RECOVER is a severity-stratified, evidence-based care model integrating multiple levels of mental illness. This analysis focuses on individuals with severe and persistent mental illness (SMI/SPMI) and complex care needs, who received outreach-based services through Assertive Community Treatment (ACT) and Crisis Resolution Teams (CRT) as core components of the RECOVER intervention. This study assesses cost-effectiveness from a societal perspective, informed by clinical outcomes. Three domains were analyzed: (1) societal costs over a 12-month follow-up were compared between RECOVER and treatment as usual (TAU) using adjusted generalized linear models; (2) cost-effectiveness was assessed by estimating the incremental cost-effectiveness ratio (ICER) and cost-effectiveness probabilities via net monetary benefit regressions; and (3) psychosocial functioning was assessed via linear mixed model for repeated measures. Among 891 randomized trial participants, 506 (56.8 %) met criteria for SMI/SPMI (RECOVER n = 252, TAU n = 254). RECOVER was associated with lower societal costs (-€6681; p < 0.01). Although outpatient costs increased (+€1593; p < 0.001), these were more than offset by inpatient cost savings (-€6382; p < 0.001), resulting in a substantial net cost reduction. The ICER revealed dominance of RECOVER compared to TAU; cost-effectiveness probabilities exceeded 99 % across varying willingness-to-pay thresholds. Effectiveness analyses showed improved psychosocial functioning in the RECOVER group relative to TAU. The RECOVER model, characterized by outreach-based care (ACT/CRT), demonstrated cost-effectiveness and reductions in inpatient service use. Results highlight the economic and structural benefits of shifting from inpatient to community-focused care for individuals with SMI/SPMI. RECOVER offers a scalable framework for sustainable mental health service reform and should inform future standard care models.

“That's not my silo”: Navigating fragmented long COVID care in the mid-Atlantic United States

Nurse practitioners' implementation assessment in Swiss nursing homes: A mixed study protocol (the EVALIPS_VD Project).

Cardiovascular disease is a significant contributor to pregnancy-related morbidity and mortality. Pregnancy-related cardiovascular disease is increasing in incidence related to adult-onset cardiovascular disease and longer survival of patients with congenital heart disease. Left ventricular cardiomyopathies represent a marked subset of this patient population. Care for these patients remain complicated by fairly limited prospective data as well as complex care coordination between multiple different teams. This review is intended to summarize diagnostic and management considerations for a variety of left ventricular cardiomyopathies that complicate pregnancy, anesthetic considerations affecting peripartum care, the development of the pregnancy heart team, and future therapeutic aims and research avenues. Cardiovascular disease remains an extremely complicated disease process with promising avenues for research for earlier recognition and intervention to improve multidisciplinary care efforts and patient outcomes. Ongoing interest and work is needed in this field to continue promoting safe, multidisciplinary, and comprehensive care for pregnant patients with heart disease.

ABSTRACT The global acceleration of population aging highlights the need for nursing education that effectively prepares students to address the complex care needs of older adults. This study examined whether a gerontological simulation enhances nursing students’ knowledge of common age-related symptoms and influences their perceptions of sensory and functional impairments in older adults. A quasi-experimental design was used with 86 third-year nursing students in the academic year 2022/23 from one institution in Slovenia. The intervention used the GERT simulation kit, which enables experiential engagement with age-related sensory and functional limitations. A study-specific questionnaire assessed knowledge of symptoms and functional impairments, as well as perceptions of aging. Before and after intervention data were analyzed using content analysis and Wilcoxon signed-rank tests. Participation in the simulation significantly improved students’ recognition of age-related symptoms and functional limitations. Correct response rates increased across all assessed conditions, with post-intervention accuracy exceeding 90% for hand tremor, tinnitus, macular degeneration, and retinal detachment. Students also showed improved identification of functional impairments and produced a wider range of descriptors reflecting the everyday challenges faced by older adults. Gerontological simulation enhanced students’ understanding of sensory and functional changes associated with aging and provided insight into the lived experience of older adults. This experiential learning approach supports the development of more compassionate, person-centered care and strengthens students’ preparedness for clinical practice in gerontological settings. Incorporating such simulation into nursing curricula may improve educational outcomes and foster more responsive, compassionate care for an aging population.

Surgeon attrition threatens access to complex and time-sensitive operative care, but specialty-specific and career-stage patterns remain poorly defined. We evaluated national trends and predictors of attrition from active clinical surgical practice. We conducted a retrospective longitudinal cohort study linking Medicare Physician and Other Practitioners Public Use Files (2013-2023) to the National Plan and Provider Enumeration System using National Provider Identifiers. Surgeons billing Medicare Part B across 19 specialties were included. Attrition was defined as the first year followed by three consecutive years with <50 evaluation and management services. Kaplan-Meier methods estimated cumulative attrition; multivariable Cox regression evaluated associations with specialty, sex, years in practice, U.S. Census region, and rural versus urban location. Among 224,629 surgeons (1,722,692 surgeon-year observations), 15,753 exited active practice over a median 8 years (IQR 6-8), yielding cumulative attrition of 9.7%. Annual attrition was 1.5-1.7% from 2013-2018, peaked at 2.5% (n=2,977) in 2019, and was 1.3% (n=1,462) in 2020. Five-year cumulative attrition reached 25.1% in oral and maxillofacial surgery, 23.2% in obstetrics and gynecology, and 19.3% in plastic surgery. In adjusted analyses, surgeons 10-14 years in practice had more than double the hazard of attrition versus 5-9 years (hazard ratio [HR] 2.58, 95% CI 2.48-2.68), whereas <5 years (HR 0.91, 95% CI 0.87-0.96) and 15-19 years (HR 0.19, 95% CI 0.13-0.27) had lower hazards. Oral and maxillofacial surgery (HR 2.64, 95% CI 2.43-2.86) and obstetrics and gynecology (HR 2.23, 95% CI 2.16-2.30) demonstrated the highest specialty-specific hazards. Female sex was not associated with attrition (HR 0.99, 95% CI 0.97-1.01). Nearly one in ten surgeons exited active practice over 8 years, with disproportionate losses among mid-career and select subspecialty surgeons. Targeted retention strategies are needed to sustain the US surgical workforce.

The global rise in disability and healthcare spending has intensified the need for cost-effective rehabilitation. Spinal cord injury/disease (SCI/D), though relatively rare, is associated with high costs and complex care needs, making it an ideal condition to study efficient resource allocation in rehabilitation. This retrospective observational study included 375 patients with SCI/D from a Swiss SCI centre. Outcome of rehabilitation was measured using the Spinal Cord Independence Measure III (SCIM III). Latent class analysis identified three patient profiles. Cost-effectiveness was assessed by relating total costs to functional improvement, with logistic regression identifying predictors of efficient rehabilitation. Three distinct patient profiles showed significant differences in costs, service utilisation, and functional gains. Average efficiency-defined as achieving above-average functional improvement at below-average cost- was estimated at ΔSCIM III of 57, with a total cost of 118,000 Swiss francs. Efficient rehabilitation was most likely among patients. in profiles 1 and 2, younger with fewer comorbidities and with severe injuries. Patient segmentation enables targeted, equitable resource allocation in rehabilitation. Efficiency varies by patient profile, and even modest gains may be meaningful for severely impaired patients. A stratified cost-effectiveness evaluation is vital for policy and practice.

People living with advanced heart failure in rural areas have poorer quality of care as their disease progresses, which may be due to lack of access to specialty palliative care. A collaborative care model, connecting specialty palliative care clinicians to embedded complex care teams in primary care practices, may increase access to palliative care in this population. Research objectives To explore perspectives on a proposed collaborative palliative care intervention and whether this intervention would be appropriate for people living with heart failure in rural areas. We conducted a qualitative study (n=26), including patients with heart failure (n=7), caregivers (n=2), complex care team members working in primary care practices (n=5), primary care providers (n=5), interdisciplinary specialty palliative care clinicians (n=4), and cardiologists (n=3) all living and/or practicing in a rural community in Maine. Interviews were audio recorded and professionally transcribed. We used Max-QDA, line-by-line coding, and grounded theory analysis. We found people living and working in rural areas wanted palliative care integrated into primary care. Participants voiced suspicion about care "from outsiders" and that introduction of a specialty palliative care team into their medical care might not be well received. As one primary care provider noted "rural [people] are less influenced by … seeing the latest specialist," so describing palliative care as a specialty may not be appealing. However, participants felt that patients would be open to receiving palliative care delivered by their primary care teams. Palliative care specialists and primary care clinical staff were enthusiastic about a collaborative care model to navigate patients' desire to avoid a new team while increasing access to specialty palliative care expertise. A collaborative palliative care model may be welcomed by patients, caregivers, and clinicians in rural areas.

Resident, family, and staff perceptions of the 'Good Life' in nursing home dementia care.

BackgroundFamily caregivers provide essential support to patients receiving home hospice care, often assuming complex clinical and personal care tasks that may impact caregiver mental health. Although hospice caregivers experience high prevalence of anxiety and depression, there is a lack of studies connecting these findings to caregivers' lived experiences, coping strategies, and openness to mental health interventions during hospice care.ObjectiveTo (1) characterize hospice caregivers' mental health symptoms and stressors, (2) identify coping strategies used during hospice, and (3) assess caregivers' receptiveness to mental health interventions during the hospice period.MethodsWe conducted semi-structured interviews with caregivers who completed the Improving Home hospice Management of End-of-life symptoms (I-HoME) study. Eligible caregivers were ≥18 years, English-speaking, and provided weekly care to a home hospice patient aged ≥65. From July to October 2025, 80 caregivers were contacted, and 26 participated. Interviews were audio-recorded and analyzed using qualitative methods.ResultsParticipants' mean age was 58; most were female (77%) and adult children (85%), providing an average of 12 caregiving hours/day. Caregivers commonly described anxiety around caregiving responsibilities and depressive symptoms associated with impending bereavement. Key stressors included witnessing a loved one's decline, caregiver burden, and the unpredictable end-of-life trajectory. Coping strategies included support from family/friends, hospice staff, and religion. Most caregivers expressed interest in mental health services.ConclusionsHome hospice caregivers experience substantial anxiety and depressive symptoms driven by patient decline, high burden, and prognostic uncertainty, yet are receptive to flexible, individualized mental health interventions during hospice care.

People with Parkinson's Disease (PD) can have complex care needs and are often cared for in an outpatient setting. Hospital admissions are associated with suboptimal care, including increased risk of adverse events, length of stay and healthcare costs. Improving the inpatient care experience for people with PD is crucial in healthcare. To identify themes that improve the inpatient care experience of people with PD. A comprehensive search was conducted using 2 electronic databases (PubMed, CINAHL). Grey literature was also obtained using Advanced Google Scholar. Literature from a 10year period (2014-2024) on patients with PD in an inpatient setting was included. Exclusion criteria were applied to rehabilitation, outpatient or palliative care settings. 15 studies were included in the review. 3 themes emerged from the literature - patient care experience, medication safety and staff education. Each of these themes are closely aligned and explore how the inpatient care experience of people with PD can be improved. The review demonstrated how people with PD can receive high quality, safe care. The themes and knowledge identified can be utilised in research and service delivery and design to inform best practice for inpatient care of people with PD.

Purpose Context is increasingly recognised as a central determinant of whether integrated care interventions succeed or fail. Yet the proliferation of contextual analysis frameworks with different epistemological perspectives and empirical applications has created uncertainty about how to make sense of context in complex health and social care systems. This paper critically compares thirteen influential frameworks to examine how they conceptualise, assess and operationalise context for integrated care implementation. Design/methodology/approach A structured and theory-informed comparative analysis was undertaken. Frameworks were purposively selected based on relevance to health and social care, conceptual clarity, empirical use and applicability to complex or multi-level settings. Each framework was examined across five analytical dimensions: epistemological foundations, conceptual structure, methodological guidance, empirical application and relevance to integrated care. An interpretive synthesis approach enabled cross-framework comparison without collapsing diverse paradigms into a single model. Findings Frameworks varied substantially in their assumptions about knowledge, causality, and system behaviour. While tools such as CFIR and Theoretical Domains Framework offer structured and widely used taxonomies, newer frameworks; including ICON, CICI, NASSS and the Context Coding Framework, better reflect the dynamic, relational and cross-boundary nature of integrated care. Participatory and realist approaches add value through attention to mechanisms, reflexivity and power, but often lack procedural guidance. No single framework fully captures the multi-level and emergent properties of integrated care systems highlighting the need for purposeful combination rather than substitution. Practical implications The analysis highlights the need for hybrid and adaptive approaches to contextual analysis, supported by greater epistemological awareness and attention to power, equity and inter-organisational dynamics. The paper offers guidance for selecting and combining frameworks depending on purpose, stage of implementation and system context. Originality/value To our knowledge, this is the first study to systematically compare contextual frameworks through the lens of integrated care. It provides conceptual orientation and practical sensemaking to support more context-sensitive, adaptive and relational approaches to integrated care implementation.

IntroductionCompleting Dental Foundation Training (DFT), guided by Educational Supervisors (ESs), is the route that almost every new UK dental graduate takes to work as independent NHS primary care performers. However, little is known about their achievements, motivations, and challenges. Few studies have included ESs.AimsThis study assessed reasons why Foundation Dentists (FDs) pursued DFT and the motivations of ESs. It examined their perceived achievements and challenges during DFT.MethodsAn anonymous online survey was sent to FDs and ESs in England, Northern Ireland and Wales in February - April 2024 about their motivations, achievements, and challenges.Results469 FDs (52% response rate) and 640 (71% response rate) ESs participated. Most (91%) FDs wanted to build their clinical confidence, and ESs (98%) wanted to explore career opportunities and share knowledge (94%). While 96% of FDs felt that DFT had enhanced their clinical skills, 62% faced challenges providing complex care. ESs (37%) had difficulty managing trainees’ performances. Six percent and 4% of FDs had experienced bullying and harassment from patients, and ESs or the dental team respectively.ConclusionsDFT provided opportunities for new graduates to develop clinical skills and confidence. Actions should address challenges in DFT related to providing complex clinical care and bullying and harassment.

Developing effective health care teams is critical to meet the rising complexity in patient care. However, optimizing team composition, interpersonal dynamics, and care processes in complex health care systems requires processing vast amounts of data that capture fluid interactions among professionals—a task that has been cumbersome, costly, and avoided by most organizations. Well-designed artificial intelligence (AI) tools can meaningfully advance the frontier of health care teamwork, but the application of AI in this regard has been lagging. To support this development, we outline the potential for AI to help optimize team composition, strengthen norms and relationships among professionals, and standardize team-based clinical care processes. These applications can improve the integration of health care teams. Given the importance of relevant data for realizing such advances, we describe the potential types and sources of data that can support AI development. Furthermore, we highlight enabling strategies, including data-sharing alliances and leadership engagement to address privacy, interoperability, and ethical considerations. We propose a sequenced roadmap for piloting these applications based on technological readiness and clinical feasibility, ensuring that human oversight remains central as AI tools are introduced into complex care environments.

Primary care physicians face increasing pressure to deliver complex care within fixed, short visit durations. Prior evidence links higher time pressure to lower-quality care, but the effects of reduced time pressure on care delivery are not well understood. To evaluate whether reduced visit-level time pressure is associated with measures related to greater comprehensiveness and preventive care delivery in primary care visits, overall and by patient chronic condition burden and continuity with one's usual physician. This quasi-experimental cross-sectional study used electronic health record data from 2021 to 2024. The study included visits to primary care physicians at primary care practices within a large integrated health system in the Northeastern US who routinely offered same-day visit slots for adult patients in their schedules. Visits preceding an unfilled same-day visit (reduced time pressure) were compared with visits preceding a filled same-day visit (regular time pressure) using linear regression models that included physician and temporal fixed effects. Reduced time pressure, defined as an unfilled same-day visit slot immediately following the index visit. Indicators for comprehensiveness of care (total and new diagnoses addressed, total and new prescriptions, diagnostic testing, and referrals) and ordering of preventive care (immunizations and health maintenance items). Among 191 269 visits across 311 physicians (170 526 regular time pressure; 20 743, reduced time pressure), mean (SD) patient age was 57.7 (18.1) years, and 59.7% of visits were with female patients. Under reduced time pressure, physicians recorded 0.11 (95% CI, 0.08-0.15) more total diagnoses, 0.09 (95% CI, 0.07-0.11) more new diagnoses, and 0.02 (95% CI, 0.01-0.03) more new prescriptions, and ordered 0.08 (95% CI, 0.03-0.13) more diagnostic tests, with no differences in referrals or preventive care. The estimated effects of reduced time pressure on total and new diagnoses were largest among patients with 3 or more chronic conditions (total diagnoses: 0.16 [95% CI, 0.10-0.21]; new diagnoses: 0.10 [95% CI, 0.07-0.14]). Visits with a patient's usual physician included more orders for diagnostic testing and preventive care, although time pressure effects were similar when seeing one's usual physician vs another physician. In this study, reduced time pressure visits had care patterns aligned with more comprehensive care, particularly for patients with multimorbidity. These modest results highlight the potential trade-offs between visit length and the scope of care delivered, underscoring the importance of addressing time constraints in primary care.

Previous studies describe disability-based discrimination in health care for children with medical complexity, perceived by family caregivers and clinicians. This study explores the perspectives of youth and young adults with medical complexity and disability on their own care. Using an inductive qualitative approach, we performed semistructured interviews with youth and young adults aged 14 to 24years who receive care in a consultative complex care service or affiliated multidisciplinary clinics at a quaternary children's hospital. Interviews were conducted on a video-conferencing platform and participants were offered the opportunity to have a family caregiver present during the interview. We performed thematic analysis of interview transcripts and compared findings with an existing framework. Ten youth/young adults participated, with different underlying diagnoses and disabilities. Identified themes included drivers and manifestations of disability-based discrimination that have been previously described, with an additional manifestation of poor personal well-being. Themes also included drivers of disability-affirming care (clinician knowledge, interest, and curiosity) and manifestations of disability-affirming care (personal well-being, quality care, and humanistic care). Findings were synthesized into an expanded conceptual framework. Youth and young adults with medical complexity perceive both disability-based discrimination and disability-affirming interactions with clinicians that impact their health and well-being. Understanding the lived experiences of youth in their own health care highlights important opportunities to improve disability training and promote inclusive care.

Existing healthcare infrastructure struggles to meet the complex care required for pediatric Post-COVID Syndrome (pPCS). Telemonitoring offers potential to enhance care access, reduce patient burden, and ensure continuity. This study introduces and evaluates a novel, multimodal telemonitoring concept for pPCS with high translational potential for broader pediatric chronic and post-infectious conditions. Telemonitoring included a patient app, digital sensors (spirometer, smartwatch), Patient Reported Outcome Measures, chat/video consultations (VC), and a medical telemonitoring platform. Patients aged 12-17 years with diagnosed PCS were recruited from two pPCS outpatient university clinics in Bielefeld and Munich, Germany. Monitoring lasted three months. Evaluation focused on feasibility, adherence, acceptance, and usability, using monitoring data, the System Usability Scale (SUS), Technology Usage Inventory (TUI), and a custom survey completed by patients and parents. 30 patients (mean age: 15y ± 1.9; 57% female (17/30); mean Baseline Bell-Score: 36.4) and 30 parents participated. Adherence was high, with an average of 3.4 (smartwatch) to 4.6 (spirometry) measurements/week. Questionnaire response rate was 86% (411/480) and 97% (58/60) of VCs were conducted. SUS scores indicated very high usability (patients: 81.25/100; parents: 75.42/100). TUI results showed low skepticism, and high interest. Telemonitoring supported symptom management independent of in-person visits, despite sensor connectivity issues. This is the first study to demonstrate successful integration of telemonitoring in pPCS, with high adherence and positive feedback from all stakeholders supporting its potential. Despite occasional technical challenges and resource needs, this concept shows promise for broader hybrid telemonitoring care implementation in PCS and other post-infectious syndromes. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), trial registration number: DRKS00029354. Registered 07 February 2023 - Retrospectively registered https://drks.de/search/en/trial/DRKS00029354/entails.

PurposeVery old adults with heart failure (HF) experience high rehospitalisation rates related to multimorbidity, functional vulnerability, and complex care transitions. Empirical evidence on factors associated with rehospitalisation in very old adults with HF managed within integrated post-discharge care pathways remains limited. This study aimed to describe rehospitalisation patterns and associated clinical markers in very old patients with HF managed within an integrated cardiogeriatric post-discharge pathway.Patients and methodsThis retrospective single-centre cohort included patients aged ≥65 years hospitalised for acute HF and enrolled at discharge in an integrated cardiogeriatric pathway combining structured remote monitoring, rapid-access day-hospital services and coordinated outpatient follow-up (April 2023–August 2025). Analyses were restricted to patients who survived the early post-discharge period and had available 12-month follow-up data, in order to assess rehospitalisation status at predefined post-discharge time points. The primary outcome was unplanned HF rehospitalisation at 12 months; secondary outcomes included rehospitalisation at 3 and 6 months, predictors of rehospitalisation and hospital length of stay. Exploratory multivariable logistic regression analyses were performed.ResultsAmong 255 very old patients with available 12-month follow-up data (median age 87 years), rehospitalisation rates were 9.8% at 3 months, 16.1% at 6 months and 24.7% at 12 months. Higher loop diuretic dose was associated with rehospitalisation at 3 months. At 6 months, moderate-to-severe mitral regurgitation, higher diuretic dose and absolute iron deficiency were independently associated with rehospitalisation. At 12 months, moderate-to-severe mitral regurgitation, iron deficiency and chronic obstructive pulmonary disease were independently associated. These findings apply to patients who survived the early post-discharge period and had sufficient follow-up data, rather than to an unselected acute HF population.ConclusionIn very old patients with HF and available longitudinal follow-up, higher loop diuretic dose, iron deficiency, moderate-to-severe mitral regurgitation, and COPD were associated with rehospitalisation status at predefined time horizons. These exploratory findings suggest that routinely available clinical markers may help support risk-stratified follow-up in advanced-age HF populations.

An estimated 150 million people have mental health care needs in India, but only 15% are able to access care. Depression and anxiety contribute to a large proportion of mental morbidity. The Systematic Medical Appraisal, Referral, and Treatment (SMART) Mental Health trial used a mobile-based clinical decision support system for primary care doctors and community health workers (CHWs) to identify and treat people at risk of depression, anxiety disorders, and self-harm. A community-based antistigma campaign was also delivered. The intervention led to improved remission rates for depression and anxiety and lower stigma scores. A process evaluation assessed (1) implementation fidelity, barriers, and facilitators; (2) perceptions of doctors and CHWs on the use of SMART Mental Health; and (3) the causal pathways that led to trial outcomes. A mixed methods evaluation combining backend program data and qualitative data was conducted. A total of 38 focus group discussions and 37 key informant interviews were conducted with primary doctors, CHWs, government officials, local community leaders, and research project staff. The data were coded and analyzed using a framework analysis approach based on the UK Medical Research Council guidance on process evaluations and the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. The intervention had high implementation fidelity. Across clusters, the median proportion of participants with at least 1 CHW follow-up was 98% (IQR 96.6%-100%). The referral rate for a psychiatrist was low (224/1697, 13.2%), and only 23.6% (53/224) of those referred visited the psychiatrist. The median exposure to antistigma audiovisual content was 84% (IQR 65.7%-95.9%). At the community level, key implementation barriers included cultural inhibitions in seeking mental health care and the unavailability of patients due to competing demands. Proximity and tight social connections between CHWs and their communities were important facilitators in seeking medical help. Doctor and CHW training, mentoring, and feedback provided by program staff were important facilitators to support the use of the digital health components by the health workforce. A complex intervention that included both community-based antistigma and clinical digital health interventions achieved high implementation fidelity. Key areas to consider for maintenance of such interventions include (1) the need for sustained community-based strategies to address stigma and other cultural barriers; (2) health workforce strengthening policies, including supportive supervision for CHWs and doctors to increase capability in the use of mental health digital health tools; and (3) strategies to improve access to specialist care for those with more complex care needs. Clinical Trial Registry India CTRI/2018/08/015355; https://tinyurl.com/5r63suxp.

Complex Care Programs (CCPs) have formed to meet the needs of children with medical complexity (CMC). The effectiveness of CCPs vary for unknown reasons. One explanation for CCP success may involve specific outcomes of the relationships between families of CMC and CCP clinicians. We sought to develop a parent-reported questionnaire, the Relational Outcomes (ReOs) Measure, to assess these relationship outcomes. The ReOs Measure was designed to capture 5 outcomes of relationships between CCPs and families: Interpersonal trust and respect; Trust regarding shared knowledge and responsibility; Understanding and being understood; Confidence and self-efficacy; and Comprehensive perspective suffused with caring. Parents of children receiving care from the CCP at a children's hospital and health professionals assessed whether the items were clear and whether the measure included all important aspects of their relationship with the CCP. We developed 15 questionnaire items based on prior research and clinical experience and conducted interviews with 14 parents: 9 for the English version and 5 for the Spanish version. Parents reported the items were clear and understandable and were able to give examples for each item from their own experience. Parents affirmed that the items captured important aspects of their relationship with the CCP. Based on parent feedback, 14 items were retained without change, 1 item was revised, and 1 new item was added. The ReOs Measure assesses key outcomes of the relationship between CCPs and families of CMC.