Development and internal validation of prediction models for future hospital care utilization by patients with multimorbidity using electronic health record data

OBJECTIVE: To develop and internally validate prediction models for future hospital care utilization in patients with multiple chronic conditions. DESIGN: Retrospective cohort study. SETTING: A teaching hospital in the Netherlands (542 beds) PARTICIPANTS: All adult patients (n = 18.180) who received care at the outpatient clinic in 2017 for two chronic diagnoses or more (including oncological diagnoses) and who returned for hospital care or outpatient clinical care in 2018. Development and validation using a stratified random split-sample (n = 12.120 for development, n = 6.060 for internal validation). OUTCOMES: ≥2 emergency department visits in 2018, ≥1 hospitalization in 2018 and ≥12 outpatient visits in 2018. STATISTICAL ANALYSIS: Multivariable logistic regression with forward selection. RESULTS: Evaluation of the models’ performance showed c-statistics of 0.70 (95% CI 0.69–0.72) for the hospitalization model, 0.72 (95% CI 0.70–0.74) for the ED visits model and 0.76 (95% 0.74–0.77) for the outpatient visits model. With regard to calibration, there was agreement between lower predicted and observed probability for all models, but the models overestimated the probability for patients with higher predicted probabilities. CONCLUSIONS: These models showed promising results for further development of prediction models for future healthcare utilization using data from local electronic health records. This could be the first step in developing automated alert systems in electronic health records for identifying patients with multimorbidity with higher risk for high healthcare utilization, who might benefit from a more integrated care approach

How are children and young people engaged in research on paediatric obesity and which issues do they report?:A scoping review

The importance of engaging children and adolescents in research is increasingly acknowledged. The aim of this scoping review is to explore how children and young people have been engaged in research on paediatric obesity and which issues they have reported, in order to highlight areas that require further inquiry or action by researchers and health care professionals. There were 13 papers eligible for this review. Methods used included in-depth interviews, structured or semi-structured interviews, and focus groups, as well as more creative qualitative research methods. Half of the studies included young people with their parents; parents were always present when the interviewees were young children. Personal and sensitive themes, such as bullying, a desire to “fit in”, strong negative emotions about oneself (e.g., low self-esteem, low self-efficacy), and not feeling supported by family, peers, and professionals, were more often shared if parents were not present. An additional issue, wanting to be independent versus being under parental control was found in studies with adolescents. Engaging children and adolescents in multiple phases of research on paediatric obesity is beneficial in allowing better insight into their perspectives and providing recommendations that are more in line with their personal needs and life circumstances; such studies are still scarce in this field, however

Oral health-related quality of life in patients with Parkinson’s disease

Background: Parkinson's disease (PD) is a neurodegenerative condition affecting the quality of life. Due to a worsening of oral health in PD patients with the progression of the disease, oral health-related quality of life (OHRQoL) could be impaired as well. Objectives: To assess whether PD patients in The Netherlands experience worse OHRQoL than historical controls, and to investigate which factors are associated with OHRQoL in PD patients. Materials & Methods: In total, 341 PD patients (65.5 ± 8.4 years) and 411 historical controls (62.6 ± 5.3 years) participated. Both groups completed a questionnaire. The PD patients were asked questions regarding demographics, PD, oral health, and OHRQoL. The historical controls filled in demographic information and questions regarding OHRQoL. The latter construct was assessed using the Dutch 14-item version of the Oral Health Impact Profile (OHIP-14). Data were analysed using independent samples t-tests and univariate and multivariate linear regression analysis. Results: The mean OHIP-14 score was higher in PD patients (19.1 ± 6.7) than in historical controls (16.5 ± 4.4) (t(239) = 6.5; p <.001). OHRQoL in PD patients was statistically significant associated with motor aspects of experiences of daily living (B = 0.31; t(315) = 7.03; p <.001), worsening of the oral environment during disease course (B = 3.39; t(315) = 4.21; p <.001), being dentate (B = −5.60; t(315) = −4.5; p <.001), tooth wear (B = 2.25; t(315) = 3.29; p =.001), and possible burning mouth syndrome (B = 5.87; t(315) = 2.87; p =.004). Conclusion: PD patients had a lower OHRQoL than historical controls. Besides, PD-related variables and oral health-related variables were associated with OHRQoL