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- Creators: College of Health Solutions
- Creators: School of Life Sciences
It is well known that the lack of care coordination in the healthcare system causes numerous problems including cost inefficiency and inconsistent care, specifically for complex pediatric and adult patients. Many pediatric patients have complex medical and social service needs which can be expensive for both the patient’s parents and the general healthcare system. Therefore, it is difficult for the healthcare system to deliver the highest quality care possible, due to the number of appointments that have to be scheduled (with some being out of state), the large volume of physical health records, and overall lack of time parents have to coordinate this care while also caring for themselves and other family members. It is integral to find a more efficient way to coordinate care for these patients, in order to improve overall care, cost efficiency, and outcomes. <br/>A number of stakeholders in Arizona came together to work on this problem over several years. They were funded through a PCORI Eugene Washington Engagement grant to investigators at ASU. This project, Take Action for Arizona's Children through Care Coordination: A Bridge to Action was developed in order to further develop a research agenda and build the network (PCOR). Regional conferences were conducted in Flagstaff, Yuma, Phoenix, and Tucson, as well as a final capstone conference held in Phoenix. At these conferences, frustrations, suggestions, and opinions regarding Children with Special Health Care Needs (CSHCN) and navigating the healthcare system were shared and testimonials were transcribed.<br/>This study focused on the capstone conference. The study design was a strategic design workshop; results of the design analysis were analyzed qualitatively using descriptive content analysis. Themes described parent’s common experiences navigating the system, impacts resulting from such experiences, and desires for the care coordination system. Quotes were then grouped into major themes and subthemes for the capstone conference. After these themes were determined, the overarching goals of stakeholders could be assessed, and implementation projects could be described.
Brave Bears was a Barrett creative project that operated under local non-profit organizations, Amanda Hope Rainbow Angels and Arizona Women’s Recovery Center. Amanda Hope Rainbow Angels provides support and education for children fighting cancer and their families. Arizona Women’s Recovery Center provides rehabilitation programs for women fighting substance abuse and housing for the women and their children. The Brave Bears Project was focused on helping children in these situations cope with the trauma they are experiencing. The children received a teddy bear, which is a transitional object. In addition, a clay pendant with the word, “brave” pressed into it was tied around the bear’s neck with a ribbon. A poem of explanation and encouragement was also included.<br/><br/>The teddy bear provided comfort to children experiencing emotionally distressing situations as they receive treatment for their illness or as their mom undergoes rehabilitation. This can be in the form of holding the teddy bear when they feel frightened, anxious, lonely or depressed. The “brave” pendant and poem seek to encourage them and acknowledge their trauma and ability to persevere.
Methods: Two-day dietary and fluid intake records as well as 24-h urine samples were collected from 177 children over different weekends. The dietary records were analyzed with Nutrition Data System for Research to obtain TWI from food (TWI-F) as well as TWI from fruits and vegetables (TWI-FV). The fluid intake data was used to determine TWI from liquids (TWI-L). The urine samples were analyzed for volume (UVol), urine osmolality (UOsm), urine specific gravity (USG), and urine color (UCol) to examine hydration. Age was categorized into 3, 4-8, and 9-13 y based on the Institute of Medicine (IOM).
Results: About 52% of the children did not meet water intake recommendations by IOM and 39.8% of the children were underhydrated based on elevated urine osmolality. The average TWI was found to be 1,911± 70 mL. TWI-F was observed to be 492±257 mL, while TWI-L was 1,419±702 mL. TWI-FV only contributed 200±144 mL. As expected TWI was significantly higher in the older children (9-13 y) than children in other age group (3 and 4-8 y). The average UVol was 709±445 mL, USG was 1.019±0.006, UOsm was 701±233 mOsm·kg-1, and UCol was a 3±1 (based on the urine color chart). Only urine volume seemed to be influenced by the age of the children as it was significantly higher for the children in the 9-13 y age group.
Conclusion: Nearly half of the children did not meet water recommendations by IOM and were underhydrated. Fruits and vegetables did not have a significant contribution to TWI. Dietary interventions to increase F&V consumption, lower consumption of SSB, as well as maintain proper hydration may benefit the health of children.