Stuck kids : a study examining the factors that contribute to hospitalized children getting placed on administrative days : a project based upon an investigation at a pediatric post-acute rehabilitation hospital

This study examined factors that contribute to medically complex children getting stuck in acute rehabilitation hospital level of care even though they were medically ready for discharge. Of special interest were caretaker and societal-related factors that may have a high potential for change and early intervention. Sample. Retrospective, non-comparative case series. Methods. The medical records of 20 children discharged between 2010 and 2012 from a specialty acute rehabilitation hospital in New England were surveyed using a protocol designed for the project. The children had been placed on administrative days (AD) prior to discharge. Univariate and bivariate analysis examined the impact of patient disease characteristics, parental characteristics, and societal factors on post-AD status length of stay. Findings. Although the final sample size (N=20) limited the reliability and types of statistical tests that could be undertaken, analysis suggested that disease factors interact with caretaker and societal factors to create the conditions that delay discharge. Findings from the study were used to inform the development of screening tools and targeted interventions for use by the Medical Social Work Service at the host hospital. And a recommendation was made to develop a prospective, comparative case series study of all admissions to further explore the factors identified in this pilot study

Defining the effect and mediators of two knowledge translation strategies designed to alter knowledge, intent and clinical utilization of rehabilitation outcome measures: a study protocol [NCT00298727]

BACKGROUND: A substantial number of valid outcome measures have been developed to measure health in adult musculoskeletal and childhood disability. Regrettably, national initiatives have merely resulted in changes in attitude, while utilization remains unacceptably low. This study will compare the effectiveness and mediators of two different knowledge transfer (KT) interventions in terms of their impact on changing knowledge and behavior (utilization and clinical reasoning) related to health outcome measures. METHOD/DESIGN: Physical and occupational therapists (n = 144) will be recruited in partnership with the national professional associations to evaluate two different KT interventions with the same curriculum: 1) Stakeholder-Hosted Interactive Problem-Based Seminar (SHIPS), and 2) Online Problem-Based course (e-PBL). SHIPS will consist of face-to-face problem-based learning (PBL) for 2 1/2 days with outcome measure developers as facilitators, using six problems generated in consultation with participants. The e-PBL will consist of a 6-week web-based course with six generic problems developed by content experts. SHIPS will be conducted in three urban centers in Canada. Participants will be block-allocated by a minimization procedure to either of the two interventions to minimize any prognostic differences. Trained evaluators at each site will conduct chart audits and chart-stimulated recall. Trained interviewers will conduct semi-structured interviews focused on identifying critical elements in KT and implementing practice changes. Interviews will be transcribed verbatim. Baseline predictors including demographics, knowledge, attitudes/barriers regarding outcome measures, and Readiness to Change will be assessed by self-report. Immediately post-intervention and 6 months later, these will be re-administered. Primary qualitative and quantitative evaluations will be conducted 6-months post-intervention to assess the relative effectiveness of KT interventions and to identify elements that contribute to changing clinical behavior. Chart audits will determine the utilization of outcome measures (counts). Incorporation of outcome measures into clinical reasoning will be assessed using an innovative technique: chart-stimulated recall. DISCUSSION: A strategy for optimal transfer of health outcome measures into practice will be developed and shared with multiple disciplines involved in primary and specialty management of musculoskeletal and childhood disability