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Jones MN, Falade E, Primack I, Liu C, Lipps L, Ehrlich S, Beck AF, Copeland K, Burkhardt MC, DeBlasio DJ, Corley AMS. The Impact of Structural Racism on Continuity of Care at Pediatric Academic Primary Care Clinics. Acad Pediatr 2024; 24:1116-1123. [PMID: 38823499 DOI: 10.1016/j.acap.2024.05.011] [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] [Received: 07/10/2023] [Revised: 04/28/2024] [Accepted: 05/25/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVE Using a structural racism framework, we assessed racial inequities in continuity of care, using the Usual Provider Continuity Index (UPC - the proportion of visits with the provider the patient saw most frequently out of all visits), in a set of large pediatric academic clinics. METHODS We conducted a retrospective cohort study. Patients 12-24 months seen at three pediatric academic primary care clinics for any visit during October 1-31, 2021 were included. We then reviewed continuity for these patients in the preceding 12 months. Outcomes included each patient's UPC for all visits, and a modified UPC for well child checks only (UPC Well). Covariates included race, ethnicity, insurance, clinic site, age, sex, care management, or seeing a social worker. We evaluated for differences in outcomes using bivariate analyses and multivariable regression models. RESULTS Our cohort included 356 patients (74% Black, 5% Hispanic, 85% Medicaid, 52% female, median age 15.8 months). The median UPC was 0.33 and median UPC Well was 0.40. Black patients had significantly lower median values for UPC (0.33 Black vs 0.40 non-Black, P < .01) and UPC Well (0.33 Black vs 0.50 non-Black, P < .01). There were similar inequities in continuity rates by insurance and clinic site. In multivariable models, clinic site was the only variable significantly associated with continuity. CONCLUSIONS Clinic sites serving higher percentages of Black patients had lower rates of continuity. The main driver of racial inequities in continuity rates was at the institutional level.
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Affiliation(s)
- Margaret N Jones
- Division of General and Community Pediatrics (MN Jones, L Lipps, AF Beck, K Copeland, MC Burkhardt, DJ DeBlasio, and AMS Corley), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics (MN Jones, E Falade, S Ehrlich, AF Beck, K Copeland, MC Burkhardt, DJ DeBlasio, and AMS Corley), University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Ebunoluwa Falade
- Department of Pediatrics (MN Jones, E Falade, S Ehrlich, AF Beck, K Copeland, MC Burkhardt, DJ DeBlasio, and AMS Corley), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ilana Primack
- Pediatric Residency Training Program (I Primack), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Chunyan Liu
- Division of Biostatistics and Epidemiology (C Liu and S Ehrlich), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lauren Lipps
- Division of General and Community Pediatrics (MN Jones, L Lipps, AF Beck, K Copeland, MC Burkhardt, DJ DeBlasio, and AMS Corley), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Shelley Ehrlich
- Department of Pediatrics (MN Jones, E Falade, S Ehrlich, AF Beck, K Copeland, MC Burkhardt, DJ DeBlasio, and AMS Corley), University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Biostatistics and Epidemiology (C Liu and S Ehrlich), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Andrew F Beck
- Division of General and Community Pediatrics (MN Jones, L Lipps, AF Beck, K Copeland, MC Burkhardt, DJ DeBlasio, and AMS Corley), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics (MN Jones, E Falade, S Ehrlich, AF Beck, K Copeland, MC Burkhardt, DJ DeBlasio, and AMS Corley), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kristen Copeland
- Division of General and Community Pediatrics (MN Jones, L Lipps, AF Beck, K Copeland, MC Burkhardt, DJ DeBlasio, and AMS Corley), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics (MN Jones, E Falade, S Ehrlich, AF Beck, K Copeland, MC Burkhardt, DJ DeBlasio, and AMS Corley), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mary C Burkhardt
- Division of General and Community Pediatrics (MN Jones, L Lipps, AF Beck, K Copeland, MC Burkhardt, DJ DeBlasio, and AMS Corley), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics (MN Jones, E Falade, S Ehrlich, AF Beck, K Copeland, MC Burkhardt, DJ DeBlasio, and AMS Corley), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Dominick J DeBlasio
- Division of General and Community Pediatrics (MN Jones, L Lipps, AF Beck, K Copeland, MC Burkhardt, DJ DeBlasio, and AMS Corley), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics (MN Jones, E Falade, S Ehrlich, AF Beck, K Copeland, MC Burkhardt, DJ DeBlasio, and AMS Corley), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Alexandra M S Corley
- Division of General and Community Pediatrics (MN Jones, L Lipps, AF Beck, K Copeland, MC Burkhardt, DJ DeBlasio, and AMS Corley), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics (MN Jones, E Falade, S Ehrlich, AF Beck, K Copeland, MC Burkhardt, DJ DeBlasio, and AMS Corley), University of Cincinnati College of Medicine, Cincinnati, Ohio
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Copeland KA, Porter L, Gorecki MC, Reyner A, White C, Kahn RS. Early Correlates of School Readiness Before and During the COVID-19 Pandemic Linking Health and School Data. JAMA Pediatr 2024; 178:294-303. [PMID: 38315472 PMCID: PMC10845043 DOI: 10.1001/jamapediatrics.2023.6458] [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: 08/09/2023] [Accepted: 12/01/2023] [Indexed: 02/07/2024]
Abstract
Importance Many known correlates of kindergarten readiness are captured in developmental and social screenings in primary care; little is known about how primary care data predicts school readiness. Objective To identify early Kindergarten Readiness Assessment (KRA) correlates by linking electronic health record (EHR) data with school district KRA data and to examine potential outcomes of the COVID-19 pandemic using KRA scores between 2018 and 2021. Design, Setting, and Participants This was a retrospective cohort study linking a large primary care practice (PCP) with school assessment data. Linkage used patient name, date of birth, and address. The setting was an urban school district and PCP affiliated with an academic medical center. Students had a KRA score from fall of 2018, 2019, or 2021 (no 2020 KRA due to the COVID-19 pandemic) and at least 1 prior well-child visit at the PCP. Exposures Exposures included year KRA administered, reported child race and ethnicity, child sex, interpreter for medical visits, child ever failed Ages & Stages Questionnaire (ASQ) 18 to 54 months, ever rarely read to, Medicaid status, food insecurity, housing insecurity, problems with benefits, and caregiver depressive symptoms. Main Outcomes and Measures KRA score (continuous), with a possible range of 0 to 300 (passing score = 270). Results A total of 3204 PCP patients (mean [SD] age, 67 [4] months; 1612 male [50.3%]; 2642 Black [82.5%]; 94 Hispanic [2.9%]; 244 White [7.6%]) were matched to their KRA score. Mean (SD) KRA scores were significantly lower in 2021 (mean [SD], 260.0 [13.0]; 214 of 998 [21.4%]) compared with 2019 (mean [SD], 262.7 [13.5]; 317 of 1114 [28.5%]) and 2018 (mean [SD], 263.5 [13.6]; 351 of 1092 [32.1%]), a pattern mirrored in the larger school district. In the linear regression final model (n = 2883), the following binary variables significantly lowered the child's KRA score (points lowered [95% CI]) below a mean passing score of 270.8: child ever failed ASQ after 18 months (-6.7; 95% CI, -7.7 to -5.6), Medicaid insured (-5.7; 95% CI, -9.0 to -2.3), Hispanic ethnicity (-3.8; 95% CI, -6.9 to -0.6), requires interpreter (-3.6; 95% CI, -7.1 to -0.1), 2021 year (-3.5; 95% CI, -4.7 to -2.3), male sex (-2.7; 95% CI, -3.7 to -1.8), ever rarely read to (-1.5; 95% CI, -2.6 to -0.4), and food insecurity (-1.2; 95% CI, -2.4 to -0.1). Race, caregiver depression, housing insecurity, and problems receiving benefits were not associated with KRA scores in final model. Conclusions and Relevance Findings of this cohort study suggest a deleterious association of the COVID-19 pandemic with early learning and development. There may be potential for PCPs and school districts to collaborate to identify and mitigate risks much earlier.
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Affiliation(s)
- Kristen A. Copeland
- Fisher Child Health Equity Center, James M. Anderson Center for Health Systems Excellence, Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Lauren Porter
- James M. Anderson Center for Health Systems Excellence, Cincinnati, Ohio
| | - Michelle C. Gorecki
- General Pediatrics Research Program, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Allison Reyner
- James M. Anderson Center for Health Systems Excellence, Cincinnati, Ohio
| | - Cynthia White
- James M. Anderson Center for Health Systems Excellence, Cincinnati, Ohio
| | - Robert S. Kahn
- Fisher Child Health Equity Center, Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Vieira DDS, Brito PKH, Bezerra ICDS, Soares AR, dos Santos LM, Toso BRGDO, Vaz EMC, Collet N, Reichert APDS. Educational action to monitor children's growth and development based on the theory of meaningful learning. Rev Esc Enferm USP 2024; 57:e20230200. [PMID: 38215032 PMCID: PMC10790301 DOI: 10.1590/1980-220x-reeusp-2023-0200en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/08/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE Evaluating the effect of an educational program on the knowledge of Primary Health Care nurses regarding the surveillance of growth and development during childcare appointments. METHOD A before-after intervention study with 30 nurses. The nurses' knowledge and practice assessment were done using a tool that had been developed and validated. The educational activity was carried out, linking child growth and development indicators with public policies for early childhood and nurses' practices. David Ausubel's Significant Learning Theory was used as a teaching-learning strategy. The same instrument was reapplied after one month. Descriptive statistics were used in the analysis and the proportion test, Wilcoxon test and Item Response Theory with the Rasch model were applied. RESULTS The nurses checked more items right in the instrument after the intervention; there was an increase in the scores of correct answers and a decrease in the item response difficulty index in the knowledge and practice section, post-intervention. CONCLUSION The educational activity had a positive effect, affecting changes in nurses' knowledge and practice, which enabled childcare consultations to become more qualified.
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Affiliation(s)
| | | | | | | | | | | | | | - Neusa Collet
- Universidade Federal da Paraíba, João Pessoa, PB, Brazil
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