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Attribute Development Using Continuous Stakeholder Engagement to Prioritize Treatment Decisions: A Framework for
Susan dosReis1, Wendy Camelo Castillo1, Melissa Ross1
1Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.
Summary
This study developed a systematic method to identify key factors for making healthcare decisions for children with co-occurring mental health and cognitive conditions. The resulting framework aids in prioritizing care management attributes.
Area of Science:
- Health Services Research
- Qualitative Research Methods
- Child and Adolescent Psychiatry
Background:
- Children with co-occurring mental health conditions and cognitive impairments present complex care management challenges.
- Effective healthcare decision-making requires a clear understanding and prioritization of relevant care attributes.
- Existing frameworks may not adequately capture the multifaceted needs of this population.
Purpose of the Study:
- To develop and validate a methodological approach for selecting, validating, and prioritizing attributes for healthcare decision-making.
- To create a framework to guide care management decisions for children with co-occurring mental health and cognitive impairments.
Main Methods:
- Grounded theory and constant comparative method used for in-depth interviews (n=48) to identify initial themes.
- Focus groups (n=42) assessed theme relevance, priority, and inter-relationships.
- Positive predictive value and sensitivity used to evaluate agreement on thematic meaning.
Main Results:
- Fourteen relevant attributes were identified from initial interviews.
- High agreement was found, with positive predictive value exceeding 90% and sensitivity ranging from 64% to 89%.
- A final framework of six actionable attributes (medication, behavior, services, social, treatment effects, school) with three levels each was established.
Conclusions:
- A systematic, qualitative-driven approach successfully produced a framework for clinical decisions.
- The framework includes relevant, important, and actionable attributes for competing alternatives in care management.
- This methodology provides a robust tool for healthcare decision-making in complex pediatric cases.
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