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Williamson AA, Amin RS, Meltzer LJ, Laposky A, Fiks AG, Tapia IE. Defining and Promoting Pediatric Pulmonary Health: Understanding Sleep and Ventilatory Health. Pediatrics 2023; 152:e2023062292D. [PMID: 37656027 PMCID: PMC10484307 DOI: 10.1542/peds.2023-062292d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 09/02/2023] Open
Abstract
Healthy sleep and optimal ventilatory control begin in early development and are crucial for positive child outcomes. This paper summarizes information presented at the Sleep and Ventilatory Control sessions of the National Heart, Lung, and Blood-sponsored 2021 Defining and Promoting Pediatric Pulmonary Health workshop. These sessions focused on pediatric sleep health, screening for sleep health and sleep disorders in primary care using the electronic health record, infant sleep and ventilatory control, and home sleep testing. Throughout this summary, we discuss key gaps in and barriers to promoting sleep and ventilatory health that were identified during the workshop sessions. We conclude with strategies to address these gaps and barriers and directions for future multidisciplinary research, patient care, and training.
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Affiliation(s)
- Ariel A. Williamson
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raouf S. Amin
- Cincinnati Children’s Medical Center, Cincinnati, Ohio
| | | | - Aaron Laposky
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Alexander G. Fiks
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ignacio E. Tapia
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Jenssen BP, Kelleher S, Karavite DJ, Nekrasova E, Thayer JG, Ratwani R, Shea JA, Nabi-Burza E, Drehmer JE, Winickoff JP, Grundmeier RW, Schnoll RA, Fiks AG. A Clinical Decision Support System for Motivational Messaging and Tobacco Cessation Treatment for Parents: Pilot Evaluation of Use and Acceptance. Appl Clin Inform 2023; 14:439-447. [PMID: 36972687 PMCID: PMC10247306 DOI: 10.1055/a-2062-9627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Research is needed to identify how clinical decision support (CDS) systems can support communication about and engagement with tobacco use treatment in pediatric settings for parents who smoke. We developed a CDS system that identifies parents who smoke, delivers motivational messages to start treatment, connects parents to treatment, and supports pediatrician-parent discussion. OBJECTIVE The objective of this study is to assess the performance of this system in clinical practice, including receipt of motivational messages and tobacco use treatment acceptance rates. METHODS The system was evaluated at one large pediatric practice through a single-arm pilot study from June to November 2021. We collected data on the performance of the CDS system for all parents. Additionally, we surveyed a sample of parents immediately after the clinical encounter who used the system and reported smoking. Measures were: (1) the parent remembered the motivational message, (2) the pediatrician reinforced the message, and (3) treatment acceptance rates. Treatments included nicotine replacement therapy, quitline referral (phone counseling), and/or SmokefreeTXT referral (text message counseling). We described survey response rates overall and with 95% confidence intervals (CIs). RESULTS During the entire study period, 8,488 parents completed use of the CDS: 9.3% (n = 786) reported smoking and 48.2% (n = 379) accepted at least one treatment. A total of 102 parents who smoke who used the system were approached to survey 100 parents (98% response rate). Most parents self-identified as female (84%), aged 25 to 34 years (56%), and Black/African American (94%), and had children with Medicaid insurance (95%). Of parents surveyed, 54% accepted at least one treatment option. Most parents recalled the motivational message (79%; 95% CI: 71-87%), and 31% (95% CI: 19-44%) reported that the pediatrician reinforced the motivational message. CONCLUSION A CDS system to support parental tobacco use treatment in pediatric primary care enhanced motivational messaging about smoking cessation and evidence-based treatment initiation.
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Affiliation(s)
- Brian P. Jenssen
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Clinical Futures, PolicyLab, and The Possibilities Project, Children's Hospital of Philadelphia, Pennsilvania, United States
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Shannon Kelleher
- Clinical Futures, PolicyLab, and The Possibilities Project, Children's Hospital of Philadelphia, Pennsilvania, United States
| | - Dean J. Karavite
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Ekaterina Nekrasova
- Clinical Futures, PolicyLab, and The Possibilities Project, Children's Hospital of Philadelphia, Pennsilvania, United States
| | - Jeritt G. Thayer
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Raj Ratwani
- MedStar Health National Center for Human Factors in Healthcare, Washington, District of Columbia, United States
| | - Judy A. Shea
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Emara Nabi-Burza
- Division of General Academic Pediatrics, Tobacco Research and Treatment Center, Massachusetts General Hospital for Children, Boston, Massachusetts, United States
| | - Jeremy E. Drehmer
- Division of General Academic Pediatrics, Tobacco Research and Treatment Center, Massachusetts General Hospital for Children, Boston, Massachusetts, United States
| | - Jonathan P. Winickoff
- Division of General Academic Pediatrics, Tobacco Research and Treatment Center, Massachusetts General Hospital for Children, Boston, Massachusetts, United States
| | - Robert W. Grundmeier
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Robert A. Schnoll
- Department of Psychiatry, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Alexander G. Fiks
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Clinical Futures, PolicyLab, and The Possibilities Project, Children's Hospital of Philadelphia, Pennsilvania, United States
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
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