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Silver AH, Tishberg L, Bhansali P. This Is Our Lane: The Urgent Need to Train Residents to Talk About Firearm Injury Prevention for Children. J Grad Med Educ 2024; 16:119-123. [PMID: 38993310 PMCID: PMC11234307 DOI: 10.4300/jgme-d-23-00689.1] [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: 07/13/2024] Open
Affiliation(s)
- Alyssa H Silver
- At the time of writing, was Associate Professor of Pediatrics, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, The Bronx, New York, USA, and is now Associate Professor of Pediatrics, Department of Pediatrics, J. M. Sanzari Children's Hospital, Hackensack Meridian Children's Health, Hackensack, New Jersey, USA; at the time of writing
| | - Lindsay Tishberg
- was a Resident, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, The Bronx, New York, USA, and is now a Fellow, Pediatric Emergency Medicine, Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA; and
| | - Priti Bhansali
- is Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences and Children's National Hospital, Washington, DC, USA
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2
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Hogan AH, Gadun A, Borrup K, Hunter AA, Campbell BT, Knod JL, Downs J, Rogers SC. Assessing the Effect of Electronic Medical Record Note Template on Firearm Access Screening in High-Risk Children. Hosp Pediatr 2022; 12:e278-e282. [PMID: 35794213 DOI: 10.1542/hpeds.2022-006515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Children who survive a suicide attempt are at greater risk of later dying by suicide. Firearm screening and provision of lethal means restriction counseling may improve the safety of this high-risk cohort. Our objective was to determine firearm screening rates among children hospitalized after suicide attempts. We also assessed the effects of templating firearm screening questions into the psychiatric consultation note. METHODS This retrospective pre- and postintervention study identified children <19 years old admitted after a suicide attempt from January 1, 2016 to March 1, 2020. In mid-2017, the psychiatry consult note incorporated a previously available optional firearm screening tool as an embedded field (intervention). The intervention effect on proportion of children at high risk screened for firearm access was assessed by interrupted time series analysis. RESULTS Of 26 088 total admissions, 357 met inclusion criteria. The majority were teenagers (15 years old, interquartile range 14 to 16), 275 were female (77%), and 167 were White (47%). Overall, 286 (80%) of patients had firearm access screening documentation. Of the 71 (20%) without screening, 21 (30%) were discharged from the hospital; 50 (70%) were transferred to psychiatric facilities. There was no significant difference in screening rates after the intervention (Intervention shift P = .74, slope P = .85). CONCLUSIONS Many children were not screened for firearm access after a suicide attempt requiring hospitalization despite the screening tool integration. Multidisciplinary quality improvement efforts are needed to ensure that this critical risk reduction intervention is implemented for all patients after a suicide attempt.
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Affiliation(s)
| | | | - Kevin Borrup
- Department of Pediatrics.,Injury Prevention Center, Hartford, Connecticut
| | - Amy A Hunter
- Department of Pediatrics.,Department of Public Health Sciences.,Trinity College, Hartford, Connecticut
| | - Brendan T Campbell
- Department of Pediatrics and Surgical Subspecialties, University of Connecticut School of Medicine, Farmington, Connecticut.,Department of Pediatric Surgery
| | - J Leslie Knod
- Department of Pediatrics and Surgical Subspecialties, University of Connecticut School of Medicine, Farmington, Connecticut.,Department of Pediatric Surgery
| | - Jennifer Downs
- Department of Psychiatry, Connecticut Children's Medical Center, Hartford, Connecticut.,Department of Pediatrics.,Institute of Living, Hartford, Connecticut
| | - Steven C Rogers
- Department of Pediatrics.,Division of Emergency Medicine, Connecticut Children's Medical Center, Hartford, Connecticut and
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3
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Silver AH, Curley M, Azzarone G, Dodson N, O'Connor K. A Parent Survey Assessing Association of Exposure to Gun Violence, Beliefs, and Physician Counseling. Hosp Pediatr 2022; 12:e95-e111. [PMID: 35112128 DOI: 10.1542/hpeds.2021-006050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The study objectives are to assess associations between hospitalized children's parental exposure to gun violence (GV) and parental beliefs about guns and gun safety; secondarily, the authors aim to describe parental views on the pediatrician's role in firearm injury prevention (FIP) counseling. METHODS Parents residing with children <20 years old hospitalized at a quaternary care hospital in a large city were eligible. Researchers administered verbal surveys between March 2017 and July 2019. We analyzed data (Wilcoxon rank-sum, χ2, or Fisher's exact tests, as appropriate) to compare the characteristics of those with exposure to GV and those without, and to assess associations of those with and without GV exposure with various beliefs. RESULTS Enrollment included 225 parents or guardians. Although 75.5% agreed pediatricians should talk to parents about safe gun storage, 8.9% reported FIP counseling by their child's doctor. There were no substantial differences in characteristics between those with GV exposure versus those without. The study revealed that 60.0% of participants reported hearing gunshots, and 41.8% had a friend/relative who had been shot; only 29.8% reported neither. There were no differences between groups in gun-related beliefs regardless of exposure. CONCLUSIONS In this population, there was no association between exposure to GV and gun-related beliefs. Most parents are receptive to FIP counseling, yet few have discussed FIP with their pediatrician despite high exposure to GV in this community. Nearly all parents agreed with the use of gunlocks and stricter laws for background checks. Regardless of exposure to GV, parents agreed with safe gun storage and support strengthening gun safety laws.
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Affiliation(s)
- Alyssa H Silver
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Department of Pediatrics, Bronx, New York; and
| | | | - Gabriella Azzarone
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Department of Pediatrics, Bronx, New York; and
| | - Nancy Dodson
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Department of Pediatrics, Bronx, New York; and
| | - Katherine O'Connor
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Department of Pediatrics, Bronx, New York; and
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4
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Roy Paladhi U, Dalve KN, Gurrey SO, Hawes SE, Mills B. Firearm ownership and access to healthcare in the U.S.: A cross-sectional analysis of six states. Prev Med 2021; 153:106830. [PMID: 34624385 DOI: 10.1016/j.ypmed.2021.106830] [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: 04/03/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 11/20/2022]
Abstract
Provider-led firearm storage counseling is a form of firearm suicide prevention intervention. Little research examines whether barriers to healthcare access for at-risk individuals limit this intervention's impact. This study explores the relationship between household firearm presence/storage practices and healthcare access/utilization using a cross-sectional analysis of the 2017 Behavioral Risk Factor Surveillance System (BRFSS), which included state-representative data from six states that completed the Firearm Safety and Healthcare Access Modules: California, Idaho, Kansas, Oregon, Texas, and Utah. Exposures were household firearm presence and firearm storage practices. Outcomes were lacking health insurance, not having a healthcare provider, inability to afford care, and no recent routine checkup. Logistic regression models adjusted for age, sex, education, employment, children in the household, and state of residency. Our analysis included 31,888 individuals; 31.1% reported a household firearm. Compared to those in firearm-owning households, those in non-firearm-owning households had higher odds of being uninsured (aOR 1.99, 95%CI 1.60-2.48), not having a provider (aOR 1.40, 95%CI 1.18-1.67), and reporting cost as a barrier to care (aOR 1.37, 95%CI 1.13-1.67). Among firearm-owning households, those with firearms stored loaded and unlocked had higher odds of lacking a personal healthcare provider (aOR 1.52, 95%CI 1.07-2.15) compared to individuals in homes where firearms were stored unloaded. Results indicate that while individuals in firearm-owning households are more likely than non-firearm owning households to have healthcare access, those in homes with the riskiest firearm storage practices had less access. Provider-led counseling may have limited reach for individuals in homes with risky firearm storage practices.
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Affiliation(s)
- Unmesha Roy Paladhi
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA; Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Kimberly N Dalve
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA; Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
| | - Sixtine O Gurrey
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA; Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
| | - Stephen E Hawes
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Brianna Mills
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA; Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
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Behrens DM, Hoops KEM. This Is Our Lane: The Role of Pediatric Intensivists in Firearm Violence and Injury Prevention. Pediatr Crit Care Med 2021; 22:1000-1002. [PMID: 34734895 DOI: 10.1097/pcc.0000000000002797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Deanna M Behrens
- Department of Pediatric Critical Care Medicine, Advocate Children's Hospital, Park Ridge, IL
| | - Katherine E M Hoops
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Winthrop ZA, Michelson CD, Nash KA. Training the Next Generation of Pediatrician-Advocates: A New Focus on the Inpatient Setting. Hosp Pediatr 2021; 11:e266-e269. [PMID: 34493588 DOI: 10.1542/hpeds.2021-005983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Zachary A Winthrop
- The Boston Combined Residency Program, Boston Children's Hospital and Boston Medical Center, Boston, Massachusetts
| | - Catherine D Michelson
- Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts.,Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Katherine A Nash
- National Clinician Scholars Program.,Department of Pediatrics, School of Medicine, Yale University, New Haven, Connecticut
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Lachman P, Batalden P, Vanhaecht K. A multidimensional quality model: an opportunity for patients, their kin, healthcare providers and professionals to coproduce health. F1000Res 2020; 9:1140. [PMID: 34158927 PMCID: PMC8191516 DOI: 10.12688/f1000research.26368.3] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 12/17/2022] Open
Abstract
Background: It is twenty years since the US Institute of Medicine (IOM) defined quality in healthcare, as comprising six domains: person-centredness, timeliness, efficiency, effectiveness, safety and equity. Since then, a new quality movement has emerged, with the development of numerous interventions aimed at improving quality, with a focus on accessibility, safety and effectiveness of care. Further gains in equity and timeliness have proven even more challenging. The challenge: With the emergence of "service-oriented" systems, complexity science, the challenges of climate change, the growth of social media and the internet and the new reality of COVID-19, the original domains proposed by the IOM invite reflection on their relevance and possibility for improvement. The possible solution: In this paper, we propose a revised model of quality that is built on never-ending learning and includes new domains, such as Ecology and Transparency, which reflect the changing worldview of healthcare. We also introduce the concept of person- or "kin-centred care" to emphasise the shared humanity of people involved in the interdependent work. The change of Person Centred Care to Kin Centred Care introduces a broader concept of the person and ensures that Person Centred Care is included in every domain of quality rather than as a separate domain. The concentration on the technological aspects of quality is an example of the problem in the past. This is a more expansive view of what "person-centredness" began. The delivery of health and healthcare requires people working in differing roles, with explicit attention to the lived realities of the people in the roles of professional and patient. The new model will provide a construct that may make the attainment of equity in healthcare more possible with a focus on kindness for all.
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Affiliation(s)
- Peter Lachman
- Royal College of Physicians Ireland (RCPI), Dublin, Ireland
| | - Paul Batalden
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Kris Vanhaecht
- KU Leuven Institute for Healthcare Policy, KU Leuven, Leuven, 3000, Belgium
- Department of Quality, University Hospitals Leuven, Leuven, 3000, Belgium
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Lachman P, Batalden P, Vanhaecht K. A multidimensional quality model: an opportunity for patients, their kin, healthcare providers and professionals to coproduce health. F1000Res 2020; 9:1140. [PMID: 34158927 PMCID: PMC8191516 DOI: 10.12688/f1000research.26368.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 09/21/2023] Open
Abstract
Background: It is twenty years since the US Institute of Medicine (IOM) defined quality in healthcare, as comprising six domains: person-centredness, timeliness, efficiency, effectiveness, safety and equity. Since then, a new quality movement has emerged, with the development of numerous interventions aimed at improving quality, with a focus on accessibility, safety and effectiveness of care. Further gains in equity and timeliness have proven even more challenging. The challenge: With the emergence of "service-oriented" systems, complexity science, the challenges of climate change, the growth of social media and the internet and the new reality of COVID-19, the original domains proposed by the IOM invite reflection on their relevance and possibility for improvement. The possible solution: In this paper we propose a revised model of quality that is built on never-ending learning and includes new domains, such as Ecology and Transparency, which reflect the changing worldview of healthcare. We also introduce the concept of person- or "kin-centred care" to emphasise the shared humanity of people involved in the interdependent work. This is a more expansive view of what "person-centredness" began. The delivery of health and healthcare requires people working in differing roles, with explicit attention to the lived realities of the people in the roles of professional and patient. The new model will provide a construct that may make the attainment of equity in healthcare more possible with a focus on kindness for all.
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Affiliation(s)
- Peter Lachman
- Royal College of Physicians Ireland (RCPI), Dublin, Ireland
| | - Paul Batalden
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Kris Vanhaecht
- KU Leuven Institute for Healthcare Policy, KU Leuven, Leuven, 3000, Belgium
- Department of Quality, University Hospitals Leuven, Leuven, 3000, Belgium
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Lachman P, Batalden P, Vanhaecht K. A multidimensional quality model: an opportunity for patients, their kin, healthcare providers and professionals in the new COVID-19 period. F1000Res 2020; 9:1140. [PMID: 34158927 PMCID: PMC8191516 DOI: 10.12688/f1000research.26368.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 12/30/2022] Open
Abstract
Background: It is twenty years since the Institute of Medicine (IOM) defined quality in healthcare, as comprising six domains: person-centredness, timeliness, efficiency, effectiveness, safety and equity. Since then, a new quality movement has emerged, with the development of numerous interventions aimed at improving quality, with a focus on accessibility, safety and effectiveness of care. Further gains in equity and timeliness have proven even more challenging. The challenge: With the emergence of "service-oriented" systems, complexity science, the challenges of climate change, the growth of social media and the internet and the new reality of COVID-19, the original domains proposed by the IOM invite reflection on their relevance and possibility for improvement. The possible solution: In this paper we propose a revised model of quality that is built on never-ending learning and includes new domains, such as Ecology and Transparency, which reflect the changing worldview of healthcare. We also introduce the concept of person- or "kin-centred care" to emphasise the shared humanity of people involved in the interdependent work. This is a more expansive view of what "person-centredness" began. The delivery of health and healthcare requires people working in differing roles, with explicit attention to the lived realities of the people in the roles of professional and patient. The new model will provide a construct that may make the attainment of equity in healthcare more possible with a focus on kindness for all.
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Affiliation(s)
- Peter Lachman
- Royal College of Physicians Ireland (RCPI), Dublin, Ireland
| | - Paul Batalden
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Kris Vanhaecht
- KU Leuven Institute for Healthcare Policy, KU Leuven, Leuven, 3000, Belgium
- Department of Quality, University Hospitals Leuven, Leuven, 3000, Belgium
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