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The pediatric inflammatory bowel disease INTERMED: A new clinical tool to assess psychosocial needs
Janice S Cohen1, John S Lyons2, Eric I Benchimol3
1Behavioral Neurosciences and Consultation Liaison Service, Mental Health, Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada; School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada; CHEO Research Institute, Ottawa, ON, Canada.
Insights
A new pediatric tool, the pIBD-INTERMED, reliably identifies psychosocial needs in children with inflammatory bowel disease (IBD). This validated instrument aids in planning individualized care and predicting healthcare utilization for pediatric IBD patients.
Area of Science:
- Pediatric gastroenterology
- Child and adolescent mental health
- Healthcare utilization research
Background:
- The adult INTERMED tool assesses case complexity and psychosocial needs.
- A validated pediatric version is needed for children and adolescents with inflammatory bowel disease (IBD).
Purpose of the Study:
- To develop and validate a pediatric version of the INTERMED (pIBD-INTERMED) for children with IBD.
- To assess the pIBD-INTERMED's utility in predicting healthcare utilization.
Main Methods:
- A cross-sectional study involved 148 children (aged 8-17 years) with IBD and their parents.
- Subjects completed semi-structured interviews scored on 34 pIBD-INTERMED items.
- Inter-rater reliability, convergent validity, and predictive validity were assessed against standardized measures and healthcare utilization data.
Main Results:
- The pIBD-INTERMED demonstrated excellent inter-rater reliability (median r=0.87) and internal consistency (α=0.91).
- Specific pIBD-INTERMED items correlated significantly with behavioral problems, depression, and anxiety.
- The pIBD-INTERMED complexity index improved prediction of healthcare utilization beyond disease severity.
Conclusions:
- The pIBD-INTERMED is a reliable and valid tool for identifying psychosocial risks in pediatric IBD patients.
- This tool can guide individualized care planning and enhance interdisciplinary care for children with IBD.
Objective:
The adult INTERMED is used to determine case complexity and psychosocial needs. We developed and validated a pediatric version of the INTERMED for children and adolescents with inflammatory bowel disease (IBD) and assessed its utility in predicting healthcare utilization.
Methods:
We performed a cross-sectional study of children (aged 8-17 y) with IBD (n = 148) and their parents, seen in a hospital-based clinic. Subjects completed semi-structured interviews that were scored on the 34 pIBD-INTERMED items. To assess inter-rater reliability, 40 interviews were videotaped and scored by a second assessor. Convergent and predictive validity were assessed by examining the relation of the pIBD-INTERMED to standardized measures of psychological, social, and family functioning, disease activity, and healthcare utilization.
Results:
Correlational analyses supported the validity of all five pIBD-INTERMED domains with very good inter-rater reliability (median r = 0.87) and internal consistency (α = 0.91) for the total complexity index. Ratings of 2-3 on the pIBD-INTERMED "mental health/cognitive threat" item were associated with greater odds of behavior and social problems (CBCL-Internalizing scale OR = 7.27, 95% CI 2.17-24.36); CBCL-Externalizing scale OR = 24.79, 95% CI 5.00-122.84), depression (Children's Depression Inventory OR = 8.52, 95% CI 1.70-43.02) and anxiety (Multidimensional Anxiety for Children OR = 11.57, 95% CI 3.00-45.37). The pIBD-INTERMED complexity index added significantly to the prediction of healthcare utilization, beyond the contribution of disease severity.
Conclusions:
The pIBD-INTERMED is a reliable and valid tool for identifying psychosocial risks and needs of children with IBD. It can be used to guide planning of individualized care and enhance interdisciplinary pediatric IBD care.
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