Katryne Lukens-Bull

Measuring the Transition Readiness of Youth with Special Healthcare Needs: Validation of the TRAQ—Transition Readiness Assessment Questionnaire

OBJECTIVE The aim of this study was to develop the Transition Readiness Assessment Questionnaire (TRAQ), a measure of readiness for transition from pediatric to adult healthcare for youth with special health care needs (YSHCN). METHODS We administered TRAQ to 192 YSHCN aged 16-26 years in three primary diagnostic categories, conducted factor analysis, and assessed differences in TRAQ scores by age, gender, race, and primary diagnosis type. RESULTS Factor analysis identified two TRAQ domains with high internal consistency: Skills for Self-Management and Skills for Self-Advocacy. Each domain had high internal consistency. In multivariate regression models, older age and a primary diagnosis of an activity limiting physical condition were associated with higher scores in Self-Management, and female gender and a primary diagnosis of an activity limiting physical condition were associated with higher scores in Self-Advocacy. CONCLUSIONS Our initial validation study suggests the TRAQ is a useful tool to assess transition readiness in YSHCN and to guide educational interventions by providers to support transition.

The Transition Readiness Assessment Questionnaire (TRAQ): Its Factor Structure, Reliability, and Validity

OBJECTIVE National consensus statements recommend that providers regularly assess the transition readiness skills of adolescent and young adults (AYA). In 2010 we developed a 29-item version of Transition Readiness Assessment Questionnaire (TRAQ). We reevaluated item performance and factor structure, and reassessed the TRAQs reliability and validity. METHODS We surveyed youth from 3 academic clinics in Jacksonville, Florida; Chapel Hill, North Carolina; and Boston, Massachusetts. Participants were AYA with special health care needs aged 14 to 21 years. From a convenience sample of 306 patients, we conducted item reduction strategies and exploratory factor analysis (EFA). On a second convenience sample of 221 patients, we conducted confirmatory factor analysis (CFA). Internal reliability was assessed by Cronbachs alpha and criterion validity. Analyses were conducted by the Wilcoxon rank sum test and mixed linear models. RESULTS The item reduction and EFA resulted in a 20-item scale with 5 identified subscales. The CFA conducted on a second sample provided a good fit to the data. The overall scale has high reliability overall (Cronbachs alpha = .94) and good reliability for 4 of the 5 subscales (Cronbachs alpha ranging from .90 to .77 in the pooled sample). Each of the 5 subscale scores were significantly higher for adolescents aged 18 years and older versus those younger than 18 (P < .0001) in both univariate and multivariate analyses. CONCLUSIONS The 20-item, 5-factor structure for the TRAQ is supported by EFA and CFA on independent samples and has good internal reliability and criterion validity. Additional work is needed to expand or revise the TRAQ subscales and test their predictive validity.

Receipt of Health Care Transition Counseling in the National Survey of Adult Transition and Health

OBJECTIVE: The goal of this study was to examine factors associated with receiving health care transition counseling services as reported by young adults. METHODS: We analyzed data from the 2007 Survey of Adult Transition and Health, a nationwide survey of young adults aged 19 to 23 years conducted by the National Center for Health Statistics, to explore self-reported receipt of services to support transition from pediatric to adult health care. Multivariate logistic regression was used to identify whether sociodemographic characteristics, health status, or markers of provider-youth health communication were associated with the receipt of 3 key transition counseling services. RESULTS: Among the 1865 Survey of Adult Transition and Health respondents, 55% reported that their physicians or other health care providers had discussed how their needs would change with age, 53% reported that their physicians or other health care providers had discussed how to obtain health insurance as an adult, and 62% reported having participated in a transition plan in school. Only 24% reported receiving all 3 transition counseling services. In multivariate logistic regression analyses, although gender, age, and race were not associated with increased receipt of the transition-related outcomes, markers of strong communication with the health system were associated with increased rates of receiving transition guidance. CONCLUSIONS: Many young adults reported not having received health care transition counseling. Provider-youth communication was associated with increased health care transition guidance, and suggests that a medical home model that promotes anticipatory guidance for health care transition could promote improvements in the transition process.

Assessing the Impact of Health Literacy on Education Retention of Stroke Patients

Introduction Inadequate health literacy is a pervasive problem with major implications for reduced health status and health disparities. Despite the role of focused education in both primary and secondary prevention of stroke, the effect of health literacy on stroke education retention has not been reported. We examined the relationship of health literacy to the retention of knowledge after recommended stroke education. Methods This prospective cross-sectional study was conducted at an urban safety-net hospital. Study subjects were patients older than 18 admitted to the hospital stroke unit with a diagnosis of acute ischemic stroke who were able to provide informed consent to participate (N = 100). Health literacy levels were measured by using the short form of Test of Functional Health Literacy in Adults. Patient education was provided to patients at an inpatient stroke unit by using standardized protocols, in compliance with Joint Commission specifications. The education outcomes for poststroke care education, knowledge retention, was assessed for each subject. The effect of health literacy on the Stroke Patient Education Retention scores was assessed by using univariate and multivariate analyses. Results Of the 100 participating patients, 59% had inadequate to marginal health literacy. Stroke patients who had marginal health literacy (mean score, 7.45; standard deviation [SD], 1.9) or adequate health literacy (mean score, 7.31; SD, 1.76) had statistically higher education outcome scores than those identified as having inadequate health literacy (mean score, 5.58; SD, 2.06). Results from multivariate analysis indicated that adequate health literacy was most predictive of education outcome retention. Conclusions This study demonstrated a clear relationship between health literacy and stroke education outcomes. Studies are needed to better understand the relationship of health literacy to key educational outcomes for primary or secondary prevention of stroke and to refine stroke education for literacy levels of high-risk populations.

An Elephant in the Emergency Department: Symptom of Disparities in Cancer Care.

Reliance on emergency departments (EDs) by economically disadvantaged people for initial cancer diagnosis in place of primary care and early diagnosis and treatment is 1 obvious plausible explanation for cancer disparities. Claims data from a safety net hospital for the years 2009-2010 were merged with hospital tumor registry data to compare hospitalizations for ED-associated initial cancer diagnoses to non-ED associated initial diagnoses. The proportion of initial cancer diagnoses associated with hospital admissions through the ED was relatively high (32%) for all safety net hospital patients, but disproportionately higher for African Americans and residents of the impoverished urban core. Use of the ED for initial diagnosis was associated with a 75% higher risk of stage 4 versus stage 1 cancer diagnosis, and a 176% higher risk of dying during the 2-year study period. Findings from this study of ED use within a safety net hospital documented profound disparities in cancer care and outcomes with major implications for monitoring disparities, Affordable Care Act impact, and safety net hospital utilization. (Population Health Management 2016;19:95-101).

The impact of third-hand smoke education in a pediatric emergency department on caregiver smoking policies and quit status: a pilot study

Abstract Environmental tobacco smoke (ETS) exposure is an international problem. Parental smoking is the primary exposure for children. While the adverse health effects of secondhand smoke to children are well recognized and used to educate caregivers, the concept of “third-hand smoke” (THS) and its use as an educational tool has been less studied. The purpose of this project was to determine the impact of brief THS intervention on smoking behaviors of caregivers of children seen in an urban pediatric ED. A convenience sample of children <36 months with caregivers who smoke brought to a pediatric ED was recruited. Consented caregivers were randomized to a control group who received routine education or intervention group who received brief THS education. Follow-up phone assessments were completed to evaluate smoking behavior changes. Of 40 caregivers analyzed, 85% were female, 72% were non-white, and mean age was 29 years. Results revealed the treatment group was more likely to change smoking policies (OR 2.0, 95% CI 0.166–24.069), reduce the number of cigarettes (OR 4.88, 95% CI 0.785–30.286), or quit smoking (OR 1.12, 95% CI 0.346–3.590). This study demonstrated that a brief THS intervention in our sample influenced smokers to change smoking behaviors. These changes would ultimately decrease ETS exposure to children and its adverse health effects. With the limitations of small sample size and high loss to follow-up, the study does not show statistical significance for generalizability.

Mercury exposure education provided by women's health clinics in Duval County, Florida.

Abstract Duval County (Jacksonville, FL, USA) has a long history of environmental health hazards, especially prevalent within its urban core, referred to as Health Zone 1. In 2009, the Duval County Health Department conducted a survey of awareness of and actual exposure to methylmercury among women in the county. The survey found that women with more education or higher incomes had a higher awareness of potential mercury exposures. Furthermore, women in the urban core were less aware and had higher exposure than those in more affluent areas. This study assesses the mercury-exposure awareness and education by healthcare providers serving women of child-bearing age. We surveyed 28 women’s health clinic offices. Sixty-one percent (17/28) indicated that they provide mercury exposure education to female patients, either written or verbal. Of these, only half (8/17) provide written education materials. Ninety-three percent of the providers indicated that a benefit to providing education on mercury exposure, is having “healthier developing fetuses and young children in the community”. Two barriers identified by providers to offering information on mercury exposure and risk were (a) a lack of interest among patients, and (b) a lack of clear, understandable educational materials. The long-term goal of our * -8project is to develop and distribute culturally effective, low literacy materials for distribution by health clinics, to document the increased awareness of mercury exposure risks, and to lessen the adverse health outcomes that may result from mercury exposure among vulnerable population groups in Duval County.

Enhancing Sexually Transmitted Infection Notification: A Quality Improvement Collaborative Case Report

This case study illustrates how a quality improvement (QI) Collaborative supports an implementation study of using mobile phone texting technology for notification of sexually transmitted infections (STI) test results. The County Health Departments making up the QI Collaborative meet monthly to discuss their progress in using QI to advance the use of texting for STI test results. The main purpose of QI Collaboratives is to maximize implementation outcomes through sharing of successes and challenges. The case study report describes how implementation research can adapt to the context of each unique CHD and the users of new knowledge rather than emphasizing the creation of new knowledge.