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Mangum CD. Journey to STEEEP healthcare: A focus on systems through a patient's experience. Curr Probl Pediatr Adolesc Health Care 2023; 53:101461. [PMID: 37996313 DOI: 10.1016/j.cppeds.2023.101461] [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: 11/25/2023]
Abstract
Healthcare systems continue to struggle with providing safe, timely, effective, efficient, equitable and patient-centered (STEEEP) care. Upon audit by clinicians, treatment processes such as those completed following clinical pathways appear to manage care safely. However, when reviewing the treatment process through the patient and/or their family's lens, the experience is quite different. This article will use a vignette detailing care provided in a primary care physician's office along with the patient's outpatient testing experience to reveal opportunities for improvement, a glimpse into the patient's experience and share methods for achieving STEEEP healthcare.
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Affiliation(s)
- Christopher D Mangum
- Quality and Safety Department, Children's Hospital of The King's Daughters, Norfolk, VA, USA.
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Alang S, Pando C, McClain M, Batts H, Letcher A, Hager J, Person T, Shaw A, Blake K, Matthews-Alvarado K. Survey of the Health of Urban Residents: a Community-Driven Assessment of Conditions Salient to the Health of Historically Excluded Populations in the USA. J Racial Ethn Health Disparities 2021; 8:953-972. [PMID: 32839897 PMCID: PMC7444865 DOI: 10.1007/s40615-020-00852-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND Data from the Survey of the Health of Urban Residents (SHUR) identified connections between police brutality and medical mistrust, generating significant media, policy, and research attention. Amidst intersecting crises of COVID-19, racism, and police brutality, this report describes survey development and data collection procedures for the SHUR. BASIC PROCEDURES We conducted focus groups with Black men, Latinxs, and immigrants in Allentown, Pennsylvania. Findings were used to develop and refine measures of conditions salient to the health of urban residents across the country. Quota sampling was employed; oversampling people of color and persons whose usual source of care was not a doctor's office. MAIN FINDINGS Non-Hispanic Whites made up just under two thirds of the sample (63.65%, n = 2793). Black/African American respondents accounted for 14.2% of the sample (n = 623), while 11.62% (n = 510) were Latinx. Only 43.46% of respondents reported a doctor's office as their usual source of care. Novel measures of population-specific stressors include a range of negative encounters with the police, frequency of these encounters, and respondents' assessments of whether the encounters were necessary. SHUR assessed the likelihood of calling the police if there is a problem, worries about incarceration, and cause-specific stressors such as race-related impression management. PRINCIPAL CONCLUSIONS SHUR (n = 4389) is a useful resource for researchers seeking to address the health implications of experiences not frequently measured by national health surveillance surveys. It includes respondents' zip codes, presenting the opportunity to connect these data with zip code-level health system, social and economic characteristics that shape health beyond individual factors.
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Affiliation(s)
- Sirry Alang
- Department of Sociology and Program in Health Medicine and Society, Lehigh University, 31 Williams Drive #280, Bethlehem, PA, USA.
| | - Cynthia Pando
- Department of Sociology and Program in Health Medicine and Society, Lehigh University, 31 Williams Drive #280, Bethlehem, PA, USA
- University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Malcolm McClain
- Department of Sociology and Program in Health Medicine and Society, Lehigh University, 31 Williams Drive #280, Bethlehem, PA, USA
- Greater Newark Conservancy, Newark, NJ, USA
| | - Hasshan Batts
- Department of Sociology and Program in Health Medicine and Society, Lehigh University, 31 Williams Drive #280, Bethlehem, PA, USA
- Promise Neighborhoods of the Lehigh Valley, Allentown, PA, USA
| | - Abby Letcher
- Lehigh Valley Health Network, Allentown, PA, USA
- Neighborhood Health Centers of the Lehigh Valley, Allentown, PA, USA
| | - Janelle Hager
- Neighborhood Health Centers of the Lehigh Valley, Allentown, PA, USA
| | - Taylor Person
- Promise Neighborhoods of the Lehigh Valley, Allentown, PA, USA
| | - Adama Shaw
- Department of Sociology and Program in Health Medicine and Society, Lehigh University, 31 Williams Drive #280, Bethlehem, PA, USA
- Digestive Care, Inc., Bethlehem, PA, USA
| | - Kwamaine Blake
- Promise Neighborhoods of the Lehigh Valley, Allentown, PA, USA
| | - Kevelis Matthews-Alvarado
- Department of Sociology and Program in Health Medicine and Society, Lehigh University, 31 Williams Drive #280, Bethlehem, PA, USA
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Chiam M, Rojas E, Bergey MR, Mackie TI. The Effect of Medical Home on Shared Decision-Making for Caregivers of Children with Emotional, Developmental, or Behavioral Health Conditions. Matern Child Health J 2021; 25:1285-1295. [PMID: 33942231 DOI: 10.1007/s10995-021-03148-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Known as the "pinnacle of patient-centered care," shared decision-making (SDM) is the process that enables and encourages the health care provider, the patient, and/or their caregiver (parent or guardian) to participate collaboratively in medical decisions. Prior research indicates that children with emotional, developmental, or behavioral health conditions (EDB) are less likely to attain SDM than children with other special health care needs (SHCNs). This study investigates whether the presence of a medical home reduces disparities in SDM among children with EDB when compared to children with other SHCNs and the general pediatric population. METHODS Using the 2016 National Survey of Children's Health, we conducted weighted descriptive statistics to investigate the prevalence of medical home and SDM for children with (1) EDB, (2) other SHCNs, and (3) no SHCNs. We then employed a nested multivariate logistic regression model to examine whether the presence of a medical home reduced the disparity between children with EDB and their counterparts. RESULTS Nationally, 21% of children with EDB (n = 647,274), 14.0% of children with other SHCNs (n = 1,086,068), and 13% of children with no SHCNs (n = 883,969) did not attain caregiver-reported SDM in medical care. In each of the health condition groups, the presence of a medical home significantly improved the odds of SDM (p < 0.001). Presence of a medical home also reduced the disparities observed in caregiver-reported SDM among children with EDB as compared to those with other SHCNs and no SHCNs. DISCUSSION Ongoing investment in medical homes may reduce disparities in SDM experienced by children with EDB.
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Affiliation(s)
| | - Erick Rojas
- Institute for Health, Health Care Policy and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St, New Brunswick, NJ, 08901, USA
| | - Meredith R Bergey
- Department of Sociology and Criminology, Villanova University, 800 Lancaster Ave., Villanova, PA, 19085, USA
| | - Thomas I Mackie
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, 683 Hoes Lane, Piscataway, NJ, 08854, USA.
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Lindsey MA, Romanelli M, Ellis ML, Barker ED, Boxmeyer CL, Lochman JE. The Influence of Treatment Engagement on Positive Outcomes in the Context of a School-Based Intervention for Students with Externalizing Behavior Problems. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:1437-1454. [PMID: 30848415 DOI: 10.1007/s10802-019-00525-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We examined the stability of and cross-influences between externalizing behaviors and intervention engagement among children participating in a randomized clinical trial of an intervention for disruptive behavioral youth. Analyses also accounted for the influence of caregiver depression, family relationship quality, and sociodemographic factors (race, income) on the relationship between behaviors and intervention engagement. Analyses were based on 118 children participating in the Coping Power intervention. Composite variables were created to represent externalizing behaviors and intervention engagement constructs. Associations between these composite variables were examined over 24 treatment sessions. Findings indicated a regressive relationship among externalizing behaviors, i.e., baseline externalizing behaviors were positively associated with immediate follow-up behaviors. There were also dynamic relationships observed among engagement constructs. Notably, engagement with in-session activities during sessions 1-8 was positively associated with out-of-session activity engagement during the same treatment time period. Engagement with out-of-session activities during sessions 1-8 was positively associated with in-session activity engagement during sessions 9-16, indicating a complete mediation between early and middle in-session engagement through the mechanism of early out-of-session engagement. A crosslag relationship was observed: middle in-session engagement was negatively associated with externalizing behaviors at immediate follow-up. Finally, an interaction of race by income on immediate follow-up externalizing behaviors was observed, such that Black children's externalizing behaviors remain static regardless of income level while White children's behaviors decreased with higher income. Our findings support the contention that focusing on intervention engagement may be especially important in prevention interventions.
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Affiliation(s)
- Michael A Lindsey
- McSilver Institute for Poverty Policy and Research, Silver School of Social Work, New York University, New York, NY, USA.
| | - Meghan Romanelli
- McSilver Institute for Poverty Policy and Research, Silver School of Social Work, New York University, New York, NY, USA
| | - Mesha L Ellis
- Ellis Evaluation & Consulting Services, Atlanta, GA, USA
| | - Edward D Barker
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Caroline L Boxmeyer
- Department of Psychiatry and Behavioral Medicine, The University of Alabama, Tuscaloosa, AL, USA
| | - John E Lochman
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
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Brent DA, Porta G, Rozenman MS, Gonzalez A, Schwartz KTG, Lynch FL, Dickerson JF, Iyengar S, Weersing VR. Brief Behavioral Therapy for Pediatric Anxiety and Depression in Primary Care: A Follow-up. J Am Acad Child Adolesc Psychiatry 2020; 59:856-867. [PMID: 31278996 PMCID: PMC6940557 DOI: 10.1016/j.jaac.2019.06.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 06/12/2019] [Accepted: 06/28/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To report on the 32-week outcome of the Brief Behavioral Therapy (BBT) for Pediatric Anxiety and Depression in Primary Care clinical trial. METHOD A total of 185 youths aged 8 to 17 years with anxiety and/or depression identified through 9 pediatric primary care (PPC) settings in San Diego and Pittsburgh were randomized to receive Assisted Referral to Care (ARC) or up to 12 sessions of BBT over 16 weeks. The primary outcome was clinical response across anxiety and depression, defined as a Clinical Global Impressions-Improvement Score of ≤2. Secondary outcomes included interview-rated functioning, depression, and anxiety. Here, we report on outcomes at 32 weeks after randomization. All analyses with primary outcomes are corrected for multiple comparisons using the false discovery rate procedure. RESULTS At 32 weeks, BBT was superior to ARC with respect to response (67.5% versus 43.1%, q = 0.03, number needed to treat [NNT] = 5) and functioning (d = 0.49, q = 0.04). BBT was superior to ARC with respect to its impact on anxiety (f = 0.21) but not depressive symptoms (f = 0.05). These findings persisted after controlling for the number of sessions received. Ethnicity moderated the impact of BBT on outcome (NNT for Hispanic youths = 2), because of a much lower response rate to ARC in Hispanic than in non-Hispanic youths (16.7% versus 49.2%, p = 0.04). CONCLUSION BBT is a promising intervention that can be effectively delivered in PPC and may be particularly effective for Hispanic patients. Further work is indicated to improve its impact on depressive symptoms and to test BBT against other treatments delivered in pediatric primary care. CLINICAL TRIAL REGISTRATION INFORMATION Brief Cognitive Behavioral Therapy (CBT) for Pediatric Anxiety and Depression in Primary Care; http://clinicaltrials.gov; NCT01147614.
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Gracy D, Fabian A, Basch CH, Scigliano M, MacLean SA, MacKenzie RK, Redlener IE. Missed opportunities: Do states require screening of children for health conditions that interfere with learning? PLoS One 2018; 13:e0190254. [PMID: 29342147 PMCID: PMC5771574 DOI: 10.1371/journal.pone.0190254] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 12/10/2017] [Indexed: 11/30/2022] Open
Abstract
METHODS Investigators reviewed websites of state departments of health and education, and legislation for all 50 states and DC. For states with mandated screenings and a required form, investigators applied structured analysis to assess HBL inclusion. RESULTS No state mandated that schools require screening for all 7 HBLs. Less than half (49%) required comprehensive school health examinations and only 12 states plus DC required a specific form. Of these, 12 of the forms required documentation of vision screening, 11 of hearing screening, and 12 of dental screening. Ten forms asked about asthma and 9 required documentation of lead testing. Seven asked about general well-being, emotional problems, or mental health. None addressed hunger. When including states without comprehensive school health examination requirements, the most commonly required HBL screenings were for vision (80% of states; includes DC), hearing (75% of states; includes DC) and dental (24% of state; includes DC). CONCLUSION The lack of state mandated requirements for regular student health screening represents a missed opportunity to identify children with HBLs. Without state mandates, accompanying comprehensive forms, and protocols, children continue to be at risk of untreated health conditions that can undermine their success in school.
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Affiliation(s)
- Delaney Gracy
- Children’s Health Fund, New York, NY, United States of America
| | - Anupa Fabian
- Children’s Health Fund, New York, NY, United States of America
| | - Corey Hannah Basch
- Department of Public Health, William Paterson University, New York, NY, United States of America
| | - Maria Scigliano
- Children’s Health Fund, New York, NY, United States of America
| | - Sarah A. MacLean
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | | | - Irwin E. Redlener
- Children’s Health Fund, New York, NY, United States of America
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY, United States of America
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