Transitioning Young Patients' Health Care Trajectories

Study Overview
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Brief Summary
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The project aims to transition the approach used to care for children with complex conditions and care pathways into a more holistic and coordinated model. The traditional model where specialists independently treat single diseases, makes joint and coordinated decisions about patients with multiple and unclear conditions difficult. In particular there is a gap between mental and somatic services. In preparation for re-designing the care model, several pre-studies are conducted, both a register study and a collection of user reported experiences. Built on the results, we have invented multi-disciplinary teams of complementary competences including paediatricians, psychologists, and physiotherapists to meet the patient and family. The study includes: To implement the new team intervention in a clinical case-control study To scientifically evaluate the intervention To systematise lessons learned in regard to potential spread across systems and patient groups Children 6-12 years together with family and professionals will constitute the team. The assessment aims to clarify the patient's condition through shared decision making and to develop a treatment plan for the child. It is a clinical randomised controlled trial where TpT children will be compared to children following treatment as usual. It includes a two years follow-up regarding a set of evaluation domains: provider perspectives, user-centred experiences and outcomes, as well as health care outcomes.

Detailed Description
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200 children with multi-referrals will be invited and randomised to either intervention or treatment as usual at their third or more referral to Haukeland university hospital. In the intervention group the child and family will meet a complementary team of professionals for more than two hours aimimg to get a clarification of the patient's condition and giving coping strategies for their condition. Outcome defined as better mental health and quality of life as well as increased school attendence are some of the measures being collected. THese outcomes will be compared to the control group after 12 and 24 mth.

Official Title
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Transitioning Young Patients' Health Care Trajectories (TpT) Bridging the Gap Between Mental and Somatic Health Services Tjenester på Tvers

Conditions
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Health Care Utilization, Mental Health Impairment, Child, Only, Multi-morbidity

Intervention / Treatment
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* Other: Transitioning young patients' health care trajectories


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 6-16 years, Previous referred to specialist health care service for 3 or more times, including mental health service as well paediatric service. Exclusion Criteria: Not within age range Less than 3 referrals

Ages Eligible for Study
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Minimum Age: 6 Years
Maximum Age: 12 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Participants are randomised to either intervention or treatment as usual
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Control<br>Control group is recieving treatment as ususal | Other: Transitioning young patients' health care trajectories<br>* New intervention where the patient with multi-referrals to specialist health service meet with a complementary professional team consisting of doctor, psychologist and physioterapist aiming clarify the child's condition through shared decison-making and agreeing upon treatment plans for the child<br>|
| Experimental: Intervention group<br>The intervention group getting the new assessment by a complementary professional team | Other: Transitioning young patients' health care trajectories<br>* New intervention where the patient with multi-referrals to specialist health service meet with a complementary professional team consisting of doctor, psychologist and physioterapist aiming clarify the child's condition through shared decison-making and agreeing upon treatment plans for the child<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Contentment with the intervention - Patient | Patient evaluate the intervention - A questionnaire for the study has been developed Contentment of the TpT intervention (Patient) with two items and for each item has a score 1-4 and 4 is most positive. | Through study completion, an average of 2 years | 
| Contentment with the intervention - Parents | Parents evaluate the intervention - A questionnaire for the study has been developed Contentment of the TpT intervention (Parent) with two items and score for each item has 1-4 and 4 is most positive. | Baseline | 
| Contentment with the intervention - Parents | Parents evaluate the intervention - A questionnaire for the study has been developed Contentment of the TpT intervention (Parent) with two items and score for each item has 1-4 and 4 is most positive. | Through study completion, an average of 2 years | 
| Contentment with the intervention - Professionals | Professionals evaluate the intervention - A questionnaire for the study has been developed Usefulness of the TpT intervention with two items and score for each item has 1-4 and 4 is most positive. | Through study completion, an average of 2 years | 
| Mental health status | Strenght and Difficulty Questionnaire (SDQ) is a mental health screening questionnaire. It constitutes 20 items, with five items in each of the four subscales:emotional problems, hyperactivity/inattention, conduct problems, and peer problems. | Baseline | 
| Mental health status | Strenght and Difficulty Questionnaire (SDQ) is a mental health screening questionnaire. It constitutes 20 items, with five items in each of the four subscales:emotional problems, hyperactivity/inattention, conduct problems, and peer problems. | 1 year after the intervention | 
| Mental health status | Strenght and Difficulty Questionnaire (SDQ) is a mental health screening questionnaire. It constitutes 20 items, with five items in each of the four subscales:emotional problems, hyperactivity/inattention, conduct problems, and peer problems. | 2 year after the intervention | 
| Quality of Life: KIDSCREEN-27 Barne/ungdomsversjon 8-18år | Using KIDSCREEN-27 to evaluate Quality of Life, caregiver provide information in five dimensions these are Rasch scales: Physical Well-Being (5 items), Psychological Well-Being (7 items), Autonomy & Parents (7 items), Peers & Social Support (4 items), and School Environment (4 items). Each item has a scale of five where 1 is not at all is worse outcome and 5 very much is the best outcome. | Baseline | 
| Quality of Life: KIDSCREEN-27 Barne/ungdomsversjon 8-18år | Using KIDSCREEN-27 to evaluate Quality of Life, caregiver provide information in five dimensions these are Rasch scales: Physical Well-Being (5 items), Psychological Well-Being (7 items), Autonomy & Parents (7 items), Peers & Social Support (4 items), and School Environment (4 items). Each item has a scale of five where 1 is not at all is worse outcome and 5 very much is the best outcome. | 1year after the intervention | 
| Quality of Life: KIDSCREEN-27 Barne/ungdomsversjon 8-18år | Using KIDSCREEN-27 to evaluate Quality of Life, caregiver provide information in five dimensions these are Rasch scales: Physical Well-Being (5 items), Psychological Well-Being (7 items), Autonomy & Parents (7 items), Peers & Social Support (4 items), and School Environment (4 items). Each item has a scale of five where 1 is not at all is worse outcome and 5 very much is the best outcome. | 2 years after the intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Contact with specialist healthcare | Post evaluation of use of health services - numbers of new referrals | 1 year after the intervention and 2 year after the intervention |