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Graaf G, Hughes PM, Gigli KH, deJong NA, McGrath RE, Thomas KC. State Differences in Children's Mental Health Care. Acad Pediatr 2024:S1876-2859(24)00504-7. [PMID: 39362631 DOI: 10.1016/j.acap.2024.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/09/2024] [Accepted: 09/20/2024] [Indexed: 10/05/2024]
Abstract
OBJECTIVES This study estimates and compares variation in the probability of child unmet need for mental health care and difficulties accessing care for each state in the United States. Estimates are also generated and compared for three socioeconomic and demographic subgroups nationwide: racial/ethnic group, household income, and insurance type. METHODS Using a retrospective, cross-sectional design, this study pooled 2016-2019 National Survey of Children's Health data. National, state, and subgroup adjusted probabilities of caregiver-reported child unmet need for mental health care and ease of access to mental health care were generated from logistic regression models with marginal post-estimation. RESULTS Adjusted national probabilities of caregiver-reported child unmet mental health need and difficulty in accessing care were 0.21 and 0.46, respectively. State probabilities of unmet need ranged from 0.08 to 0.32. One state was significantly above the national estimate; nine states were below it. State probabilities of difficulty accessing mental health care ranged from 0.28 to 0.57; nine states' probabilities were significantly below the national estimate and two states were significantly above it. Estimates of unmet mental health need and difficulty accessing care varied more widely across states than across racial or ethnic groups, income groups, insurance groups. CONCLUSIONS Geographic inequities in children's mental health care access persist; in some cases, they are larger than sociodemographic inequities.
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Affiliation(s)
- Genevieve Graaf
- School of Social Work, University of Texas at Arlington, 501 W. Mitchell Street, Box 19129, Arlington, TX 76019, USA.
| | - Phillip M Hughes
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, 301 Pharmacy Ln, Chapel Hill, NC 27516; Division of Research, UNC Health Sciences at MAHEC, 121 Hendersonville Road Asheville, NC 28803; Cecil G. Sheps Center for Health Services Research, University of North Carolina, 725 M.L.K. Jr Blvd, Chapel Hill, NC 27516
| | - Kristin H Gigli
- College of Nursing and Health Innovation, University of Texas at Arlington, 701 S. Nedderman Drive, Arlington, TX, 76019
| | - Neal A deJong
- Department of Pediatrics, University of North Carolina School of Medicine, 333 South Columbia St Chapel Hill, NC 27599-7220
| | - Robert E McGrath
- School of Psychology and Counseling, Fairleigh Dickinson University, 1000 River Rd, Teaneck, NJ 07666
| | - Kathleen C Thomas
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, 301 Pharmacy Ln, Chapel Hill, NC 27516; Cecil G. Sheps Center for Health Services Research, University of North Carolina, 725 M.L.K. Jr Blvd, Chapel Hill, NC 27516
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2
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Shah S, Lou L. Advocacy in neonatology: current issues and introduction to the series. J Perinatol 2023; 43:1050-1054. [PMID: 36725986 DOI: 10.1038/s41372-023-01615-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 02/03/2023]
Abstract
Advocacy is an increasingly important skill for neonatologists. As social factors play a greater influence on short & long-term newborn outcomes, neonatal physicians must be attentive to policy factors and work to ensure they benefit the health of both patients and the specialty. In this article, we review advocacy issues of current relevance to neonatal practice, including the "Born Alive Executive Order," the "Newborn Screening Saves Lives Act," subspecialty loan repayment and legislation related to donor human milk, as well as introduce topics further discussed as part of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine Advocacy Series.
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Affiliation(s)
- Shetal Shah
- Division of Neonatology, Department of Pediatrics, Maria Fareri Children's Hospital, New York Medical College, Valhalla, NY, USA.
| | - Lily Lou
- Division of Newborn Medicine, Children's Hospital University of Illinois, Chicago, IL, USA
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3
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Beers LS, Williams-Willingham MA, Chamberlain LJ. Making Advocacy Part of Your Job: Working for Children in Any Practice Setting. Pediatr Clin North Am 2023; 70:25-34. [PMID: 36402468 DOI: 10.1016/j.pcl.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Effective child health advocacy is an essential strategy to improve child health, and can improve access to equitable care. It can also be professionally rewarding and improve career satisfaction. However, while advocacy has been a part of pediatrics since its origins as a specialty, many barriers to engaging in health advocacy exist which can be challenging to navigate. There are a wide range of organizational practice settings, which are each accompanied by unique strengths and limitations. No matter the practice setting, pediatricians can be effective advocates for child health through leveraging organizational, professional, and community resources and partnerships.
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Affiliation(s)
- Lee Savio Beers
- Child Health Advocacy Institute, Children's National Hospital, 111 Michigan Avenue Northwest, Washington, DC 20010, USA.
| | | | - Lisa J Chamberlain
- Department of Pediatrics, Stanford, School of Medicine, 453 Quarry Road, Mail Code 5459, Stanford, CA 94305, USA
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4
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Chung RJ, Ramirez MR, Best DL, Cohen MB, Chamberlain LJ. Advocacy and Community Engagement: Perspectives from Pediatric Department Chairs. J Pediatr 2022; 248:6-10.e3. [PMID: 35032554 DOI: 10.1016/j.jpeds.2021.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/17/2021] [Accepted: 12/05/2021] [Indexed: 01/17/2023]
Affiliation(s)
- Richard J Chung
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Melanie R Ramirez
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Debra L Best
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Mitchell B Cohen
- Department of Pediatrics, The University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Lisa J Chamberlain
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
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5
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Kokko P. Improving the value of healthcare systems using the Triple Aim framework: A systematic literature review. Health Policy 2022; 126:302-309. [DOI: 10.1016/j.healthpol.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 02/11/2022] [Accepted: 02/16/2022] [Indexed: 12/30/2022]
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6
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Graaf G, Annis I, Martinez R, Thomas KC. Predictors of Unmet Family Support Service Needs in Families of Children with Special Health Care Needs. Matern Child Health J 2021; 25:1274-1284. [PMID: 33942229 DOI: 10.1007/s10995-021-03156-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study describes rates of perceived and unmet need for family support services (care coordination, respite care, and family mental health care) among a national sample of children with special health care needs (CSHCN), distinguishing children with emotional, behavioral, or developmental problems (EBDPs) from children with primarily physical chronic conditions. It also examines if a child having EBDPs is associated with perceived and unmet family support service needs and investigates public versus private health insurance's moderating effect on this association. METHODS Using data from the National Survey of Children with Special Health Care Needs (2005/2006 and 2009/2010), this cross-sectional study uses multi-level, fixed effects logistic regression. RESULTS When compared to CSHCN with no EBDPs, parents of CSHCN with EBDPs report greater need for all family support services and greater rates of unmet need for all support services. This pattern of greater need for CSHCN with EBDPs versus those without is similar among those with public and private health insurance. Among CSHCN with family support needs, however, the pattern differs. For CSHCN with EBDPs, having public insurance is associated with lower probabilities of unmet needs compared to private insurance. For CSHCN without EBDPs, having public insurance has a mixed effect on probability of reporting unmet need. CONCLUSION Having EBDPs and public insurance is associated with increased perceived need, but public insurance also confers particular benefit for children with EBDPs.
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Affiliation(s)
- Genevieve Graaf
- School of Social Work, University of Texas At Arlington, Social Work Complex-A, 112D 211 South Cooper Street, Box 19129, Arlington, TX, 76019, USA.
| | - Izabela Annis
- Eshelman School of Pharmacy, University of North Carolina At Chapel Hill, Chapel Hill, USA
| | - Regina Martinez
- School of Social Work, University of Texas At Arlington, Social Work Complex-A, 112D 211 South Cooper Street, Box 19129, Arlington, TX, 76019, USA
| | - Kathleen C Thomas
- Eshelman School of Pharmacy, University of North Carolina At Chapel Hill, Chapel Hill, USA
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7
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Keller DM, Davis MM, Freed GL. Access to pediatric subspecialty care for children and youth: possible shortages and potential solutions. Pediatr Res 2020; 87:1151-1152. [PMID: 32294663 DOI: 10.1038/s41390-020-0889-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/21/2020] [Indexed: 01/21/2023]
Affiliation(s)
- David M Keller
- Department of Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA.
| | - Matthew M Davis
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital and Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gary L Freed
- Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, MI, USA
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8
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Szilagyi PG, Schaffer S, Rand CM, Goldstein NP, Hightower AD, Younge M, Albertin CS, DiBitetto K, Yoo BK, Humiston SG. School-Located Influenza Vaccination: Do Vaccine Clinics at School Raise Vaccination Rates? THE JOURNAL OF SCHOOL HEALTH 2019; 89:1004-1012. [PMID: 31612491 DOI: 10.1111/josh.12840] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Only half of US schoolchildren receive influenza vaccine. School-located influenza vaccination (SLIV) might raise vaccination rates but conducting flu vaccine clinics at schools is challenging to implement. We compared 2 school-based programs designed to raise influenza vaccination rates: parent reminder/educational messages sent to parents from schools which is a low-intensity intervention vs the combination of reminder/educational messages plus SLIV clinics which is a high-intensity intervention. METHODS We assigned 36 schools (6 school districts, 2 per group) to 3 groups: (1) control, ie, no SLIV and no parent reminder/education, (2) parent reminder/education emailed by schools, and (3) parent reminder/education plus SLIV clinics. Some schools had SLIV clinics in prior years. Health department nurses conducted SLIV clinics. RESULTS Among 24,832 children at 36 schools, vaccination rates were control (51.3%), parent reminder/education-only (41.2%), and reminder/education + SLIV (58.7%). On multivariate analyses which controlled for vaccination in prior seasons, children in reminder/education + SLIV schools had higher vaccination rates (OR 1.27, 95% CI 1.10-1.47), but children in reminder/education-only schools had lower rates (OR 0.87, 95% CI 0.75-1.00) than children in control schools. CONCLUSIONS Parent reminder/education combined with SLIV clinics raise vaccination rates, but parent reminder/education alone does not.
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Affiliation(s)
- Peter G Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California Los Angeles (UCLA), Los Angeles, CA, 10833
| | - Stanley Schaffer
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642
| | - Cynthia M Rand
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642
| | - Nicolas Pn Goldstein
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642
| | - A Dirk Hightower
- Department of Clinical and Social Psychology, University of Rochester and Children's Institute, Rochester, NY, 14642
| | - Mary Younge
- Department of Public Health, Monroe County, NY, 14620
| | - Christina S Albertin
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California Los Angeles (UCLA), Los Angeles, CA, 14642
| | - Kristine DiBitetto
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642
| | - Byung-Kwang Yoo
- Department of Public Health Sciences, University of California at Davis, Davis, CA, 95616
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9
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Effects of a Care Coordination Intervention with Children with Neurodevelopmental Disabilities and Their Families. J Dev Behav Pediatr 2019; 39:471-480. [PMID: 29672338 DOI: 10.1097/dbp.0000000000000576] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
UNLABELLED : Care coordination is integral to improving the health of children and families. Using a Shared Plan of Care (SPoC) as a care coordination activity is recommended, but related research on outcomes in pediatric populations with complex medical conditions is scarce. OBJECTIVE This study explores family outcomes associated with implementation of a care coordination/SPoC intervention with a population of children with neurodevelopmental disabilities and their families. METHODS Children aged 2 to 10 years with a neurodevelopmental disability (autism spectrum disorder: 60.9%; global developmental delay/intellectual disability: 39.1%) were referred by pediatric subspecialty programs for care coordination. The intervention included previsit assessments, planned care visits, SPoC development, and 6-month care coordination. A single-group, repeated-measures design was used to evaluate model feasibility and effects on care coordination access, SPoC use, family/clinician goals and needs met, family-professional partnerships, family empowerment, and worry. Times 1 and 2 survey data were collected from a total of 70 families. RESULTS Analysis shows significant improvement in care coordination access, SPoC use, goals achieved, needs met, family empowerment, and reduced worry. There was no significant change in family-professional partnerships and reported SPoC use. CONCLUSION Findings provide preliminary evidence that a care coordination model using a family-centered, goal-oriented SPoC is a feasible and effective approach with a cohort of children with complex neurodevelopmental disorders and is associated with improved family outcomes. Replication studies are warranted and should include a control group, prolonged time period, additional validated outcome measures, and measurement of costs and professional impact.
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10
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Keller D, Reynolds A. Behavioral Pediatrics Meets Behavioral Economics: Autism, Mandates, and High Deductibles. Pediatrics 2019; 143:peds.2019-0926. [PMID: 31092587 DOI: 10.1542/peds.2019-0926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- David Keller
- Department of Pediatrics, School of Medicine, University of Colorado and Children's Hospital Colorado, Aurora, Colorado
| | - Ann Reynolds
- Department of Pediatrics, School of Medicine, University of Colorado and Children's Hospital Colorado, Aurora, Colorado
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11
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Francis L, DePriest K, Wilson M, Gross D. Child Poverty, Toxic Stress, and Social Determinants of Health: Screening and Care Coordination. ONLINE JOURNAL OF ISSUES IN NURSING 2018; 23. [PMID: 31427855 DOI: 10.3912/ojin.vol23no03man02] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Social determinants of health (SDOH) refer to the social, economic, and physical conditions in which people live that may affect their health. Poverty, which affects nearly 15 million children in the United States, has far-reaching effects on children's physical and mental health. Although it is difficult to change a family's economic circumstances, nurses can play a critical role to address SDOH through screening and effective coordination of care. As nurses, our role is to minimize the effects of SDOH, including poverty, on child health and well-being through our practice, research, and professional education. We present three exemplars of child poverty to demonstrate the impact on child health and well-being and propose a model of care for nurses to assess and address SDOH in the pediatric clinical setting.
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12
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Bultas MW, McMillin SE, Broom MA, Zand DH. Brief, Rapid Response, Parenting Interventions Within Primary Care Settings. J Behav Health Serv Res 2018; 44:695-699. [PMID: 26289564 DOI: 10.1007/s11414-015-9479-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Opportunities created by the Patient Protection and Affordable Care Act along with the increased prevalence of pediatric behavioral and mental health concerns provide new challenges for pediatric health care providers. To address these matters, providers need to change the manner by which they provide health care to families. A novel approach is providing brief, rapid response, evidence-based parenting interventions within the pediatric primary care setting. Family-focused parenting programs support the American Academy of Pediatrics recommendations of improving mental health via supports in pediatric primary care to maximize the social and psychological well-being of families. A considerable body of research indicates that parenting interventions reduce the severity and frequency of disruptive behavior disorders in children and provide support to parent by bolstering parental resilience and improving overall family functioning. Providing these services within the pediatric primary care setting addresses the need for fully integrated health services that are family-centered and easily accessible.
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Affiliation(s)
- Margaret W Bultas
- School of Nursing, Saint Louis University, 3525 Caroline Street, St. Louis, MO, 63104, USA.
| | | | - Matthew A Broom
- Department of Pediatrics, School of Medicine, Saint Louis University, 1465 S Grand Blvd, St. Louis, MO, 63104, USA
| | - Debra H Zand
- Department of Pediatrics, School of Medicine, Saint Louis University, 1465 S Grand Blvd, St. Louis, MO, 63104, USA
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13
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Szilagyi PG, Schaffer S, Rand CM, Goldstein NP, Hightower AD, Younge M, Eagan A, Blumkin A, Albertin CS, DiBitetto K, Concannon C, Vincelli P, Yoo BK, Humiston SG. Impact of elementary school-located influenza vaccinations: A stepped wedge trial across a community. Vaccine 2018; 36:2861-2869. [DOI: 10.1016/j.vaccine.2018.03.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 11/29/2022]
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Langer CS, Antonelli RC, Chamberlain L, Pan RJ, Keller D. Evolving Federal and State Health Care Policy: Toward a More Integrated and Comprehensive Care-Delivery System for Children With Medical Complexity. Pediatrics 2018; 141:S259-S265. [PMID: 29496977 DOI: 10.1542/peds.2017-1284k] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 11/24/2022] Open
Abstract
Irrespective of any future changes in federal health policy, the momentum to shift from fee-for-service to value-based payment systems is likely to persist. Public and private payers continue to move toward alternative payment models that promote novel care-delivery systems and greater accountability for health outcomes. With a focus on population health, patient-centered medical homes, and care coordination, alternative payment models hold the potential to promote care-delivery systems that address the unique needs of children with medical complexity (CMC), including nonmedical needs and the social determinants of health. Notwithstanding, the implementation of care systems with meaningful quality measures for CMC poses unique and substantive challenges. Stakeholders must view policy options for CMC in the context of transformation within the overall health system to understand how broader health system changes impact care delivery for CMC.
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Affiliation(s)
- Carolyn S Langer
- Office of Clinical Affairs, Commonwealth Medicine, University of Massachusetts Medical School, Worcester, Massachusetts;
| | - Richard C Antonelli
- Boston Children's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | | | - David Keller
- Children's Hospital Colorado, School of Medicine, University of Colorado, Aurora, Colorado
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15
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Fairbrother G, Dougherty D, Pradhananga R, Simpson LA. Road to the Future: Priorities for Child Health Services Research. Acad Pediatr 2017; 17:814-824. [PMID: 28457940 DOI: 10.1016/j.acap.2017.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 01/21/2017] [Accepted: 04/17/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Prior health services research (HSR) agendas for children have been published, but major ones are now over 15 years old and do not reflect augmented understanding of the drivers and determinants of children's health; recent changes in the organization, financing, and delivery of health care; a growing emphasis on population health; and major demographic shifts in the population. A policy-relevant research agenda that integrates knowledge gained over the past 2 decades is essential to guide future child HSR (CHSR). We sought to develop and disseminate a robust, domestically focused, policy-oriented CHSR agenda. METHODS The new CHSR agenda was developed through a series of consultations with leaders in CHSR and related fields. After each round of consultation, the authors synthesized the previous experts' guidance to help inform subsequent discussions. The multistep process in generation of the agenda included identification of major policy-relevant research domains and specification of high-value research questions for each domain. Stakeholders represented in the discussions included those with expertise in child and family advocacy, adult health, population health, community development, racial and ethnic disparities, women's health, health economics, and government research funders and programs. RESULTS In total, 180 individuals were consulted in developing the research agenda. Six priority domains were identified for future research, including both enduring and emerging emphases: 1) framing children's health issues so that they are compelling to policy-makers; 2) addressing poverty and other social determinants of child health and wellbeing; 3) promoting equity in population health and health care; 4) preventing, diagnosing, and treating high priority health conditions in children; 5) strengthening performance of the health care system; and 6) enhancing the CHSR enterprise. Within these 6 domains, 40 specific topics were identified as the most pertinent for future research. Three overarching and crosscutting themes that affect research across the domains were also noted: the need for syntheses to build on the current, and sometimes extensive, evidence base to avoid duplication; the interrelated nature of the domains, which could lead to synergies in research; and the need for multidisciplinary collaborations in conducting research because research studies will look beyond the health sector. CONCLUSIONS The priorities presented in the agenda are policy-oriented and include a greater emphasis on how findings are framed and communicated to support action. We expect that the agenda will be useful for immediate uptake by investigators and research funders.
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16
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Szilagyi PG, Schaffer S, Rand CM, Vincelli P, Eagan A, Goldstein NPN, Hightower AD, Younge M, Blumkin A, Albertin CS, Yoo BK, Humiston SG. School-Located Influenza Vaccinations: A Randomized Trial. Pediatrics 2016; 138:peds.2016-1746. [PMID: 27940785 DOI: 10.1542/peds.2016-1746] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Assess impact of offering school-located influenza vaccination (SLIV) clinics using both Web-based and paper consent upon overall influenza vaccination rates among elementary school children. METHODS We conducted a cluster-randomized trial (stratified by suburban/urban districts) in upstate New York in 2014-2015. We randomized 44 elementary schools, selected similar pairs of schools within districts, and allocated schools to SLIV versus usual care (control). Parents of children at SLIV schools were sent information and vaccination consent forms via e-mail, backpack fliers, or both (depending on school preferences) regarding school vaccine clinics. Health department nurses conducted vaccine clinics and billed insurers. For all children registered at SLIV/control schools, we compared receipt of influenza vaccination anywhere (primary outcome). RESULTS The 44 schools served 19 776 eligible children in 2014-2015. Children in SLIV schools had higher influenza vaccination rates than children in control schools county-wide (54.1% vs 47.4%, P < .001) and in suburban (61.9% vs 53.6%, P < .001) and urban schools (43.9% vs 39.2%; P < .001). Multivariate analyses (controlling for age, grade, vaccination in previous season) confirmed bivariate findings. Among parents who consented for SLIV, nearly half of those notified by backpack fliers and four-fifths of those notified by e-mail consented online. In suburban districts, SLIV did not substitute for primary care influenza vaccination. In urban schools, some substitution occurred. CONCLUSIONS SLIV raised seasonal influenza vaccination rates county-wide and in both suburban and urban settings. SLIV did not substitute for primary care vaccinations in suburban settings where pediatricians often preorder influenza vaccine but did substitute somewhat in urban settings.
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Affiliation(s)
- Peter G Szilagyi
- Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, California;
| | - Stanley Schaffer
- Department of Pediatrics, Golisano Children's Hospital, School of Medicine and Dentistry, and
| | - Cynthia M Rand
- Department of Pediatrics, Golisano Children's Hospital, School of Medicine and Dentistry, and
| | - Phyllis Vincelli
- Department of Pediatrics, Golisano Children's Hospital, School of Medicine and Dentistry, and
| | - Ashley Eagan
- Department of Pediatrics, Golisano Children's Hospital, School of Medicine and Dentistry, and
| | - Nicolas P N Goldstein
- Department of Pediatrics, Golisano Children's Hospital, School of Medicine and Dentistry, and
| | - A Dirk Hightower
- Department of Clinical and Social Psychology, Children's Institute Rochester, University of Rochester, Rochester, New York
| | - Mary Younge
- Department of Public Health, Monroe County, New York
| | - Aaron Blumkin
- Department of Pediatrics, Golisano Children's Hospital, School of Medicine and Dentistry, and
| | - Christina S Albertin
- Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, California
| | - Byung-Kwang Yoo
- Department of Public Health Sciences, University of California at Davis, Davis, California; and
| | - Sharon G Humiston
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
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17
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Plax K, Donnelly J, Federico SG, Brock L, Kaczorowski JM. An Essential Role for Pediatricians: Becoming Child Poverty Change Agents for a Lifetime. Acad Pediatr 2016; 16:S147-54. [PMID: 27044693 DOI: 10.1016/j.acap.2016.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 01/13/2016] [Accepted: 01/15/2016] [Indexed: 10/22/2022]
Abstract
Poverty has profound and enduring effects on the health and well-being of children, as well as their subsequent adult health and success. It is essential for pediatricians to work to reduce child poverty and to ameliorate its effects on children. Pediatricians have important and needed tools to do this work: authority/power as physicians, understanding of science and evidence-based approaches, and first-hand, real-life knowledge and love of children and families. These tools need to be applied in partnership with community-based organizations/leaders, educators, human service providers, business leaders, philanthropists, and policymakers. Examples of the effects of pediatricians on the issue of child poverty are seen in Ferguson, Missouri; Denver, Colorado; and Rochester, New York. In addition, national models exist such as the American Academy of Pediatrics Community Pediatrics Training Initiative, which engages numerous pediatric faculty to learn and work together to make changes for children and families who live in poverty and to teach these skills to pediatric trainees. Some key themes/lessons for a pediatrician working to make changes in a community are to bear witness to and recognize injustice for children and families; identify an area of passion; review the evidence and gain expertise on the issue; build relationships and partnerships with community leaders and organizations; and advocate for effective solutions.
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Affiliation(s)
- Katie Plax
- Department of Pediatrics, Washington University School of Medicine, St Louis, Mo; American Academy of Pediatrics, Community Pediatrics Training Initiative, Elk Grove Village, Ill.
| | - Jeanine Donnelly
- American Academy of Pediatrics, Community Pediatrics Training Initiative, Elk Grove Village, Ill
| | | | - Leonard Brock
- United Way of Greater Rochester, Rochester-Monroe Anti-Poverty Initiative, NY
| | - Jeffrey M Kaczorowski
- American Academy of Pediatrics, Community Pediatrics Training Initiative, Elk Grove Village, Ill; University of Rochester Medical Center, Golisano Children's Hospital, NY
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Childhood Poverty and Its Effect on Health and Well-being: Enhancing Training for Learners Across the Medical Education Continuum. Acad Pediatr 2016; 16:S155-62. [PMID: 27044694 DOI: 10.1016/j.acap.2015.12.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 12/21/2015] [Accepted: 12/29/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Childhood poverty is unacceptably common in the US and threatens the health, development, and lifelong well-being of millions of children. Health care providers should be prepared through medical curricula to directly address the health harms of poverty. In this article, authors from The Child Poverty Education Subcommittee (CPES) of the Academic Pediatric Association Task Force on Child Poverty describe the development of the first such child poverty curriculum for teachers and learners across the medical education continuum. METHODS Educators, physicians, trainees, and public health professionals from 25 institutions across the United States and Canada were convened over a 2-year period and addressed 3 goals: 1) define the core competencies of child poverty education, 2) delineate the scope and aims of a child poverty curriculum, and 3) create a child poverty curriculum ready to implement in undergraduate and graduate medical education settings. RESULTS The CPES identified 4 core domains for the curriculum including the epidemiology of child poverty, poverty-related social determinants of health, pathophysiology of the health effects of poverty, and leadership and action to reduce and prevent poverty's health effects. Workgroups, focused on each domain, developed learning goals and objectives, built interactive learning modules to meet them, and created evaluation and faculty development materials to supplement the core curriculum. An editorial team with representatives from each workgroup coordinated activities and are preparing the final curriculum for national implementation. CONCLUSIONS This comprehensive, standardized child poverty curriculum developed by an international group of educators in pediatrics and experts in the health effects of poverty should prepare medical trainees to address child poverty and improve the health of poor children.
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Chien AT, Schiavoni KH, Sprecher E, Landon BE, McNeil BJ, Chernew ME, Schuster MA. How Accountable Care Organizations Responded to Pediatric Incentives in the Alternative Quality Contract. Acad Pediatr 2016; 16:200-7. [PMID: 26523636 DOI: 10.1016/j.acap.2015.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/15/2015] [Accepted: 10/24/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE From 2009 to 2010, 12 accountable care organizations (ACOs) entered into the alternative quality contract (AQC), BlueCross BlueShield of Massachusetts's global payment arrangement. The AQC included 6 outpatient pediatric quality measures among 64 total measures tied to pay-for-performance bonuses and incorporated pediatric populations in their global budgets. We characterized the pediatric infrastructure of these adult-oriented ACOs and obtained leaders' perspectives on their ACOs' response to pediatric incentives. METHODS We used Massachusetts Health Quality Partners and American Hospital Association Survey data to characterize ACOs' pediatric infrastructure as extremely limited, basic, and substantial on the basis of the extent of pediatric primary care, outpatient specialist, and inpatient services. After ACOs had 16 to 43 months of experience with the AQC, we interviewed 22 leaders to gain insight into how organizations made changes to improve pediatric care quality, tried to reduce pediatric spending, and addressed care for children with special health care needs. RESULTS ACOs' pediatric infrastructure ranged from extremely limited (eg, no general pediatricians in their primary care workforce) to substantial (eg, 42% of workforce was general pediatricians). Most leaders reported intensifying their pediatric quality improvement efforts and witnessing changes in quality metrics; most also investigated pediatric spending patterns but struggled to change patients' utilization patterns. All reported that the AQC did little to incentivize care for children with special health care needs and that future incentive programs should include this population. CONCLUSIONS Although ACOs involved in the AQC were adult-oriented, most augmented their pediatric quality improvement and spending reduction efforts when faced with pediatric incentives.
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Affiliation(s)
- Alyna T Chien
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Katherine H Schiavoni
- Harvard Medical School, Boston, Mass; Department of Medicine and Pediatrics, Massachusetts General Hospital, Boston, Mass
| | - Eli Sprecher
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass
| | - Bruce E Landon
- Department of Health Care Policy, Harvard Medical School, Boston, Mass; Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Barbara J McNeil
- Department of Health Care Policy, Harvard Medical School, Boston, Mass; Department of Radiology, Brigham and Women's Hospital, Boston, Mass
| | - Michael E Chernew
- Department of Health Care Policy, Harvard Medical School, Boston, Mass
| | - Mark A Schuster
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
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20
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Beck AF, Tschudy MM, Coker TR, Mistry KB, Cox JE, Gitterman BA, Chamberlain LJ, Grace AM, Hole MK, Klass PE, Lobach KS, Ma CT, Navsaria D, Northrip KD, Sadof MD, Shah AN, Fierman AH. Determinants of Health and Pediatric Primary Care Practices. Pediatrics 2016; 137:e20153673. [PMID: 26933205 DOI: 10.1542/peds.2015-3673] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2015] [Indexed: 11/24/2022] Open
Abstract
More than 20% of children nationally live in poverty. Pediatric primary care practices are critical points-of-contact for these patients and their families. Practices must consider risks that are rooted in poverty as they determine how to best deliver family-centered care and move toward action on the social determinants of health. The Practice-Level Care Delivery Subgroup of the Academic Pediatric Association's Task Force on Poverty has developed a roadmap for pediatric providers and practices to use as they adopt clinical practice redesign strategies aimed at mitigating poverty's negative impact on child health and well-being. The present article describes how care structures and processes can be altered in ways that align with the needs of families living in poverty. Attention is paid to both facilitators of and barriers to successful redesign strategies. We also illustrate how such a roadmap can be adapted by practices depending on the degree of patient need and the availability of practice resources devoted to intervening on the social determinants of health. In addition, ways in which practices can advocate for families in their communities and nationally are identified. Finally, given the relative dearth of evidence for many poverty-focused interventions in primary care, areas that would benefit from more in-depth study are considered. Such a focus is especially relevant as practices consider how they can best help families mitigate the impact of poverty-related risks in ways that promote long-term health and well-being for children.
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Affiliation(s)
- Andrew F Beck
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
| | - Megan M Tschudy
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Tumaini R Coker
- Department of Pediatrics, David Geffen School of Medicine and Mattel Children's Hospital, Los Angeles, California
| | - Kamila B Mistry
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Agency for Healthcare Research and Quality; Rockville, Maryland
| | - Joanne E Cox
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Benjamin A Gitterman
- Department of Pediatrics, Children's National Health System; Washington, District of Columbia
| | - Lisa J Chamberlain
- Department of Pediatrics, Lucile Packard Children's Hospital, Palo Alto, California
| | - Aimee M Grace
- Office of US Senator Brian Schatz (D-HI) and George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Michael K Hole
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Perri E Klass
- Department of Pediatrics, New York University School of Medicine, New York, New York
| | - Katherine S Lobach
- Department of Pediatrics, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Christine T Ma
- Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, Oakland, California
| | - Dipesh Navsaria
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kimberly D Northrip
- Department of Pediatrics, University of Kentucky College of Medicine, Lexington, Kentucky; and
| | - Matthew D Sadof
- Department of Pediatrics, Baystate Children's Hospital, Springfield, Massachusetts
| | - Anita N Shah
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Arthur H Fierman
- Department of Pediatrics, New York University School of Medicine, New York, New York
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Abstract
Addressing the health status and needs of incarcerated youth represents an issue at the nexus of juvenile justice reform and health care reform. Incarcerated youth face disproportionately higher morbidity and higher mortality compared to the general adolescent population. Dental health, reproductive health, and mental health needs are particularly high, likely as a result of lower access to care, engagement in high-risk behaviors, and underlying health disparities. Violence exposure and injury also contribute to the health disparities seen in this population. Further, juvenile incarceration itself is an important determinant of health. Juvenile incarceration likely correlates with worse health and social functioning across the life course. Correctional health care facilities allow time for providers to address the unmet physical and mental health needs seen in this population. Yet substantial challenges to care delivery in detention facilities exist and quality of care in detention facilities varies widely. Community-based pediatricians can serve a vital role in ensuring continuity of care in the postdetention period and linking youth to services that can potentially prevent juvenile offending. Pediatricians who succeed in understanding and addressing the underlying social contexts of their patients' lives can have tremendous impact in improving the life trajectories of these vulnerable youth. Opportunities exist in clinical care, research, medical education, policy, and advocacy for pediatricians to lead change and improve the health status of youth involved in the juvenile justice system.
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Szilagyi PG. The Children's Health Insurance Program and the Goldilocks Effect. Acad Pediatr 2015; 15:S13-4. [PMID: 25906955 DOI: 10.1016/j.acap.2015.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Peter G Szilagyi
- Mattel Children's Hospital, University of California at Los Angeles (UCLA), Los Angeles, Calif.
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23
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Abstract
The Patient Protection and Affordable Care Act (ACA) was designed to (1) decrease the number of uninsured Americans, (2) make health insurance and health care affordable, and (3) improve health outcomes and performance of the health care system. During the design of ACA, children in general and children and youth with special health care needs and disabilities (CYSHCN) were not a priority because before ACA, a higher proportion of children than adults had insurance coverage through private family plans, Medicaid, or the State Children's Health Insurance Programs (CHIP). ACA benefits CYSHCN through provisions designed to make health insurance coverage universal and continuous, affordable, and adequate. Among the limitations of ACA for CYSHCN are the exemption of plans that had been in existence before ACA, lack of national standards for insurance benefits, possible elimination or reductions in funding for CHIP, and limited experience with new delivery models for improving care while reducing costs. Advocacy efforts on behalf of CYSHCN must track implementation of ACA at the federal and the state levels. Systems and payment reforms must emphasize access and quality improvements for CYSHCN over cost savings. Developmental-behavioral pediatrics must be represented at the policy level and in the design of new delivery models to assure high quality and cost-effective care for CYSHCN.
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Policy, politics, and procedure: our role in building systems that improve the health of children. Acad Pediatr 2014; 14:425-9. [PMID: 25169154 DOI: 10.1016/j.acap.2014.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 07/09/2014] [Indexed: 11/22/2022]
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Chamberlain LJ, Kaczorowski JM. "You get what you pay for": resources for training and practice in community pediatrics matter. Pediatrics 2014; 134:173-5. [PMID: 24982107 DOI: 10.1542/peds.2014-1130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Lisa Jo Chamberlain
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Jeffrey M Kaczorowski
- Community Pediatrics Training Initiative, American Academy of Pediatrics, Elk Grove Village, Illinois; and Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
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