clinicaltrials.gov Identifier: NCT02805712.

Introduction:This study employed the Delphi method, an exploratory method used for group consensus building, to determine the benefits and challenges associated with community engagement in patient-centered outcomes research.Methods:A series of email surveys were sent to the Patient-Centered Outcomes Research Institute (PCORI)-funded researchers (n = 103) in New England. Consensus was achieved through gathering themes and engaging participants in ranking their level of agreement over three rounds. In round one, participant responses were coded thematically and then tallied. In round two participants were asked to state their level of agreement with each of the themes using a Likert scale. Finally, in round three, the group was asked to rank the round two themes based on potential impact.Results:Results suggested the greatest benefit of community engagement is that it brings multiple perspectives to the table, with 92% ranking it as the first or second most important contribution. Time was ranked as the most significant barrier to engaging community. Strategies to overcome barriers to community engagement include engaging key stakeholders early in the research, being kind and respectful and spending time with stakeholders. The most significant finding was that no researchers reported having specific measures to evaluate community engagement.Conclusion:Community engagement can enhance both research relevance and methodology when researchers are engaged in meaningful collaborations. Advancing the science of community engagement will require the development of evaluation metrics to examine the multiple domains of partnership.

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Introduction: Acute heart failure is significant source of morbidity, mortality, and resource utilization in both children and adults. Previous studies suggest there is increased morbidity, mortality, and cost in pediatric compared to adult hospitalizations. However, there are few data on the differences in heart failure prevalence or outcomes in the emergency department (ED). Hypothesis: Pediatric heart failure related (HFR) ED visits are more commonly associated with congenital heart disease (CHD), have increased charges, and more frequent hospitalizations compared to adult HFR ED visits. Methods: A retrospective analysis of the Nationwide Emergency Department Sample from 2010 was performed to assess HFR ED visits in pediatric (age # 18 years) and adult (age O 18 years) patients and compare factors associated with hospital admission, morbidity, mortality, and resource utilization. Results: 982,525 adult and 1,299 pediatric HFR ED visits were identified. Pediatric HFR ED visits were more likely at a metropolitan teaching hospital (72.9% vs 38.9%; p!0.001) and have a primary payer of Medicaid (62.8% vs 8.6%; p!0.001) compared to adult HFR ED visits. CHD was more common (42% vs 0.4%; p! 0.001) and cardiomyopathy was similar (14% vs 12%; p50.160) in pediatric vs adult HFR ED visits. Comorbidities of renal failure (17% vs 5%; p!0.001) and arrhythmias (37% vs 15%; p!0.001) were more common among adults; pulmonary hypertension was more common among pediatric patients (12% vs 9%; p50.002). Adults were more likely to be admitted to the hospital (72% vs 60%; p!0.001) and incur greater charges in the ED (median $1,611 interquartile range [IQR] $1,011 to $2,554 vs median $1,460, IQR $861 to $2,038; p!0.001) compared to pediatric patients, but pediatric patients incurred more charges if admitted to the hospital (median $38,400, IQR $15,202 to $116,327 vs median $25,630, IQR $14,318 to $49,012; p! 0.001). The overall hospital mortality was similar among all admissions (5.6% pediatric vs 5.0% adults; p50.28) but trended toward increased mortality in pediatric cardiomyopathy vs adult cardiomyopathy patients (7.6% vs 4.4%; p50.06). Conclusions: Pediatric and adult HFR ED visits usually lead to hospital admission and are frequently associated with comorbidities. Pediatric patients were more likely to be cared for at metropolitan teaching hospitals, have CHD, and less likely to be admitted to the hospital. However, when pediatric patents were admitted to the hospital, they incurred greater charges compared to adults. Further study is needed to improve care and resource utilization in this complex population.