Ryan J Coller1, Carlos F Lerner2, Jay G Berry3, Thomas S Klitzner2, Carolyn Allshouse4, Gemma Warner5, Carrie L Nacht5, Lindsey R Thompson2, Jens Eickhoff6, Mary L Ehlenbach5, Andrea J Bonilla2, Melanie Venegas2, Brigid M Garrity3, Elizabeth Casto3, Terah Bowe5, Paul J Chung7. 1. Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI. Electronic address: rcoller@pediatrics.wisc.edu. 2. Department of Biostatistics and Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI. 3. Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA. 4. Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA. 5. Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI. 6. Family Voices of Minnesota, Stillwater, MN. 7. Department of Health Systems Science, Kaiser Permanente School of Medicine, Los Angeles, CA; Departments of Pediatrics and Health Policy & Management, UCLA, RAND Health, Los Angeles, CA; RAND Corporation, Los Angeles, CA.
Abstract
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.
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.
Authors: David A Fedele; Christopher C Cushing; Alyssa Fritz; Christina M Amaro; Adrian Ortega Journal: JAMA Pediatr Date: 2017-05-01 Impact factor: 16.193
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