Continuity Of Care For Children Research Articles

"Tremendous burdens often unveil enormous gifts": The experiences of South African caregivers implementing speech and language teletherapy for children with cerebral palsy during COVID-19.

In accordance with South Africa's restrictions to mitigate the spread of COVID-19, some speech-language pathologists (SLPs) attempted to engage in novice teletherapy regimes to ensure continuity of care for children with cerebral palsy (CP). This study aimed to explore the experiences of caregivers of children with CP implementing SLP teletherapy during COVID-19 in South Africa. The goal was to shed light on how these families can be better supported and how teletherapy practices can be adjusted for this population. This study employed a qualitative phenomenological research design using in-person and virtual semi-structured interviews with 18 purposively sampled participants with children with CP who received speech and language teletherapy during COVID-19. The data was evaluated using an inductive thematic analysis approach whereby themes elicited from the caregivers' narratives were analyzed. Interviews (n = 18) unveiled the significant understanding caregivers gained by becoming integral and active stakeholders in the provision of teletherapy. Caregivers were able to meaningfully communicate and bond with their children with CP. However, caregivers also assumed the burden that teletherapy placed on them, as they had to renegotiate their role during the pandemic in order to provide routine teletherapy. Findings indicated the need for person-centered SLP teletherapy interventions that utilize contextually and culturally responsive techniques and resources.

Continuity of care for children with anorexia nervosa in the Netherlands: a modular perspective

Care provision for children with anorexia nervosa is provided by outpatient care teams in hospitals, but the way these teams are organized differs per hospital and hampers the continuity of care. The aim of this study is to explore the organization and continuity of care for children with anorexia nervosa in the Netherlands by using a modular perspective.We conducted a qualitative, exploratory case study and took the healthcare provision for children with anorexia nervosa, provided by outpatient care teams, as our case. We conducted nine interviews with healthcare professionals involved in outpatient care teams from six hospitals. A thematic analysis was used to analyze the data.The modular perspective offered insights into the work practices and working methods of outpatient care teams. We were able to identify modules (i.e. the separate consultations with the various professionals), and components (i.e. elements of these consultations). In addition, communication mechanisms (interfaces) were identified to facilitate information flow and coordination among healthcare professionals. Our modular perspective revealed gaps and overlap in outpatient care provision, consequently providing opportunities to deal with unnecessary duplications and blind spots. Conclusion: A modular perspective can be applied to explore the organization of outpatient care provision for children with anorexia nervosa. We specifically highlight gaps and overlap in healthcare provision, which in turn leads to recommendations on how to support the three essential parts of continuity of care: informational continuity, relational continuity, and management continuity.What is Known:• Care provision for children with anorexia nervosa requires a network of health care professionals from different organizations, as a result the organization and provision of care faces challenges.What is New:• Modular care provision sheds light on the complexity and organization of outpatient care provision and supports the three dimensions of continuity of care as experienced by children with anorexia nervosa and their parents/caregivers.

Experience of caregivers on the continuum of care and prevention of malnutrition among children with cholera in Ethiopia: a phenomenology study

IntroductionMalnutrition is a public health problem in low- and middle-income countries among children. Although illnesses such as diarrhea are common immediate drivers of childhood malnutrition, their consequences could be averted through optimal sick child feeding and care to ensure the continuum of care. This study aimed to explore the lived experiences of mothers/caregivers on continuum of care to prevent malnutrition among children with cholera in Ethiopia.MethodsA phenomenology study design was applied to explore experiences of mothers/caregivers in the Bale and Guji zones of the Oromia region, southeast Ethiopia, from November to December 2022 using an unstructured interview guide. The saturation of ideas was used to stop the in-depth interview. Translated data were cleaned and imported into ATLAS.ti7 software for analysis. Using an open coding system, the data were coded into a meaningful context. Deeper immersion into data with repeated reading, creating themes, subthemes, and family/category were carried out. In coding and categorization, multiple coders were involved. The finding was presented using well-spoken verbatim/quotes as illustrations and in narratives.ResultsIn this qualitative study, ten participants were taken to explore their lived experience on the continuum of care for children with acute malnutrition and cholera. The study found that poverty, expensive cost of living, and poor utilization of diversified food were challenges. Moreover, health facilities did not provide any services to mothers whose child was admitted for malnutrition treatment. Children five years and above were excluded from both therapeutic food and screening for malnutrition program. Interruptions of supplies, low attention given to child feeding, inadequate knowledge, and lack of time to prepare diversified food were the main findings.ConclusionPoverty, poor feeding habits, supplies interruption and non-inclusion of malnourished children five and above in screening for malnutrition and in the therapeutic feeding program is missed opportunities that lead to decreased early detection and treatment of malnutrition among children with cholera. Moreover, mothers/caregivers did not receive any service from health facilities when their child was admitted for treatment of malnutrition. This situation forces them to stop treatment before their child recovers from malnutrition, which has a negative impact on the continuum of care and prevention of malnutrition. Therefore, we strongly recommend strengthening emergency nutrition within the country’s health system and revising the food and nutrition policy to incorporate emergency nutrition, with a particular focus on children under the age of fifteen. Additionally, it is important that the study’s recommendations underscore the significance of a multi-sectoral approach that involves collaboration among the health sector, government agencies, and non-governmental organizations. Moreover, adaptive agricultural products be made easily accessible to the community which is crucial in effective preventing and reducing malnutrition in children in the study and similar settings.

Child Sexual Abuse Documentation in Primary Care Settings.

Primary care providers (PCPs) can play an important role in the continuity of care for children who experience sexual abuse (SA). We performed a retrospective, chart-based study of children 3 to 17 years old with SA history. Primary care medical records were reviewed for 2 years after a subspecialty SA evaluation. Descriptive statistics and logistic regression were used to assess factors associated with documentation of SA history and mental health management by the PCP. Of 131 included patients, 43% had PCP documentation of their SA history, which was associated with care from resident providers (P < .01). There was greater mental health management and mental health referrals by PCPs for the group with documentation compared with the group without documentation (52% vs 23%, P < .001). Overall, child SA history was poorly documented in primary care settings. Identifying mechanisms to improve communication about a child's SA history with PCPs is important for the child's ongoing care.

An international telehealth experience in Guatemala.

An increase in competition for nurse practitioner preceptors and United States-based clinical practicum sites along with an increase in required direct patient care clinical hours demand innovative methods for gaining valuable nurse practitioner clinical experiences. Involving nurse practitioner students in medical mission trips to low-resource countries and follow-up telehealth clinics have been beneficial for all involved. Guatemala is a developing country in Latin America that has a high rate of poverty, malnutrition, and a lack of health care. Annual medical mission trips are beneficial in meeting the health care needs of Guatemalans but lack the frequent follow-up necessary to promote a more sustained impact. A monthly telehealth program was established in a rural area of Guatemala to promote the continuity of care for children with malnutrition. This article discusses associated barriers, strategies to overcome those barriers, and the inclusion of nurse practitioner students to meet the needs of the Guatemalan children with malnutrition using a telehealth program.

Health worker compliance with severe malaria treatment guidelines in the context of implementing pre-referral rectal artesunate in the Democratic Republic of the Congo, Nigeria, and Uganda: An operational study.

For a full treatment course of severe malaria, community-administered pre-referral rectal artesunate (RAS) should be completed by post-referral treatment consisting of an injectable antimalarial and oral artemisinin-based combination therapy (ACT). This study aimed to assess compliance with this treatment recommendation in children under 5 years. This observational study accompanied the implementation of RAS in the Democratic Republic of the Congo (DRC), Nigeria, and Uganda between 2018 and 2020. Antimalarial treatment was assessed during admission in included referral health facilities (RHFs) in children under 5 with a diagnosis of severe malaria. Children were either referred from a community-based provider or directly attending the RHF. RHF data of 7,983 children was analysed for appropriateness of antimalarials; a subsample of 3,449 children was assessed additionally for dosage and method of ACT provision (treatment compliance). A parenteral antimalarial and an ACT were administered to 2.7% (28/1,051) of admitted children in Nigeria, 44.5% (1,211/2,724) in Uganda, and 50.3% (2,117/4,208) in DRC. Children receiving RAS from a community-based provider were more likely to be administered post-referral medication according to the guidelines in DRC (adjusted odds ratio (aOR) = 2.13, 95% CI 1.55 to 2.92, P < 0.001), but less likely in Uganda (aOR = 0.37, 95% CI 0.14 to 0.96, P = 0.04) adjusting for patient, provider, caregiver, and other contextual factors. While in DRC, inpatient ACT administration was common, ACTs were often prescribed at discharge in Nigeria (54.4%, 229/421) and Uganda (53.0%, 715/1,349). Study limitations include the unfeasibility to independently confirm the diagnosis of severe malaria due to the observational nature of the study. Directly observed treatment was often incomplete, bearing a high risk for partial parasite clearance and disease recrudescence. Parenteral artesunate not followed up with oral ACT constitutes an artemisinin monotherapy and may favour the selection of resistant parasites. In connection with the finding that pre-referral RAS had no beneficial effect on child survival in the 3 study countries, concerns about an effective continuum of care for children with severe malaria seem justified. Stricter compliance with the WHO severe malaria treatment guidelines is critical to effectively manage this disease and further reduce child mortality. ClinicalTrials.gov (NCT03568344).

Continuity of care for children in Primary Health Services in a border region

Resumo Objetivou-se compreender a continuidade do cuidado da criança na Atenção Primária à Saúde em região de fronteira por meio de um estudo qualitativo, realizado em Foz do Iguaçu, Paraná, Brasil, com mães de crianças de 0 a 24 meses e enfermeiras. A coleta de dados foi feita com entrevista semiestruturada e registros das cadernetas infantis, entre março de 2018 e junho de 2019. A análise temática de conteúdo orientou a análise dos dados. A continuidade do cuidado infantil se faz principalmente por meio da puericultura, atrelada à Educação em Saúde, da imunização e do teste do pezinho. São requeridas políticas públicas nacionais e regionais que contemplem especificidades de saúde da criança nas fronteiras, bem como acordos entre gestores em saúde dos países fronteiriços, para garantia da continuidade do cuidado, particularmente a crianças brasileiras residentes no Paraguai.

Continuity of care for children with chronic conditions: mixed methods research.

To analyze the continuity of care for children with chronic conditions from the transition from hospital to home. Parallel-convergent mixed-methods research, with a cross-sectional study and Grounded Theory. A characterization instrument and the Care Transitons Measure were applied to 201 legal guardians of children with chronic conditions, and semi-structured interviews were conducted with 35 participants (among professionals and guardians). Data were combined by integration. The efforts of the hospital team to promote continuity of care after discharge from the transition from hospital to home impact on the quality-of-care transition perceived by caregivers, with a mean of 89.5 (standard deviation = 12.5) points. However, the absence of formal mechanisms to guide the transition of care makes it difficult to achieve continuity of care in the health network. Continuity of care for children is hindered by barriers, against which hospital care professionals seek individual strategies to overcome them. It is essential to establish institutional actions and public policies aiming at the transition of care to promote continuity of care.

Continuity of care for children with special healthcare needs during the COVID-19 pandemic.

To describe the continuity of care for children with special healthcare needs during the COVID-19 pandemic through the perception of their caregivers in the Northeast of Brazil. Qualitative descriptive-exploratory research carried out between June and September 2020, in a municipality in the Northeast of Brazil. Eleven caregivers participated through semi-structured interviews conducted at home. The data were submitted to thematic content analysis. The social isolation period and the suspension of health services affected the continuity of care, configuring the category "Implications of the COVID-19 pandemic for the continuity of care". Caregivers expressed fear of children contracting the coronavirus, characterizing the category "Fears and uncertainties of the COVID-19 pandemic in view of the vulnerability of children with special healthcare needs". Caregivers' reports revealed problems in the continuity of care for the studied cohort. Therefore, health care practices must be rethought in times of pandemic.

Continuity of care for children with chronic conditions after discharge: a constructivist grounded theory.

to understand the meaning of continuity of care for children with chronic conditions through transitional care from hospital to home. this is a qualitative study, conducted from a Constructivist Grounded Theory perspective. Purposive and theoretical sampling were used to recruit 35 participants, including nurses, professionals from the interprofessional hospital team, and actors responsible for healthcare in the home context. The research was conducted at two large hospitals, between March and September 2019. Semi-structured interviews were conducted. Data analysis was carried out using initial and focused coding, according to constructivist grounded theory. the substantive theory that emerged from this study was named "Postponing the next hospitalization". Eight categories-concepts and 18 elements were derived from the data to support the substantive theory. transitional care from hospital to home acts as a reminder for the resumption of continuity of care after discharge.

A scoping review to inform care coordination strategies for youth with traumatic brain injuries: Care coordination tools

Introduction &amp; importance Children with traumatic brain injury (TBI) report unmet needs several years after their injury and may require long-term care. However, this chronic health condition is often only treated and monitored in the short-term. Care for young persons with TBI often relies on parents to manage their child's complex care network. Effective care coordination can close these gaps and facilitate continuity of care for children with TBI. The purpose of this scoping review was to develop a better understanding of tools that improve care coordination for Children with Special Health Care Needs (CSHCN). This, in turn, can inform care for children with TBI. Methods A scoping review was conducted following the PRISMA framework and methodology. OVID/Medline, CINAHL, PsycINFO, EMBASE, and ERIC databases were searched for articles relevant to care coordination tools used with CSHCN. Results 21 articles met the criteria for inclusion in the review, and 6 major categories of care coordination tools were identified: telehealth, online health records and tools, care plans, inpatient discharge protocols, family training, and reminders. Discussion Studies examining telehealth, online tools, care plans, and family training care coordination interventions for CSHCN have shown positive outcomes and would be relevant strategies to improve the care of children with TBI. Future prospective research should investigate these tools to explore whether they might improve communication, reduce unmet needs, increase service access, and improve long-term outcomes for children with TBI.

P-88: Supporting Intestinal Families in the Virtual World During the COVID-19 Pandemic

Introduction: The Covid-19 pandemic has placed many of our services under greater strain, raising challenges to maintain monitoring protocol and continuity of care for children and families. Social distancing measures were introduced in the UK in March 2020. Virtual clinics were identified as a potential way forward to ensure patient management was at the forefront of our care. Aim: To describe our experience of supporting children and families following intestinal transplant during a global pandemic. Method All calls and emails reviewed from Nurse Led telephone advice service (March 2020 – January 2021) and key concerns identified. Discuss the need for face to face (F2F) appointments and admissions if circumstances require. Virtual clinic platforms like Accurx, Zoom and Microsoft teams were used. Results: Increased telephone calls to our nurse led telephone advice service for reassurance and families’ desire for information on shielding and safety within hospital environments. Providing information leaflets on accessing different platforms for virtual clinics has been essential to increase engagement to new systems. Initial feedback from the families was that virtual clinics/information sessions can feel overwhelming and distant. Reassuring patients and families has been essential for the MDT to acknowledge this while helping them develop new strategies to cope with the changes and challenges faced.Signposting families to support networks to manage their anxiety through practical support and providing up to date information. Enabling families to sign consent forms for transplant in collaboration with local teams. Discussion: Children and families were reassured that virtual clinics provide the same opportunities to discuss their child’s/young person’s clinical needs as well as emotional support. Involvement of MDT team members e.g. Clinical Psychologist, Dietitian in virtual clinic platforms restored confidence in families about our holistic delivery of care. Virtual clinics helped in reducing social and welfare issues for many families. Conclusion: New virtual technology has been embraced by families and many are keen to continue with a combination of virtual and F2F appointments in the future. Virtual clinics and information sessions can offer greater access and convenience to patients and their families, many of whom travel great distances to attend hospital appointments.

English

BACKGROUND Malnutrition is one of the leading causes of morbidity and mortality in children under 5 years of age. Children with severe acute malnutrition have nine times higher mortality than those in well-nourished children. The purpose of this study was to describe the demography, clinical profile, and outcome of children with severe acute malnutrition aged between 6 months to 59 months admitted in nutrition rehabilitation centre at a tertiary care hospital in North East India. METHODS A cross sectional-observational hospital-based study was conducted between May 2019 and April 2020 on 140 children. Severe acute malnutrition was diagnosed as per WHO criteria by using standard techniques. Variables recorded were demographic factors, anthropometry, clinical profile, laboratory tests, and medical complications. The outcome indicators including hospital course were studied. RESULTS In the present study 63.6 % were males and the mean age of presentation was 20.0 ± 1.54 months. 57.1 % children were found to be having both weight for height z-score below – 3 SD and mid upper arm circumference less than 115 mm together. Acute gastroenteritis (45.2 %) was the most common co-morbid condition followed by respiratory tract infection (26.2 %). Iron deficiency anaemia was found in 70.7 % of study children. Recovery rate from severe acute malnutrition was 86.4 % with average weight gain of 6.4 g / kg / day. CONCLUSIONS Children with severe acute malnutrition tend to suffer from serious co-morbid conditions. Early identification and treatment in nutrition rehabilitation centre with facility for critical care support should become a key component of continuum of care for children with severe acute malnutrition. KEYWORDS Children, Clinical Profile, Facility-Based Care, Severe Acute Malnutrition, Outcome

Impact of COVID-19 nationwide lockdown on retinoblastoma treatment and outcome: A study of 476 eyes of 326 children.

Purpose:The novel coronavirus SARS-CoV-2 (COVID-19) and the resultant nationwide lockdown and travel restrictions led to difficulty in providing timely and regular treatment to patients with childhood cancers such as retinoblastoma. This study is aimed at assessing the demography, clinical presentation, treatment strategies, and outcome of treatment defaulters due to the lockdown.Methods:Cross-sectional, observational study of retinoblastoma patients at a tertiary care ocular oncology center during the first wave of COVID-19 and the resulting nationwide lockdown.Results:Of the 476 eyes of 326 patients undergoing active management with a median age of 57 months (range: 4–214 months), 205 (63%) patients returned for follow-up after a mean delay of 45.8 ± 24.3 weeks (range: 8–80 weeks) and 121 (37%) were defaulters according to the data analyzed till June 30, 2021. Distance of residence was ≥1000 km for 148 patients (46%). In terms of need for active treatment, the number of emergent cases was 2 (<1%), 11 (3%) were urgent, and 313 (96%) were semi-urgent. International classification groups D (n = 107 eyes, 23%) and E (n = 173 eyes, 36%) were in majority, and 13 eyes (4%) and 4 eyes (1%) were at stages 3 and 4, respectively. Prior to lockdown, 86 eyes (18%) had active tumor, which remained unchanged (n = 26, 30%) or worsened (n = 49, 60%) after failure to follow-up. Vision (47%), eye (92%), and life salvage (98%) were achieved by individualized protocol-based management after the patients returned for further management. Five children succumbed to intracranial extension.Conclusion:The COVID-19-related nationwide lockdown has deprived retinoblastoma patients of optimal and timely management, leading to prolonged treatment interruptions, delays, permanent default, and death. It is of paramount importance for all the stakeholders to increase awareness, make necessary travel and logistic arrangements, and ensure continuity of care for children with retinoblastoma.

Psychological impact of Covid-19 pandemic in Italian families of children with neurodevelopmental disorders

Research on the psychological impact of the COVID-19 pandemic highlighted negative effects on the general population and particularly on parents. However, little is known about families of children with Neurodevelopmental Disorder (NDD). The present study investigated parental stress, coparenting, and child adjustment in Italian families with children with NDD (N = 82) and typical developing children (TD, N = 82) during lockdown, using an online survey. Results of quantitative analyses showed a significant increase in parental stress and child externalizing behaviors, but not of coparenting. Parental stress is predicted by externalizing behaviors, and coparenting acted as a moderator in the relationship between the change in the amount of time spent with the children before and during lockdown and parental stress. In children with NDD, the decrease in therapeutic/rehabilitation support predicted higher externalizing behaviors. Qualitative analysis showed that beyond the difficulties and worries arising during lockdown, most of the parents appreciated the opportunity of spending more time with their children and strengthening the parent-child relationship. In conclusion, our results point out the importance of ensuring continuity of care for children with NDD (e.g. telehealth) during home confinement and of providing psychological support for parents.

COVID-19 Pandemic-Related Practices and Policies Affecting the Continuity of Behavioral Health Care Among Children With Diabetes.

COVID-19 has led to substantial challenges in continuing to deliver behavioral health care to all patients, including children with chronic diseases. In the case of diabetes, maintaining strong connections among children, their families, and their care team is essential to promote and sustain daily adherence to a complex medical regimen. The purpose of this paper is to describe COVID-19 pandemic-related practices and policies affecting the continuity of behavioral health care among children with diabetes. Challenges and opportunities were encountered at the provider, patient, and family levels throughout the rapid transition period from in-person to online care to ensure continuity of services. Institutional, regional, and national policies that impacted the care team’s capacity to respond swiftly to patients’ changing needs were counterbalanced by those related to standards of care, education and training, and resource constraints. At the policy level, COVID-19 re-exposed a number of long-standing and complicated issues about professional licensure among behavioral health providers at the local and state levels and national long-distance practice restrictions during times of crisis. Issues of insurance reimbursement and regulations intended to protect the public may need to adapt and evolve as the practice of behavioral medicine increasingly takes place remotely, online, and over great distances. The sudden transition to telehealth instigated by COVID-19, in addition to the increasing recognition of the benefits of telehealth to favorably affect the reach and impact of traditional behavioral medicine services, offers an unprecedented opportunity to reimagine the medical home and continuity of care for children with diabetes.

Health Disparities in the Hospitalized Child.

Health care disparities exist along the continuum of care for children admitted to the hospital; they start before admission, impact hospital course, and continue after discharge. During an acute illness, risk of admission, length of stay, hospital costs, communication during family-centered rounds, and risk of readmission have all been shown to vary by socioeconomic status, race, and ethnicity. Understanding factors beyond the acute illness that increase a child's risk of admission, increase hospital course complications, and lower discharge quality is imperative for the new generation of pediatric hospitalists focused on improving health for a population of children. In this article, we describe a framework to conceptualize socioeconomic, racial, and ethnic health disparities for the hospitalized child. Additionally, we offer actions pediatric hospitalists can take to address disparities within their practices.

Diagnosis of Concussion in the Hospital

A significant number of children who are admitted to the hospital with traumatic injuries also have concussion symptoms. Yet, the optimal or standard pathway of care for children with concussion in the hospital setting is not known. Diagnosing concussion in hospital is important because planning of therapies and perioperative anesthetic care is needed in order to minimize risks that could impede recovery. So too is a clinical practice guideline that enables triage, diagnosis, management, and continuity of care for children in hospital with concussion. Therefore, in this review we provide a practical approach to the diagnosis and management of concussion in the hospital, and emphasize the importance of a standardized neurological assessment and multidisciplinary care to identify concussion and its comorbidities, and appropriate follow up care after discharge. Discharge planning should provide education about concussion, encourage compliance with therapies, and importantly, aim to ensure continuity in care through post hospital follow up, particularly for children with high symptom burdens and co-existing mental health conditions.

Habilitation services for children blind from retinopathy of prematurity: Health care professionals' perspective in Maharashtra.

Purpose:To explore the knowledge of retinopathy of prematurity (ROP) and habilitation services for children with visual loss from ROP, among health care professionals (HCPs) involved in care of preterm children and to explore their attitudes and practices in relation to referral for habilitation.Methods:A modified knowledge, attitude and practice questionnaire were administered to ophthalmologists and paediatricians associated with ROP care. Data were collected about their knowledge, beliefs and practices of ROP and referral to rehabilitation facilities. Data were analysed to establish level of knowledge, type of attitude and practices and its association with speciality.Results:Response rate was 78% (25/32). Most (14/25, 56%) were ophthalmologists. All (100%) participants knew that ROP can cause blindness. Knowledge about Indian ROP screening criteria was poor among a third (8/25, 32%), more so in paediatricians (5/11, 45.5%). Most (21/25, 84%) did not have knowledge of what a habilitation service entails and where such facilities are located. More than two-thirds (18/25, 72%) believed that special education should be preferred over inclusive education. Overall, 10/25 (40%) of the HCPs had never referred a child for rehabilitation. More than a half (13/25, 52%) were not confident of counselling parents of blind children. All agreed that rehabilitation services are not part of but should be included in medical curriculum.Conclusion:Indian guidelines for ROP screening are not universally known among HCPs. Educating medical undergraduates, providing counselling training to professionals and integration of rehabilitation into the health system will ensure continuity of care for children with visual loss and their families.

Medical Needs after Pediatric Traumatic Brain Injury: Probabilistic Linkage of State Claims Data with Trauma Center Data

IntroductionTraumatic brain injury (TBI) causes enormous morbidity and mortality in both adults and children. Children who survive TBI may have significant disability. It is not known if patterns of outpatient claim use among TBI survivors can be used to estimate patient functional status.&#x0D; Objectives and ApproachThe objectives of this study are to 1) link regional data sources to create a dataset containing information about the entire continuum of care for children with TBI and 2) identify patterns of outpatient medical needs that can serve as proxies for functional status. We probabilistically linked trauma registry and electronic medical record (EMR) data for children hospitalized after acute TBI at the two pediatric trauma centers in Colorado, Children’s Hospital Colorado (CHCO) and Denver Health (DH), with claims data from the Colorado All Payer Claims Database (APCD) (2009-2014). Probabilistic linkage was performed using LinkSolv (Strategic Matching, Inc., Morrisonville, NY).&#x0D; ResultsOf 737 hospitalized children, 387 (53%) linked to records in the APCD. Among the children in the linked cohort (213 at CHCO and 174 at DH), the median age was 5 years (interquartile range [IQR] 2 to 13) and 264 (68%) were male. Most had either mild (Glasgow Coma Scale [GCS] 13-15, 51%) or severe (GCS &lt;= 8, 36%) TBI. The 1-year hospital readmission rate among the 355 (92%) survivors was 52/355 (15%). Among the 248/355 (70%) who had a medication claim and the 316/355 (89%) who had an outpatient claim in the first year, respectively, the median number of medication claims was 6 (IQR 2 to 14) and the median number of outpatient claims was 5 (IQR 3 to 11).&#x0D; Conclusion/ImplicationsWe will leverage the linked registry, EMR, and claims data by using unsupervised machine learning to identify patterns of outpatient care that can serve as proxies for functional status in children who survive TBI. Analyses are ongoing and will be completed by September 2018.