deJong Neal A, Vu Maihan B, Cui Jiawei, Dole Michael, Moulton Dedrick E, Kappelman Michael D
University of North Carolina School of Medicine, Department of Pediatrics; Division of General Pediatrics and Adolescent Medicine; 231 MacNider Hall, CB# 7225; 301B S. Columbia St., Chapel Hill, NC 27599.
University of North Carolina, Center for Health Promotion and Disease Prevention; Qualitative Research Unit, Department #4985, 1700 Martin Luther King Jr. Boulevard, CB# 7426, Chapel Hill, NC 27599.
Int J Care Coord. 2020 Dec;23(4):156-164. doi: 10.1177/2053434520979957.
Effective care coordination is critical to manage unpredictable complications of conditions such as pediatric inflammatory bowel disease (IBD) that have a relapsing and remitting course. Our objective was to explore perspectives of care coordination following emergency department (ED) visits by children with IBD, because these may indicate deficient care coordination.
Using a multiple case study approach, we sought perspectives through semi-structured interviews of caregivers (parents, primary care providers, and gastroenterologists) for children with IBD who had a recent ED visit in either of two large pediatric referral centers in the southeastern US. We used criterion sampling to identify eligible participants through a medical record report of ED visits, and iterative sampling concurrent with analysis until no new themes were identified. Interviews were transcribed verbatim, and transcripts were coded using directed content analysis to identify emergent themes.
From twenty-six interviews, three major themes emerged: perceptions of appropriate expertise, desire for integration of information and services, and making assumptions instead of engaging. Participants describe distinct roles for primary care and gastroenterology providers and recognize communication and information barriers to better coordination. Some parents and gastroenterologists perceive challenges to engaging primary care providers. Common recommendations include explicit guidance from gastroenterologists to primary care providers and methods for direct communication.
Stakeholders describe common barriers and facilitators for effective care coordination, but some express beliefs about provider roles that could hinder improvement efforts. Tools to support asynchronous communication and shared planning may improve coordination and care quality for complications of IBD.
有效的护理协调对于管理诸如小儿炎症性肠病（IBD）等具有复发和缓解病程的疾病的不可预测并发症至关重要。我们的目标是探讨IBD患儿急诊就诊后护理协调的观点，因为这些可能表明护理协调不足。
采用多案例研究方法，我们通过对美国东南部两个大型儿科转诊中心之一近期有急诊就诊的IBD患儿的护理人员（父母、初级保健提供者和胃肠病学家）进行半结构化访谈来寻求观点。我们使用标准抽样通过急诊就诊的病历报告来确定符合条件的参与者，并在分析的同时进行迭代抽样，直到没有新的主题出现。访谈逐字转录，转录本使用定向内容分析进行编码以识别新出现的主题。
从26次访谈中出现了三个主要主题：对适当专业知识的认知、对信息和服务整合的渴望以及做出假设而非参与。参与者描述了初级保健和胃肠病学提供者的不同角色，并认识到更好协调的沟通和信息障碍。一些家长和胃肠病学家认为让初级保健提供者参与存在挑战。常见的建议包括胃肠病学家对初级保健提供者的明确指导以及直接沟通的方法。
利益相关者描述了有效护理协调的常见障碍和促进因素，但一些人表达了可能阻碍改进努力的关于提供者角色的信念。支持异步沟通和共享规划的工具可能会改善IBD并发症的协调和护理质量。
