Browsing by Subject "Rehospitalizations"

Now showing 1 - 3 of 3
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    Caregiver Engagement Enhances Outcomes among Randomized Control Trials of Transitional Care Interventions: A Systematic Review and Meta-Analysis
    (Wolters Kluwer, 2022) Levoy, Kristin; Rivera, Eleanor; McHugh, Molly; Hanlon, Alexandra; Hirschman, Karen B.; Naylor, Mary D.; School of Nursing
    Background: Fluctuations in health among chronically ill adults result in frequent health care transitions. Some interventions to improve patient outcomes after hospitalization include caregiver engagement as a core component, yet there is unclear evidence of the effects of this component on outcomes. Objective: The objective of this study was to synthesize evidence regarding the attention given to caregiver engagement in randomized control trials of transitional care interventions (TCIs), estimate the overall intervention effects, and assess caregiver engagement as a moderator of intervention effects. Methods: Three databases were systematically searched for randomized control trials of TCIs targeting adults living with physical or emotional chronic diseases. For the meta-analysis, overall effects were computed using the relative risk (RR) effect size and inverse variance weighting. Results: Fifty-four studies met criteria, representing 31,291 participants and 66 rehospitalizations effect sizes. Half (51%) the interventions lacked focus on caregiver engagement. The overall effect of TCIs on all-cause rehospitalizations was nonsignificant at 1 month (P=0.107, k=29), but significant at ≥2 months [RR=0.89; 95% confidence interval (CI): 0.82, 0.97; P=0.007, k=27]. Caregiver engagement moderated intervention effects (P=0.05), where interventions with caregiver engagement reduced rehospitalizations (RR=0.83; 95% CI: 0.75, 0.92; P=0.001), and those without, did not (RR=0.97; 95% CI: 0.87, 1.08; P=0.550). Interventions with and without caregiver engagement did not differ in the average number of components utilized, however, interventions with caregiver engagement more commonly employed baseline needs assessments (P=0.032), discharge planning (P=0.006), and service coordination (P=0.035). Discussion: Future TCIs must consistently incorporate the active participation of caregivers in design, delivery, and evaluation.
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    Daycare Attendance is linked to Increased Risk of Respiratory Morbidities in Preterm Children with Bronchopulmonary Dysplasia
    (Elsevier, 2022) McGrath-Morrow, Sharon A.; Agarwal, Amit; Alexiou, Stamatia; Austin, Eric D.; Fierro, Julie L.; Hayden, Lystra P.; Lai, Khanh; Levin, Jonathan C.; Manimtim, Winston M.; Moore, Paul E.; Rhein, Lawrence M.; Rice, Jessica L.; Sheils, Catherine A.; Tracy, Michael C.; Bansal, Manvi; Baker, Christopher D.; Cristea, A. Ioana; Popova, Antonia P.; Siddaiah, Roopa; Villafranco, Natalie; Nelin, Leif D.; Collaco, Joseph M.; Pediatrics, School of Medicine
    Objectives: To test the hypothesis that daycare attendance among children with bronchopulmonary dysplasia (BPD) is associated with increased chronic respiratory symptoms and/or greater health care use for respiratory illnesses during the first 3 years of life. Study design: Daycare attendance and clinical outcomes were obtained via standardized instruments for 341 subjects recruited from 9 BPD specialty clinics in the US. All subjects were former infants born preterm (<34 weeks) with BPD (71% severe) requiring outpatient follow-up between 0 and 3 years of age. Mixed logistic regression models were used to test for associations. Results: Children with BPD attending daycare were more likely to have emergency department visits and systemic steroid usage. Children in daycare up to 3 years of age also were more likely to report trouble breathing, having activity limitations, and using rescue medications when compared with children not in daycare. More severe manifestations were found in children attending daycare between 6 and 12 months of chronological age. Conclusions: In this study, children born preterm with BPD who attend daycare were more likely to visit the emergency department, use systemic steroids, and have chronic respiratory symptoms compared with children not in daycare, indicating that daycare may be a potential modifiable risk factor to minimize respiratory morbidities in children with BPD during the preschool years.
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    Insurance coverage and respiratory morbidities in bronchopulmonary dysplasia
    (Wiley, 2022) Collaco, Joseph M.; Tracy, Michael C.; Sheils, Catherine A.; Rice, Jessica L.; Rhein, Lawrence M.; Nelin, Leif D.; Moore, Paul E.; Manimtim, Winston M.; Levin, Jonathan C.; Lai, Khanh; Hayden, Lystra P.; Fierro, Julie L.; Austin, Eric D.; Alexiou, Stamatia; Agarwal, Amit; Villafranco, Natalie; Siddaiah, Roopa; Popova, Antonia P.; Cristea, Ioana A.; Baker, Christopher D.; Bansal, Manvi; McGrath‐Morrow, Sharon A.; Pediatrics, School of Medicine
    Introduction: Preterm infants and young children with bronchopulmonary dysplasia (BPD) are at increased risk for acute care utilization and chronic respiratory symptoms during early life. Identifying risk factors for respiratory morbidities in the outpatient setting could decrease the burden of care. We hypothesized that public insurance coverage was associated with higher acute care usage and respiratory symptoms in preterm infants and children with BPD after initial neonatal intensive care unit (NICU) discharge. Methods: Subjects were recruited from BPD clinics at 10 tertiary care centers in the United States between 2018 and 2021. Demographics and clinical characteristics were obtained through chart review. Surveys for clinical outcomes were administered to caregivers. Results: Of the 470 subjects included in this study, 249 (53.0%) received employer-based insurance coverage and 221 (47.0%) received Medicaid as sole coverage at least once between 0 and 3 years of age. The Medicaid group was twice as likely to have sick visits (adjusted odd ratio [OR]: 2.06; p = 0.009) and emergency department visits (aOR: 2.09; p = 0.028), and three times more likely to be admitted for respiratory reasons (aOR: 3.04; p = 0.001) than those in the employer-based group. Additionally, those in the Medicaid group were more likely to have nighttime respiratory symptoms (aOR: 2.62; p = 0.004). Conclusions: Children with BPD who received Medicaid coverage were more likely to utilize acute care and have nighttime respiratory symptoms during the first 3 years of life. More comprehensive studies are needed to determine whether the use of Medicaid represents a barrier to accessing care, lower socioeconomic status, and/or a proxy for detrimental environmental exposures.