Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Provider Training/Education, Guideline Change and Implementation, Provider Tools

Intervention Description: Parents were interviewed and instructed on creating a care map. That map was then shared with HCP. Both parents and HCP were intereviewed to learn what their thoughts were about implementing both care maps and care plans.

Intervention Results: Two themes reflected two primary categories: (a) the utility of care plans and care maps, and (b) the intersection of care plans and care maps. results indicated that care maps are useful and should be created and discussed with HCP prior to creating a care plan.

Conclusion: No Conclusion: Results: Data analysis exploring the relationship and utility of care plans and care maps revealed six primary themes related to using care plans and care maps that were grouped into two primary categories: (a) utility of care plans and maps; and (b) intersection of care plans and care maps. Discussion: Care plans and care maps were identified as valuable complementary documents. Their integration offers context about family experience and respects the parents' experiential wisdom in a standard patient care document, thus promoting improved understanding and integration of the family experience into care decision making

Study Design: A qualitative design with thematic analysis

Setting: CMC: Hospital/Clinic - tertiary pediatric academic health sciences center, The Hospital for Sick Children (SickKids), and at a community hospital, North York General Hospital (NYGH), both located in Ontario, Canada.

Population of Focus: CMC - healthcare providers, including pediatricians, pediatric subspecialists, pediatric nurse practitioners, social workers, occupational and physiotherapists, pharmacists, and community nurses, who provide care for children with medical complexity.

Sample Size: 15 parents, 30 HCP - 15 parents of children with medical complexity who created care maps, and 30 healthcare providers who provided care to children with medical complexity.

Age Range: 1/17/2024

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), CLASSROOM_SCHOOL, PROFESSIONAL_CAREGIVER, Outreach (caregiver), Communication Tools, Distribution of Promotional Items (Classroom/School)

Intervention Description: In Michigan, a school-based outreach effort was piloted using existing school communication tools to identify children who are currently uninsured and may be eligible for state-subsidized health insurance. School districts were provided with two health insurance status collection forms to be included with the free and reduced school lunch application, and as part of the student registration packet and welcome materials for school. Completed forms were sent to a state registered application-assisting agency to ensure families can access the coverage and services they need. A final step in the process is outreach to eligible respondents by the Michigan Primary Care Association to help ensure that they receive information and access to the healthcare coverage and services they need.

Intervention Results: As a result of the survey, 156 children were identified as not having health insurance. This represents more than 44% of the 358 children who are eligible for State subsidized health insurance, in the participating school districts, but are uninsured. Integrating the collection of health insurance status into routine school communication channels is an effective way to identify children who do not have health insurance and may be eligible for state subsidized benefits.

Conclusion: 1. The Michigan Department of Community Health should lead the effort to work with the Michigan Department of Education to modify the Free and Reduced Lunch Application to capture whether or not the applicant has health insurance. 2. The Michigan Department of Community Health should lead the effort to incorporate into the direct certified free and reduced lunch eligibility process a systematic check as to whether or not the applicant has State subsidized health insurance. 3. The Michigan Department of Community Health should provide resources from the expected performance bonus to work with schools across the State to implement these changes.

Study Design: Cross-sectional pilot study

Setting: Schools (School districts in Van Buren County, Michigan)

Population of Focus: Uninsured children

Data Source: Survey data

Sample Size: 8,999 children

Age Range: School-aged children

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Provider Training/Education, Guideline Change and Implementation, Provider Tools

Intervention Description: Participants were asked to complete the Family-Centered Care Questionnaire—Revised (FCCQ-R), a 45-item measure of healthcare professionals’ perceptions of the practice and importance of 9 core dimensions of family-centered care.

Intervention Results: Six main themes emerged from the analysis of the concerns and recommendations for family-centered care described in the comments: language translation; communication between staff and families; staffing and workflow; team culture and leadership; staff and parent education, and the NICU physical environment

Conclusion: No Conclusion: Implications for Practice: The NICU healthcare professionals identified a range of issues that support or impede delivery of family-centered care and provided actionable recommendations for improvement. Implications for Research: Future research should include economic analyses that will enable determination of the return on investment so that NICUs can better justify the human and capital resources needed to implement high-quality family-centered care.

Study Design: Data for this qualitative analysis were obtained from a multicenter survey of family-centered care practices completed by NICU healthcare professionals from 6 geographically and demographically diverse NICUs in California during the baseline (familycentered care) phase of a study comparing usual family-centered NICU care with mobile-enhanced family integrated care (mFICare) (NCT03418870)

Setting: NICU - six geographically and demographically diverse neonatal intensive care units (NICUs) in California

Population of Focus: NICU Professionals - NICU healthcare professionals, such as registered nurses, physicians, and neonatal nurse practitioners, who provided care in the NICUs involved in the study .

Sample Size: 382 NICU staff - The study involved 382 NICU healthcare providers from 6 NICUs who completed the survey, and 68 of them (18%) provided 89 free-text comments/recommendations about family-centered care , .

Age Range: adult professionals in NICU settings - The study reported that 65% of the sample were 50 years of age or younger, and 35% of the sample were older than 50 years .

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Provider Training/Education, Guideline Change and Implementation, Provider Tools

Intervention Description: The training intervention was delivered by the research team and a parent representative during a half-day face-to-face workshop. Real-life case studies were discussed, and the parent representative described his/her own journey of receiving different news and the impact of the news on his/her family nit, during the workshop. Data were collected through pretraining and post-training questionnaires (5-point Likert scale, ranging from 1, indicating strongly disagree, to 5, indicating strongly agree) on participants' skills, knowledge, and attitudes related to delivering different news, as well as emistructured interviews.

Intervention Results: There was a significant improvement in domain 1 (of the TDF), which related to knowledge, skills, and beliefs about capabilities. Specifically, there were increased mean postworkshop scores relating to understanding of the effect of different news, importance of empathy when delivering different news, confidence to deliver different news, and skills to deliver different news (p < .001). Domain 2 related to social/professional roles and identity and social influences. All participants believed that HCPs who deliver different news needed appropriate training; however, only 30.8% (n ¼ 8) of the participants had received formal training in delivering different news. Domain 3 was related to environmental context and resources, wherein it was recorded almost all participants (96.2%; n ¼ 25) agreed that the training covered topics relevant to their practice. Domain 4 was optimism, wherein there was a significant improvement in understanding how to provide a balanced description of a condition (p < .001). Domain 5 related to beliefs and consequences. All participants stated they would recommend the training to colleagues. Domain 6 was emotion. There was a significant improvement (p < .001) with participants' rating being better able to manage their emotions related to delivering different news.

Conclusion: Communication between family members and HCPs is routine practice and influences all aspects of patient care and how families cope during their relatives' stay in the ICU. Critical illness and recovery is difficult for both patients and family members, which is why honest, accurate, PFCC-focused communication is fundamental. The READY framework allows HCPs to prepare themselves to deliver information in a supportive family-focused manner to minimise the distress, anxiety, and depression associated with receiving distressing information. The effectiveness of this framework should be examined further in the ICU context and include both economic and family member evaluation.

Study Design: sequential mixed-methods design

Setting: ICU England - National Health Service in South East England

Population of Focus: HCP - healthcare providers who deliver different news to parents, specifically those working in the National Health Service in South East England.

Sample Size: 26 multidisciplinary HCPs - 26 multidisciplinary healthcare providers who delivered different news to parents within the National Health Service in South East England. Eight of these healthcare providers were interviewed as part of the study .

Age Range: patients were children to adults

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement, Provider Tools

Intervention Description: The "Playbook for the Successful Elimination of Early Elective Deliveries" developed by the National Quality Forum (NQF) Maternity Action Team in 2014 outlines strategies and guidance for healthcare providers, hospitals, and policymakers to reduce the rate of early elective deliveries (EED), which are defined as deliveries before 39 weeks of gestation without medical indication. The playbook identifies common barriers to reducing EED, such as lack of effective policies, provider resistance, lack of patient awareness, and data collection challenges. It provides recommendations to overcome these barriers through policy changes, hard-stop policies, provider education, patient education resources, data collection guidance, and measurement strategies using The Joint Commission's PC-01 measure for EED.

Intervention Results: Step 1 — Count the number of patients that delivered babies between 37 and 38 6/7 weeks gestation. Step 2 — Next, subtract the number of patients that meet exclusion criteria listed in Appendix A, Table 11.07 (found in The Joint Commission Specifications Manual) from Step 1. Then, subtract any patients less than 8 years of age, greater than or equal to 65 years of age, length of stay >120 days, or enrolled in clinical trials,. This is your DENOMINATOR. Step 3 — Now, take your DENOMINATOR from Steps 1 and 2 and out of these cases, subtract the number of nonelective deliveries. (Note: Deliveries that do not meet the elective delivery definition are considered nonelective. Elective deliveries are defined as a medical induction of labor or a c-section and all of the following: not in labor or and no history of a Prior uterine Surgery.) This is your NUMERATOR. Step 4 — Divide your NUMERATOR by your DENOMINATOR to calculate your EED rate. The difference between the numerator and the denominator is that the NUMERATOR contains only those cases in which the mother delivered electively between 37 and 38 6/7 weeks without a medical indication that is on the list provided in Appendix A, Table 11.07; the DENOMINATOR contains ALL cases in which the mother delivered between 37 and 38 6/7 weeks, either spontaneously or electively, minus the indications on the list in Appendix A, Table 11.07 or other exclusion.

Conclusion: Despite significant progress in reducing early elective delivery rates across the country, the playbook acknowledges that some areas still face difficulties in achieving desired results. It emphasizes the importance of a concerted effort from various stakeholders, including healthcare providers, hospitals, professional organizations, patient advocates, and policymakers. The playbook serves as a comprehensive resource, offering evidence-based strategies, educational tools, and exemplars to support the elimination of early elective deliveries. By addressing barriers, promoting policy changes, enhancing data collection and measurement, and increasing awareness among providers and patients, the playbook aims to facilitate sustainable improvements in maternal and neonatal health outcomes.

Study Design: N/A

Setting: N/A

Data Source: N/A

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Provider Training/Education, Guideline Change and Implementation, Provider Tools

Intervention Description: Nine primary care sites from pediatrics, family medicine, and medicine-pediatrics implemented the Adolescent Champion model. Each site identified a multidisciplinary champion team to undergo training on adolescent-centered care, deliver prepackaged trainings to other staff and providers, make youth-friendly site changes, implement a standardized flow to confidentially screen for risky behaviors, and complete a quality improvement project regarding confidentiality practices. Adolescent patients, staff, and providers were surveyed at baseline, year-end, and 1-year follow-up to assess changes.

Intervention Results: Adolescent patients’ perceived experience with both their provider and the clinic overall significantly improved from baseline to year-end across every survey measure, and this improvement was consistently sustained at 1-year follow-up

Conclusion: Implementing the Adolescent Champion model successfully helped primary care sites become more adolescent-centered. Further studies are needed to evaluate the effects of this model on patient outcomes.

Study Design: Over the first 6 months of implementing the model, Adolescent Champion teams gathered to attend 3 2-hour trainings (Continuing Medical Education credits provided). Clinic staff at the Adolescent Champion sites administered baseline and year-end paper surveys to (1) adolescent patients aged 12-21 years to assess satisfaction with the site and providers (with a goal of 50 surveys per site per collection period), (2) providers to assess attitudes and usual practice when caring for adolescents, and (3) staff members to assess the clinic climate related to the care of adolescents.

Setting: Primary care sites in MI - nine primary care sites, including pediatrics, family medicine, and medicine-pediatrics

Population of Focus: Providers of adolescent care & their patients - primary care providers with an interest in adolescent health

Sample Size: The sample size varied across the different surveys and time points. For example, the adolescent patient surveys had 474 respondents at baseline, 386 at year-end, and 331-343 at 1-year follow-up . The staff survey had 121 respondents at baseline and 109 at year-end . However, it's important to note that the exact number of unique adolescent patients, providers, and staff who completed the surveys at all three time points is unknown .

Age Range: 12-21 year old patients - The research focused on adolescent patients aged 12-21 years . This age range is consistent with the World Health Organization's definition of adolescence, which spans from 10 to 19 years of age .

Intervention Components (click on component to see a list of all articles that use that intervention): Visual Display (Hospital), Patient-Centered Medical Home, Quality Improvement, Provider Tools

Intervention Description: After the introduction of the “A Bit About Me” boards, staff and parents were surveyed again over the course of 3 weeks. Items from the preintervention questionnaire were used after the intervention to measure for changes across the parameters of interest.

Intervention Results: There was a significant increase in whether nurses felt they knew what comforts their patients and their patients’ favorite toy (P < .005). A significant improvement in whether doctors felt they knew their patients well (P < .5) and could recognize them outside the hospital (P < .005) was also observed Table 2). Moreover, the perception of the PICU as a welcoming environment improved (P < .05); following our intervention, both doctors and parents felt that nurses know their patients well (P < .05). Improvements in all other questionnaire items were also noted; however, these did not demonstrate statistical significance (Table 3). These results were further supported by improved parents’ views regarding whether HCPs knew what comforts their child (pre, 77%; post, 100%) (Figure 3A and B), their favorite toy (pre, 45%; post, 100%) (Figure 3C and D), and if they could recognize their child outside the hospital (pre, 66%; post, 100%) (Figure 3E and F).

Conclusion: Personalized bedside boards significantly improved how well HCPs knew their patients across various elements. Patient-centered care and, in turn, patient safety in PICUs can be promoted by using personalized bedside boards containing nonmedical information to help HCPs understand their patients’ individual needs and tailor their treatment.

Study Design: An unpaired, two-tailed Student’s t-test was used to analyze and compare the pre- and postintervention results.

Setting: PICU in London - 13-bed Pediatric Intensive Care Unit (PICU) of St. Mary’s Hospital, London, United Kingdom

Population of Focus: families of children in PICU - healthcare professionals (doctors, nurses, physiotherapists, and pharmacists) working in the PICU, as well as the parents of children in the PICU

Sample Size: 36 - combination of parents, doctors, nurses, others - The project collected 38 questionnaires to obtain baseline data, while 36 questionnaires were completed after the introduction of the personalized bedside boards .

Age Range: parents of children in the PICU

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Provider Training/Education, Guideline Change and Implementation, Provider Tools

Intervention Description: We collected parent demographic information via survey and infant characteristics via medical record review. Study staff interviewed parents at 3 distinct time points: (1) following recorded family conferences, (2) at discharge from the hospital, and (3) 6 months following hospital discharge.

Intervention Results: We present parent-driven recommendations for the provision of information about neurologic prognosis. ALIGN represents a novel, inductively-derived framework that centers the voices and lived experiences of parents caring for critically ill children. These recommendations are organized by key phases of information delivery and can guide clinicians as they navigate conversations with caregivers of critically ill infants and support interventions to improve prognostic communication.

Conclusion: No Conclusion section - Discussion: The ALIGN framework offers a novel, parent-informed strategy to effectively communicate neurologic prognosis. Although ALIGN represents key elements of a conversation about prognosis, each clinician can adapt this framework to their own approach. Future work will assess the effectiveness of this framework on communication quality and prognostic understanding.

Study Design: Interviews were audio recorded. Each interview was transcribed and deidentified. We analyzed qualitative data using a conventional content analysis inductive approach.

Setting: NICU: Intensive care unit (ICU) with parents of infants with neurologic conditions. Duke Hospital

Population of Focus: parents of critically ill infants with neurologic conditions - healthcare professionals, particularly those working in neonatal and pediatric neurology contexts, who are involved in communicating information about neurologic prognosis to parents of critically ill infants.

Sample Size: 61 parents - The study enrolled 61 parents (40 mothers and 21 fathers) of 40 infants with neurologic conditions in the ICU. Of these, 52 parents (37 mothers and 15 fathers) completed 123 interviews.

Age Range: parents (>18) of infants - The median age of the parents who participated in the study was 31 years, with a range from 19 to 46 years. This indicates that the parents included in the study were primarily in their late teens to mid-forties, reflecting a broad range of ages within the parent population .