Research activities
Why evaluate interventions?
While many clinicians, adolescents and their parents agree that transition interventions are needed, there is very little evidence to support what types of interventions actually make a difference. Only a handful of researchers have looked at pre- and post-satisfaction questionnaires and even fewer have looked at concrete outcome measures before and after a transition intervention was implemented.
Our transition team would like to meet the challenge of improving transitions at SickKids in an informed, scientific manner. In other words, we would like to increase transition efforts throughout the Hospital by promoting those techniques that have the best evidence to support their efficacy but also by aiding programs in the organization and testing of these and new interventions within strong research designs. It is our hope that such research will allow us to better understand our patients’ needs much better and will be an enormous addition to the small body of literature in this area.
How to do research
Define the problem
- What would you like to change?
- What do you worry is not working well now?
Demonstrate the problem with data
Plan an intervention
- Are your outcome measures operationalized?
- What transition intervention(s) would you like to implement?
- What kind of research design makes sense for your clinic? For example:
- Cross sectional versus longitudinal
- Within subjects versus between subjects
- Power analysis; how many subjects do you need to show an effect?
An example
Some clinicians and researchers have been concerned that their paediatric patients delay their first adult appointment well past that which is recommended. The first step in tackling this problem would be to collect objective data; in this case, the number of days between the last pediatric and the first adult appointment. If you found that 30 per cent of your patients did not make it to their first adult health-care appointment within two years of their last paediatric appointment despite the recommendation that they meet with an adult provider within a year, you may decide to design a transition intervention to improve (lower) this percentage.
Example outcome measures
Outcome | Operational measurement |
|---|---|
Duration until first adult appointment | Number of days between the last pediatric appointment to the first adult health-care appointment minus the number recommended |
Patient adherence to medical regimen | Number of refills in last year minus the number recommended |
Decreased depression | Score on the Children’s Depression Inventory (CDI) |
Decreased anxiety | Score on the Children’s Anxiety Inventory |
Patient increased satisfaction with the pediatric health-care system | Satisfaction questionnaire |
Parents increased satisfaction with the pediatric health-care system | Satisfaction Questionnaire |
Patient satisfaction with the adult health-care system | Satisfaction questionnaire |
Parent satisfaction with the adult health-care system | Satisfaction questionnaire |
Increase quality of life for the patient | Quality of Life questionnaire |
Patient acquisition of employment | Number of days working in the past year |
Stability of illness:
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