS: Retrospective chart review and hospital administrative data were used to gather medical characteristics, demographics, and process-level metrics for readmitted patients between July 1, 2015, and June 30, 2016. All readmissions were reviewed by 2 senior authors and assigned a preventability category. Subgroup analysis comparing preventability in 0-to-7-and 8-to-30-day readmissions groups was performed. Qualitative thematic analysis was performed on readmissions deemed preventable. RESULTS: Of 1523 discharges that occurred during the study period, 49 patients, with 65 distinct readmission encounters, were readmitted for an overall 30-day readmission rate of 4.3% (65 of 1523). Twenty-eight percent (9 of 32) of readmissions within 7 days of discharge and 12.1% (4 of 33) occurring 8 to 30 days after discharge were deemed potentially preventable (P 5 .13). Combined, the 30-day preventable readmission rate was 20% (13 of 65). CONCLUSIONS: We identified a possible association between preventability and time to readmission. If confirmed by larger studies, the 7-day, rather than 30-day, time frame may represent a better quality metric for readmitted pediatric patients.

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“…Primary NICH interventions included skill building related to patient coping techniques for pain, caregiver limit-setting, and caregiver-child communication. Interventions also targeted improved coordination of care and communication between family and medical team members (see Harris et al, 2015 for NICH applied to chronic pain). These interventions were associated with a range of improvements across settings.…”

Section: Resultsmentioning

confidence: 99%

Single (aim)-minded strategies for demonstrating value to payers for youth with medical complexity.

Harris¹,

Teplitsky

Nagra

et al. 2018

Clinical Practice in Pediatric Psychology

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In the current financial climate, health care institutions and providers experience substantial challenges in achieving the Triple Aim in health care reform (i.e., reducing costs, improving health, improving care). The present study describes the successes and challenges of garnering payment for a population health program, Novel Interventions in Children's Health care (NICH), for youth with both medical and social vulnerability. Using 4 real patient scenarios, this study provides examples of how to use economic data to demonstrate program value to key stakeholders (i.e., insurance providers, hospital administrators) and obtain authorization and payment for services. Health care utilization and cost data were retrieved through retrospective review of patient medical records and hospital financial records. NICH utilized distinct strategies to overcome systemic barriers, demonstrate value, and show need for intervention to key stakeholders. Strategies included highlighting patients': (a) history of utilization, (b) accumulated medical expenditures, (c) projected costs for anticipated procedures, and (d) social risk linked to poor health and high utilization. We describe each effort using real patient scenarios that feature varied medical conditions including Type 1 diabetes, chronic pain, and failure-to-thrive. Economic data can be a useful tool in garnering support for behavioral health interventions. And while these data offer programs like NICH the opportunity to make the case for investing in an alternative intervention, the strategies utilized by NICH to advocate for services can be applied by pediatric psychologists working with youth with medical complexity and social vulnerability. Implications for Impact StatementIn order to increase service access for individuals, families, and medical teams in an ever-changing fiscal environment, psychologists and other behavioral health providers should be prepared to highlight the financial value of their efforts to health care systems and payers. This article provides (a) an example of how a behavioral health program can identify and collect economically relevant data and (b) strategies that use economic data to convince payers to authorize and evaluate the services of such programs. For each of these strategies, we provide real patient scenarios to better illustrate how behavioral health providers can make a compelling case for intervention programs through the strategic presentation of medical, social, and economic data.

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Novel interventions in children’s healthcare for youth hospitalized for chronic pain.

Cited by 13 publications

References 30 publications

Identification of Caregiver-Reported Social Risk Factors in Hospitalized Children

Identification of Caregiver-Reported Social Risk Factors in Hospitalized Children

Preventability of 7-Day Versus 30-Day Readmissions at an Academic Children’s Hospital

Single (aim)-minded strategies for demonstrating value to payers for youth with medical complexity.

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