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Gutierrez-Wu JC, Ritter V, McMahon EL, Heerman WJ, Rothman RL, Perrin EM, Shonna Yin H, Sanders LM, Delamater AM, Flower KB. Language Disparities in Caregiver Satisfaction with Physician Communication at Well Visits from 0-2 Years. Acad Pediatr 2024; 24:930-939. [PMID: 38458488 PMCID: PMC11283991 DOI: 10.1016/j.acap.2024.03.004] [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] [Received: 10/30/2023] [Revised: 02/23/2024] [Accepted: 03/01/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE This study aimed to describe caregiver satisfaction with physician communication over the first two years of life and examine differences by preferred language and the relationship to physician continuity. METHODS Longitudinal data were collected at well visits (2 months to 2 years) from participants in a randomized controlled trial to prevent childhood obesity. Satisfaction with communication was assessed using the validated Communication Assessment Tool (CAT) questionnaire. Changes in the odds of optimal scores were estimated in mixed-effects logistic regression models to evaluate the associations between satisfaction over time and language, interpreter use, and physician continuity. RESULTS Of 865 caregivers, 35% were Spanish-speaking. Spanish-speaking caregivers without interpreters had lower odds of an optimal satisfaction score compared with English speakers during the first 2 years, beginning at 2 months [OR 0.64 (95% CI: 0.43, 0.95)]. There was no significant difference in satisfaction between English-speaking caregivers and Spanish-speaking caregivers with an interpreter. The odds of optimal satisfaction scores increased over time for both language groups. For both language groups, odds of an optimal satisfaction score decreased each time a new physician was seen for a visit [OR 0.82 (95% CI: 0.69, 0.97)]. CONCLUSION Caregiver satisfaction with physician communication improves over the first two years of well-child visits for both English- and Spanish-speakers. A loss of physician continuity over time was also associated with lower satisfaction. Future interventions to ameliorate communication disparities should ensure adequate interpreter use for primarily Spanish-speaking patients and address continuity issues to improve communication satisfaction.
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Affiliation(s)
- Jennifer C Gutierrez-Wu
- Division of General Pediatrics and Adolescent Medicine (JC Gutierrez-Wu, V Ritter, and KB Flower), Department of Pediatrics, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research (JC Gutierrez-Wu), University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Victor Ritter
- Division of General Pediatrics and Adolescent Medicine (JC Gutierrez-Wu, V Ritter, and KB Flower), Department of Pediatrics, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Division of General Pediatrics (V Ritter and LM Sanders), Stanford University School of Medicine, Palo Alto, Calif
| | - Ellen L McMahon
- Division of General Pediatrics (EL McMahon, WJ Heerman, and RL Rothman), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tenn
| | - William J Heerman
- Division of General Pediatrics (EL McMahon, WJ Heerman, and RL Rothman), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tenn
| | - Russell L Rothman
- Division of General Pediatrics (EL McMahon, WJ Heerman, and RL Rothman), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tenn
| | - Eliana M Perrin
- Division of General Pediatrics (EM Perrin), Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md; Johns Hopkins University School of Nursing (EM Perrin), Baltimore, Md; Department of Population, Family, and Reproductive Health (EM Perrin), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - H Shonna Yin
- Departments of Pediatrics and Population Health (H Shonna Yin), New York University School of Medicine, New York City, NY
| | - Lee M Sanders
- Division of General Pediatrics (V Ritter and LM Sanders), Stanford University School of Medicine, Palo Alto, Calif
| | - Alan M Delamater
- Department of Pediatrics (AM Delamater), University of Miami Miller School of Medicine, Miami, Fla
| | - Kori B Flower
- Division of General Pediatrics and Adolescent Medicine (JC Gutierrez-Wu, V Ritter, and KB Flower), Department of Pediatrics, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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Paget SP, Mcintyre S, Schneuer FJ, Martin T, Sellars L, Burnett H, Price S, Nassar N. Outpatient encounters, continuity of care, and unplanned hospital care for children and young people with cerebral palsy. Dev Med Child Neurol 2024; 66:733-743. [PMID: 37946594 DOI: 10.1111/dmcn.15800] [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: 04/23/2023] [Revised: 09/19/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023]
Abstract
AIM To describe the relationships between outpatient encounters, continuity of care, and unplanned hospital care in children/young people with cerebral palsy (CP). METHOD In this population-based data-linkage cohort study we included children/young people with CP identified in the New South Wales/Australian Capital Territory CP Register (birth years 1994-2018). We measured the frequency of outpatient encounters and unplanned hospital care, defined as presentations to emergency departments and/or urgent hospital admissions (2015-2020). Continuity of outpatient care was measured using the Usual Provider of Care Index (UPCI). RESULTS Of 3267 children/young people with CP, most (n = 2738, 83.8%, 57.6% male) had one or more outpatient encounters (123 463 total encounters, median six outpatient encounters per year during childhood). High UPCI was more common in children/young people with mild CP (Gross Motor Function Classification System levels I-III, with no epilepsy or no intellectual disability), residing in metropolitan and areas of least socioeconomic disadvantage. Low UPCI was associated with four or more emergency department presentations (adjusted odds ratio [aOR] 2.34; 95% confidence interval [CI] 1.71-3.19) and one or more urgent hospital admissions (aOR 2.02; 95% CI 1.57-2.61). INTERPRETATION Children/young people with CP require frequent outpatient services. Improving continuity of care, particularly for those residing in regional/remote areas, may decrease need for unplanned hospital care. WHAT THIS PAPER ADDS Many children with cerebral palsy use multiple and frequent outpatient services. Better continuity of care is associated with living in metropolitan and less socioeconomically disadvantaged areas. Outpatient service utilization reduces at the time of transition to adult services. High outpatient utilization is associated with unplanned hospital care. Decreased continuity of care is associated with unplanned hospital care.
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Affiliation(s)
- Simon P Paget
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, The University of Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Sarah Mcintyre
- Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Francisco J Schneuer
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, The University of Sydney, New South Wales, Australia
| | - Tanya Martin
- School of Nursing and Midwifery, The University of Sydney, Sydney, New South Wales, Australia
| | - Louise Sellars
- Agency for Clinical Innovation, NSW Health, Sydney, New South Wales, Australia
| | - Heather Burnett
- HNEkidsHealth, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Sophie Price
- Agency for Clinical Innovation, NSW Health, Sydney, New South Wales, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, The University of Sydney, New South Wales, Australia
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Fortin O. Continuity of care and medical complexity in children and young people with cerebral palsy are distinct interrelated concepts. Dev Med Child Neurol 2024; 66:685-686. [PMID: 37968866 DOI: 10.1111/dmcn.15805] [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: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/17/2023]
Abstract
This commentary is on the original article by Paget et al. on pages 733–743 of this issue.
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Affiliation(s)
- Olivier Fortin
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA
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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:S1876-2859(24)00166-9. [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] [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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Nkoy FL, Stone BL, Zhang Y, Luo G. A Roadmap for Using Causal Inference and Machine Learning to Personalize Asthma Medication Selection. JMIR Med Inform 2024; 12:e56572. [PMID: 38630536 PMCID: PMC11063904 DOI: 10.2196/56572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/12/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
Inhaled corticosteroid (ICS) is a mainstay treatment for controlling asthma and preventing exacerbations in patients with persistent asthma. Many types of ICS drugs are used, either alone or in combination with other controller medications. Despite the widespread use of ICSs, asthma control remains suboptimal in many people with asthma. Suboptimal control leads to recurrent exacerbations, causes frequent ER visits and inpatient stays, and is due to multiple factors. One such factor is the inappropriate ICS choice for the patient. While many interventions targeting other factors exist, less attention is given to inappropriate ICS choice. Asthma is a heterogeneous disease with variable underlying inflammations and biomarkers. Up to 50% of people with asthma exhibit some degree of resistance or insensitivity to certain ICSs due to genetic variations in ICS metabolizing enzymes, leading to variable responses to ICSs. Yet, ICS choice, especially in the primary care setting, is often not tailored to the patient's characteristics. Instead, ICS choice is largely by trial and error and often dictated by insurance reimbursement, organizational prescribing policies, or cost, leading to a one-size-fits-all approach with many patients not achieving optimal control. There is a pressing need for a decision support tool that can predict an effective ICS at the point of care and guide providers to select the ICS that will most likely and quickly ease patient symptoms and improve asthma control. To date, no such tool exists. Predicting which patient will respond well to which ICS is the first step toward developing such a tool. However, no study has predicted ICS response, forming a gap. While the biologic heterogeneity of asthma is vast, few, if any, biomarkers and genotypes can be used to systematically profile all patients with asthma and predict ICS response. As endotyping or genotyping all patients is infeasible, readily available electronic health record data collected during clinical care offer a low-cost, reliable, and more holistic way to profile all patients. In this paper, we point out the need for developing a decision support tool to guide ICS selection and the gap in fulfilling the need. Then we outline an approach to close this gap via creating a machine learning model and applying causal inference to predict a patient's ICS response in the next year based on the patient's characteristics. The model uses electronic health record data to characterize all patients and extract patterns that could mirror endotype or genotype. This paper supplies a roadmap for future research, with the eventual goal of shifting asthma care from one-size-fits-all to personalized care, improve outcomes, and save health care resources.
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Affiliation(s)
- Flory L Nkoy
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Bryan L Stone
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Yue Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
- Division of Biostatistics, Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Gang Luo
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States
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Punjwani Z, Patton M, Alladin-Karan A, Samborn S, Samuel S. Role of primary care in enhancing continuity of care for adolescents and young adults with chronic kidney disease undergoing transition to adult health services. Pediatr Nephrol 2024; 39:1077-1084. [PMID: 37667084 DOI: 10.1007/s00467-023-06140-4] [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: 03/22/2023] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 09/06/2023]
Abstract
The transition from pediatric to adult health care is a vulnerable period for adolescents and young adults (AYA) with chronic conditions as it involves a multitude of changes and challenges while they enter adulthood. The transition to adult care can be particularly challenging for AYA living with chronic kidney disease (CKD) due to the complex care needed for treatment. Continuity of care is crucial for a successful transition to adult health care. The aim of this educational review is to discuss the potential role of primary care providers in the transition from pediatric to adult health services for AYA with CKD and kidney failure treated with dialysis and/or transplant. We address the significance of the medical home model and how it can provide continuity of care for AYA with CKD. Primary care providers can enhance care for AYA with chronic conditions by providing continuity of care, reducing exacerbation of chronic health conditions, providing holistic care, and fostering collaboration with specialists. Despite their vital role, primary care providers face barriers in maintaining this continuity, necessitating further attention and support in this area. By addressing these barriers and encouraging primary care providers to work alongside pediatric and adult nephrologists during the transition to adult health care, there are significant opportunities to improve the care and health outcomes of AYA with CKD.
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Affiliation(s)
- Zoya Punjwani
- Department of Pediatrics, University of Calgary, 28 Oki Drive NW, CalgaryAlberta, AB, T3B 6A8, Canada
| | - Megan Patton
- Department of Pediatrics, University of Calgary, 28 Oki Drive NW, CalgaryAlberta, AB, T3B 6A8, Canada
| | - Areefa Alladin-Karan
- Department of Pediatrics, University of Calgary, 28 Oki Drive NW, CalgaryAlberta, AB, T3B 6A8, Canada
| | - Sophie Samborn
- Department of Pediatrics, University of Calgary, 28 Oki Drive NW, CalgaryAlberta, AB, T3B 6A8, Canada
| | - Susan Samuel
- Department of Pediatrics, University of Calgary, 28 Oki Drive NW, CalgaryAlberta, AB, T3B 6A8, Canada.
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Kaplan C, Kranidis A, Saint-Fleur AL, Christophides A, Kier C. Bridging the Gap from Acute to Chronic Care: Partnerships and Tools for Pediatric Asthma. Pediatr Rev 2023; 44:578-584. [PMID: 37777653 DOI: 10.1542/pir.2022-005599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Affiliation(s)
- Carl Kaplan
- Stony Brook Children's Hospital, Stony Brook, NY
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Hodes T, Marino M, Lucas JA, Bazemore A, Peterson L, Trivedi MK, Giebultowicz S, Heintzman J. Quality of Care for Latinx Children with Asthma: Associations with Language Concordance and Continuity of Care. J Am Board Fam Med 2023; 36:616-625. [PMID: 37321656 PMCID: PMC10578095 DOI: 10.3122/jabfm.2022.220379r1] [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] [Received: 11/04/2022] [Revised: 01/06/2023] [Accepted: 01/17/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Language concordance between Latinx patients and their clinicians has been shown to affect health outcomes. In addition, there is evidence that consistent continuity of care (COC) can improve health care outcomes. The relationship between language concordance and COC and their association with health equity in chronic disease is less clear. Our aim was to study the moderating effect of clinician and patient language concordance on the association between COC and asthma care quality in Latinx children. METHODS We utilized an electronic health record dataset from a multistate network of community health centers to compare influenza vaccinations and inhaled steroid prescriptions, by ethnicity and language concordance groups overall and stratified by COC. RESULTS We analyzed electronic health records for children with asthma (n = 38,442) age 3 to 17 years with ≥2 office visits between 2005 to 2017. Overall, 64% of children had low COC (defined as COC < 0.5) while 21% had high COC (defined as >0.75). All Latinx children had higher rates and odds of receiving influenza vaccination compared with non-Hispanic White children. In addition, Spanish-preferring Latinx children had higher rates and odds of being prescribed inhaled steroids while English-preferring Latinx children had lower odds (OR = 0.85 95%CI = 0.73,0.98) compared with non-Hispanic White children. CONCLUSION Overall, Latinx children regardless of COC category or language concordance were more likely to receive the influenza vaccine. English-preferring Latinx children with persistent asthma received fewer inhaled steroid prescriptions compared with non-Hispanic White children. Panel chart review and seeing a practice partner might be one way to combat these inequities.
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Affiliation(s)
- Tahlia Hodes
- From the Department of Family Medicine, Oregon Health & Science University (THM, MM, JAL, JH); American Board of Family Medicine (AB, LP); Division of Pediatric Pulmonology, Department of Pediatrics, University of Massachusetts Chan Medical School/UMass Memorial Children's Medical Center (MKT); OCHIN, Inc. (SG, JH)
| | - Miguel Marino
- From the Department of Family Medicine, Oregon Health & Science University (THM, MM, JAL, JH); American Board of Family Medicine (AB, LP); Division of Pediatric Pulmonology, Department of Pediatrics, University of Massachusetts Chan Medical School/UMass Memorial Children's Medical Center (MKT); OCHIN, Inc. (SG, JH)
| | - Jennifer A Lucas
- From the Department of Family Medicine, Oregon Health & Science University (THM, MM, JAL, JH); American Board of Family Medicine (AB, LP); Division of Pediatric Pulmonology, Department of Pediatrics, University of Massachusetts Chan Medical School/UMass Memorial Children's Medical Center (MKT); OCHIN, Inc. (SG, JH)
| | - Andrew Bazemore
- From the Department of Family Medicine, Oregon Health & Science University (THM, MM, JAL, JH); American Board of Family Medicine (AB, LP); Division of Pediatric Pulmonology, Department of Pediatrics, University of Massachusetts Chan Medical School/UMass Memorial Children's Medical Center (MKT); OCHIN, Inc. (SG, JH)
| | - Lars Peterson
- From the Department of Family Medicine, Oregon Health & Science University (THM, MM, JAL, JH); American Board of Family Medicine (AB, LP); Division of Pediatric Pulmonology, Department of Pediatrics, University of Massachusetts Chan Medical School/UMass Memorial Children's Medical Center (MKT); OCHIN, Inc. (SG, JH)
| | - Michelle K Trivedi
- From the Department of Family Medicine, Oregon Health & Science University (THM, MM, JAL, JH); American Board of Family Medicine (AB, LP); Division of Pediatric Pulmonology, Department of Pediatrics, University of Massachusetts Chan Medical School/UMass Memorial Children's Medical Center (MKT); OCHIN, Inc. (SG, JH)
| | - Sophia Giebultowicz
- From the Department of Family Medicine, Oregon Health & Science University (THM, MM, JAL, JH); American Board of Family Medicine (AB, LP); Division of Pediatric Pulmonology, Department of Pediatrics, University of Massachusetts Chan Medical School/UMass Memorial Children's Medical Center (MKT); OCHIN, Inc. (SG, JH)
| | - John Heintzman
- From the Department of Family Medicine, Oregon Health & Science University (THM, MM, JAL, JH); American Board of Family Medicine (AB, LP); Division of Pediatric Pulmonology, Department of Pediatrics, University of Massachusetts Chan Medical School/UMass Memorial Children's Medical Center (MKT); OCHIN, Inc. (SG, JH)
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9
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Davis E, Fagnano M, Halterman JS, Frey SM. Utilization of the emergency department as a routine source of care among children with asthma. J Asthma 2023; 60:1377-1385. [PMID: 36399630 PMCID: PMC10192056 DOI: 10.1080/02770903.2022.2149409] [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: 07/20/2022] [Revised: 10/28/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Abstract
Objective: To describe characteristics of children with persistent asthma in the ED who receive most of their healthcare in emergency settings; and determine whether recent asthma experiences or historic patterns of care are associated with identifying the ED as a typical location for care.Methods: We conducted a sub-analysis of baseline data from Telemedicine Enhanced Asthma Management through the Emergency Department (TEAM-ED), an RCT of children (3-12 years) presenting to the ED with persistent asthma (2016-2020). Caregivers identified reasons for seeking emergency care, including if their child received most overall healthcare in the ED ('ED Care'; primary outcome) or not ('Other Care'). Independent variables included demographics, recent symptoms and quality of life (QOL), and historic preventive care and healthcare use. We compared responses between ED Care and Other Care groups using bivariate and multivariate analyses.Results: We analyzed data for 355 children (31% ED Care, 69% Other Care). Compared with Other Care, ED Care respondents were more likely to identify the ED as the closest source of healthcare; report fewer symptom nights but a poorer quality of life; and describe the ED as a usual place for sick care, despite most having a PCP.Conclusions: Many children with asthma use the ED as a typical source of healthcare, and are distinguished by need for proximity, poorer caregiver QOL, and historic patterns of care-seeking. Efforts to improve timely access to outpatient care and reinforce the role of PCP-directed asthma management, such as through telemedicine, may reduce preventable morbidity including ED visits.
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Affiliation(s)
- Erin Davis
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Maria Fagnano
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Jill S. Halterman
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Sean M. Frey
- University of Rochester School of Medicine and Dentistry, Rochester, NY
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10
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Chen KY, Jones R, Lei S, Shanthikumar S, Sanci L, Carlin J, Hiscock H. Primary health care utilization and hospital readmission in children with asthma: a multi-site linked data cohort study. J Asthma 2023:1-8. [PMID: 36594684 DOI: 10.1080/02770903.2022.2164200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To (1) describe primary health care utilization and (2) estimate the effect of primary care early follow-up, continuity, regularity, frequency, and long consultations on asthma hospital readmission, including secondary outcomes of emergency (ED) presentations, asthma preventer adherence, and use of rescue oral corticosteroids within 12 months. METHODS An Australian multi-site cohort study of 767 children aged 3-18 years admitted with asthma between 2017 and 2018, followed up for at least 12 months with outcome and primary care exposure data obtained through linked administrative datasets. We estimated the effect of primary care utilization through a modified Poisson regression adjusting for child age, asthma severity, socioeconomic status and self-reported GP characteristics. RESULTS The median number of general practitioner (GP) consultations, unique GPs and clinics visited was 9, 5, and 4, respectively. GP care was irregular and lacked continuity, only 152 (19.8%) children visited their usual GP on more than 60% of occasions. After adjusting for confounders, there was overall weak indication of effects due to any of the exposures. Increased frequency of GP visits was associated with reduced readmissions (4-14 visits associated with risk ratio of 0.71, 95% CI 0.50-1.00, p = 0.05) and ED presentations (>14 visits associated risk ratio 0.62, 95% CI 0.42-0.91, p = 0.02). CONCLUSIONS Our study demonstrates that primary care use by children with asthma is often irregular and lacking in continuity. This highlights the importance of improving accessibility, consistency in care, and streamlining discharge communication from acute health services.
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Affiliation(s)
- Katherine Yh Chen
- Health Services Group, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of General Medicine, The Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Renee Jones
- Health Services Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Shaoke Lei
- Health Services Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Shivanthan Shanthikumar
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Department of Respiratory and Sleep Medicine, The Royal Children's Hospital, Parkville, VIC, Australia.,Respiratory Diseases Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Lena Sanci
- Department of General Practice, The University of Melbourne, Parkville, VIC, Australia
| | - John Carlin
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute and The University of Melbourne, Parkville, VIC, Australia
| | - Harriet Hiscock
- Health Services Group, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Centre for Community and Child Health, The Royal Children's Hospital, Parkville, VIC, Australia
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Juhn YJ, Ryu E, Wi CI, King KS, Malik M, Romero-Brufau S, Weng C, Sohn S, Sharp RR, Halamka JD. Assessing socioeconomic bias in machine learning algorithms in health care: a case study of the HOUSES index. J Am Med Inform Assoc 2022; 29:1142-1151. [PMID: 35396996 PMCID: PMC9196683 DOI: 10.1093/jamia/ocac052] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 03/24/2022] [Accepted: 04/05/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Artificial intelligence (AI) models may propagate harmful biases in performance and hence negatively affect the underserved. We aimed to assess the degree to which data quality of electronic health records (EHRs) affected by inequities related to low socioeconomic status (SES), results in differential performance of AI models across SES. MATERIALS AND METHODS This study utilized existing machine learning models for predicting asthma exacerbation in children with asthma. We compared balanced error rate (BER) against different SES levels measured by HOUsing-based SocioEconomic Status measure (HOUSES) index. As a possible mechanism for differential performance, we also compared incompleteness of EHR information relevant to asthma care by SES. RESULTS Asthmatic children with lower SES had larger BER than those with higher SES (eg, ratio = 1.35 for HOUSES Q1 vs Q2-Q4) and had a higher proportion of missing information relevant to asthma care (eg, 41% vs 24% for missing asthma severity and 12% vs 9.8% for undiagnosed asthma despite meeting asthma criteria). DISCUSSION Our study suggests that lower SES is associated with worse predictive model performance. It also highlights the potential role of incomplete EHR data in this differential performance and suggests a way to mitigate this bias. CONCLUSION The HOUSES index allows AI researchers to assess bias in predictive model performance by SES. Although our case study was based on a small sample size and a single-site study, the study results highlight a potential strategy for identifying bias by using an innovative SES measure.
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Affiliation(s)
- Young J Juhn
- Precision Population Science Lab, Mayo Clinic, Rochester, Minnesota, USA
- Artificial Intelligence Program of Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Euijung Ryu
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Chung-Il Wi
- Precision Population Science Lab, Mayo Clinic, Rochester, Minnesota, USA
- Artificial Intelligence Program of Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Katherine S King
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Momin Malik
- Center for Digital Health, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Sunghwan Sohn
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard R Sharp
- Biomedical Ethics Program, Mayo Clinic, Rochester, Minnesota, USA
| | - John D Halamka
- Center for Digital Health, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Platform, Rochester, Minnesota, USA
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