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Rea CJ, Toomey SL, Hauptman M, Rosen M, Samuels RC, Karpowicz K, Flanagan S, Shah SN. Predictors of Subspecialty Appointment Scheduling and Completion for Patients Referred From a Pediatric Primary Care Clinic. Clin Pediatr (Phila) 2024; 63:512-521. [PMID: 37309813 PMCID: PMC10863332 DOI: 10.1177/00099228231179673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Failure to complete subspecialty referrals decreases access to subspecialty care and may endanger patient safety. We conducted a retrospective analysis of new patient referrals made to the 14 most common referral departments at Boston Children's Hospital from January 1 to December 31, 2017. The sample included 2031 patient referrals. The mean wait time between referral and appointment date was 39.6 days. In all, 87% of referrals were scheduled and 84% of scheduled appointments attended, thus 73% of the original referrals were completed. In multivariate analysis, younger age, medical complexity, being a non-English speaker, and referral to a surgical subspecialty were associated with a higher likelihood of referral completion. Black and Hispanic/Latino race/ethnicity, living in a Census tract with Social Vulnerability Index (SVI) ≥ 90th percentile, and longer wait times were associated with a lower likelihood of appointment attendance. Future interventions should consider both health care system factors such as appointment wait times and community-level barriers to referral completion.
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Affiliation(s)
- Corinna J. Rea
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sara L. Toomey
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Marissa Hauptman
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Melissa Rosen
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
| | - Ronald C. Samuels
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of General Pediatrics, The Children’s Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kristin Karpowicz
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
| | - Shelby Flanagan
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
| | - Snehal N. Shah
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Goenka A, Fonseca LD, Kumar G. Demographic and geographic variations in the access time of pediatric patients presenting with staring spells. Epilepsy Behav 2023; 145:109299. [PMID: 37336135 DOI: 10.1016/j.yebeh.2023.109299] [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: 03/29/2023] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE To assess the demographic and geographic variations in access time - defined as years between the date of symptom onset and initial date of neurological care - in pediatric patients presenting with staring spells. MATERIALS AND METHODS We conducted a secondary analysis of a retrospective chart review study from 2011 to 2021. A total of 1,353 staring spell patients, aged 0 to 17.9 years, were analyzed for age, sex, race/ethnicity, insurance, county, average county annual per capita personal income, and access time. RESULTS Patients aged 0-2.9 years had the shortest median access time of 0.3 years, compared to 1.2 years in patients aged 3-12.9 years and 1.0 year in patients aged 13-17.9 years. Statistically significant differences were seen based on race/ethnicity and insurance with White patients having shorter access time of 0.5 years compared to Black patients with 1.0 year and self-pay patients having the shortest access time of 0.4 years compared to patients with private insurance (0.7 years). Warren County had the largest annual per capita personal income of $65,855 and access time of 0.5 years compared to Preble county with the least annual per capita personal income of $45,016 and access time of 1.1 years. CONCLUSION Demographic parameters of age, race/ethnicity, insurance, and annual county per capita personal income appeared to be associated with access time to initial neurological care in patients with staring spells. These associations need to be investigated further to ensure timely access to neurological care and to ensure equity in health care.
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Affiliation(s)
- Ajay Goenka
- Department of Neurology, Dayton Children's Hospital, Dayton, OH, USA; Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.
| | - Laura D Fonseca
- Department of Neurology, Dayton Children's Hospital, Dayton, OH, USA.
| | - Gogi Kumar
- Department of Neurology, Dayton Children's Hospital, Dayton, OH, USA; Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.
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Platt JM, Nettel-Aguirre A, Bjornson CL, Mitchell I, Davis K, Bailey JM. Multidisciplinary coordination of care for children with esophageal atresia and tracheoesophageal fistula. J Child Health Care 2023:13674935231174503. [PMID: 37224564 DOI: 10.1177/13674935231174503] [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] [Indexed: 05/26/2023]
Abstract
Esophageal Atresia/Tracheoesophageal Atresia (EA/TEF) is a multisystem congenital anomaly. Historically, children with EA/TEF lack coordinated care. A multidisciplinary clinic was established in 2005 to provide coordinated care and improve access to outpatient care. This single-center retrospective cohort study was conducted to describe our cohort of patients with EA/TEF born between March 2005 and March 2011, assess coordination of care, and to compare outcomes of children in the multidisciplinary clinic to the previous cohort without a multi-disciplinary clinic. A chart review identified demographics, hospitalizations, emergency visits, clinic visits, and coordination of outpatient care. Twenty-seven patients were included; 75.9% had a C-type EA/TEF. Clinics provided multidisciplinary care and compliance with the visit schedule was high with a median of 100% (IQR 50). Compared to the earlier cohort, the new cohort (N = 27) had fewer hospital admissions and LOS was reduced significantly in the first 2 years of life. Multidisciplinary care clinics for medically complex children can improve coordination of visits with multiple health care providers and may contribute to reduced use of acute care services.
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Affiliation(s)
- Jody M Platt
- Department of Pediatrics, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alberto Nettel-Aguirre
- Department of Pediatrics, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Candice L Bjornson
- Department of Pediatrics, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Kathryn Davis
- Alberta Children's Hospital, Alberta Health Services, University of Calgary, Calgary, AB, Canada
| | - Ja Michelle Bailey
- Department of Pediatrics, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
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Grefe A, Chen SH, Ip EH, Kirkendall E, Nageswaran S. Audio or Video? Access to Pediatric Neurology Outpatient Services Varies by the Type of Telehealth, Especially for Black Children. J Child Neurol 2023; 38:263-269. [PMID: 37186764 PMCID: PMC10524612 DOI: 10.1177/08830738231172633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Children of minority race/ethnicity face barriers to accessing specialty services. During the COVID pandemic, health insurance companies reimbursed telehealth services. Our objective was to evaluate the effect of audio versus video visits on children's access to outpatient neurology services, particularly for Black children. METHODS Using Electronic Health Record data, we collected information about children who had outpatient neurology appointments in a tertiary care children's hospital in North Carolina from March 10, 2020, to March 9, 2021. We used multivariable models to compare appointment outcomes (canceled vs completed, and missed vs completed) by visit type. We then conducted similar evaluation for the subgroup of Black children. RESULTS A total of 1250 children accounted for 3829 scheduled appointments. Audio users were more likely to be Black and Hispanic, and to have public health insurance than video users. Adjusted odds ratio (aOR) for appointments completed versus canceled was 10 for audio and 6 for video, compared to in-person appointments. Audio visits were twice as likely as in-person visits to be completed versus missed; video visits were not different. For the subgroup of Black children, aOR for appointments completed versus canceled for audio was 9 and video was 5, compared to in-person appointments. For Black children, audio visits were 3 times as likely as in-person visits to be completed versus missed; video visits were not different. CONCLUSIONS Audio visits improved access to pediatric neurology services, especially for Black children. Reversal of policies to reimburse audio visits could deepen the socioeconomic divide for children's access to neurology services.
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Affiliation(s)
- Annette Grefe
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Shyh-Huei Chen
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Edward H. Ip
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Eric Kirkendall
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
- Center for Health Care Innovation, Wake Forest School of Medicine, Winston-Salem, NC
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Findings from the implementation of a novel needs assessment survey in children and youth with epilepsy; The impact of social determinants of health on utilization of medical services. BRAIN DISORDERS 2022. [DOI: 10.1016/j.dscb.2022.100043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Peng J, Patel AD, Burch M, Rossiter S, Parker W, Rust S. Predicting Patient No-Shows in an Academic Pediatric Neurology Clinic. J Child Neurol 2022; 37:582-588. [PMID: 35593069 DOI: 10.1177/08830738221099735] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: No-shows can negatively affect patient care. Efforts to predict high-risk patients are needed. Previously, our epilepsy clinic identified patients with 2 or more no-shows or late cancelations in the past 18 months as being at high risk for no-shows. Our objective was to develop a model to accurately predict the risk of no-shows among patients with epilepsy seen at our neurology clinic. Methods: Using electronic health record data, we developed a least absolute shrinkage and selection operator (LASSO)-regularized logistic regression model to predict no-shows and compared its performance with our neurology clinic's above-mentioned ad hoc rule. Results: The ad hoc rule identified 13% of patients seen at our neurology clinic as high-risk patients for no-shows and resulted in a positive predictive value of 38%. In comparison, our LASSO model resulted in a positive predictive value of 48%. Our LASSO model identified that lack of private insurance, inactive Epic MyChart, greater past no-show rates, fewer appointment changes before the appointment date, and follow-up appointments were more likely to result in no-shows. Conclusions: Our LASSO model outperformed the ad hoc rule used by our neurology clinic in predicting patients at high risk for no-shows. Social workers can use the no-show risk scores generated by our LASSO model to prioritize high-risk patients for targeted intervention to reduce no-shows at our neurology clinic.
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Affiliation(s)
- Jin Peng
- Information Technology Research & Innovation, 2650Nationwide Children's Hospital, Columbus, OH, USA
| | - Anup D Patel
- Division of Neurology, Nationwide Children's Hospital, Columbus, OH, USA.,The Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, OH, USA
| | - Maggie Burch
- Division of Neurology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Samantha Rossiter
- Division of Rheumatology, Nationwide Children's Hospital, Columbus, OH, USA
| | - William Parker
- Division of Neurology, Nationwide Children's Hospital, Columbus, OH, USA.,The Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, OH, USA
| | - Steve Rust
- Information Technology Research & Innovation, 2650Nationwide Children's Hospital, Columbus, OH, USA
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