S

Development of a Survey Instrument to Assess Family

Participation in Follow-up Care in Pediatric

Antimicrobial Home Infusion Therapy

Alex FinlinsonKatie BrownTracy GoldenSarah Grant

Emily Hoopes (Parent Consultant)

Pediatric Antimicrobial Home Infusion Therapy

(HIT)

The administration of IV antibiotic/antimicrobial in the home is to treat an acute infection.

The administration of the antibiotic/antimicrobial is for a time-limited period and is not an ongoing infusion that may be part of the child's regular, daily care.

The person giving the IV treatment is the child's parent or other family member, not a medical professional providing a paid service

Statement of Problem

Missed follow-up visits for HIT may be cost inefficient and may contribute to a lower quality of care and poorer outcomes for families, including re-hospitalization.

Key Literature

HIT follow-up appointments will likely reduce the rate of re-hospitalization (Nguyen 2010; Gilchrist, Franklin &

Patel, 2008).

Scheduling, clinic attributes, and transportation contribute to missed follow-up appointments (Daggey

et al., 2010; Chariatte, Berchtold, Akré, Michaud & Suris, 2008 ).

Individual characteristics contribute to missed follow-up appointments (Daggey et al.; Chariatte et al.).

Families of children on HIT may have similar risk factors, but may have unique factors as well.

Objectives

Year I: Develop and beta test a survey instrument to gain insight into the perspective of parents regarding HIT and assess possible underlying causes for missed follow-up visits in pediatric, antimicrobial HIT (2011-2012).

Year II: Deliver the survey to a random sample of parents participating in HIT and use results to make recommendations for process change (2012-2013).

Methods

Procedures – survey development and testing

Participants - volunteer families with child participants of HIT

Analysis – synthesis of feedback to refine the survey

Results/Data Analysis

Parent Feedback

Qualtrics Survey

Correlational Analysis: Demographics Satisfaction with HIT Barriers to Follow-up Family’s experience with HIT

Limitations

Small number of parents who provided feedback for beta testing

Lack of a pilot of the survey to collect and analyze a sample of data

Only provided in English which will limit participation by minority groups such as Spanish speakers

Emily Feedback

A web-based survey attempts to address obstacles of distance, time & availability for respondents.

Limitations of a web-based study: May exclude respondents without web access at home (lower income,

working parents). Patients most likely to respond may also be more likely to attend follow-up

appointments. Respondents must be self-motivated to seek out study.

Many chronic patients are over-surveyed & question the value of this type of study.

Not possible to beta test across diagnoses (acute vs. chronic).

Sarah Feedback

Post PDC discussion with mentors

Include time for discussion immediately after each PDC

Positive and critical feedback in a timely manner to better understand the layers of complexity and subtlety in working with families –focusing on the interaction more than the content

Katie Feedback

Nutrition Therapy for children with special health care needs

Interdisciplinary teams in the school setting

Physical activity for persons with disabilities

Tracy Feedback

Identify the change/additions to the program that you are suggesting: clinic discussion group Identify how it could/should be implemented

Discussion time during a seminar Individual assignment with reaction to clinic visit

Identify why you think this would make you a more effective leader

Time to process what is/isn’t effective in clinic settings that we could bring into our own work settings as models

Alex Feedback

Encourage and build strong mentor and trainee relationships

Create expectations or guidelines of communication

Enhances experience, communication skills, goal setting, and networking

Special Thanks

To Emily Hoopes, volunteer families, and our project mentor Terry Pavia

References

Nguyen HH. Hospitalist to home: outpatient parenteral antimicrobial therapy at an academic center. Clin Infect Dis.51 Suppl 2:S220-223.

Gilchrist M, Franklin BD, Patel JP. An outpatient parenteral antibiotic therapy (OPAT) map to identify risks associated with an OPAT service. J Antimicrob Chemother. 2008;62:177-183.

Daggy J, Lawley M, Willis D, Thayer D, Suelzer C, DeLaurentis PC, Turkcan A, Chakraborty S, Sands L. Using no-show modeling to improve clinic performance. Health Informatics Journal. 2010;16: 246.

Chariatte V, Berchtold A, Akré C, Michaud PA, Suris JC. Missed appointments in an outpatient clinic for adolescents, an approach to predict the risk of missing. Journal of Adolescent Health. 43 2008; 38–45.