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Horan MR, Latendresse SJ, Limbers CA. Mental Health in Mothers of Autistic Children with a Medical Home: The Potentially Mechanistic Roles of Coping and Social Support. J Autism Dev Disord 2024; 54:2682-2692. [PMID: 37142909 DOI: 10.1007/s10803-023-05997-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/06/2023]
Abstract
Mothers of autistic children often report poor mental health outcomes. One established risk factor for these outcomes is the child having a medical home. This study examined possible mediating variables (coping, social support) in this relationship in 988 mothers of autistic children from the 2017/2018 National Survey of Children's Health (NSCH). The results of the multiple mediation model suggest the relationship between having a medical home and maternal mental health is largely explained by indirect associations with coping and social support. These findings suggest that clinical interventions for coping and social support provided by the medical home for mothers of autistic children may improve maternal mental health outcomes over and above implementation of a medical home.
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Affiliation(s)
- Madeline R Horan
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS735, 38105, Memphis, TN, USA.
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2
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Mahmood A, Kedia S, Arshad H, Mou X, Dillon PJ. Disparities in Access to Mental Health Services Among Children Diagnosed with Anxiety and Depression in the United States. Community Ment Health J 2024:10.1007/s10597-024-01305-3. [PMID: 38907843 DOI: 10.1007/s10597-024-01305-3] [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: 11/02/2023] [Accepted: 05/24/2024] [Indexed: 06/24/2024]
Abstract
Child and adolescent mental health are major public health concerns in the US. Overall, 20% of US children have a reported mental health condition, while an estimated 40% will be diagnosed with one by age 18. Despite these concerns, little is known about factors associated with access to mental health services among children and adolescents. We analyzed data from a sample of 6655 children (aged 6 to 17 years) with either anxiety and/or depression drawn from the 2020-2021 National Survey of Children's Health (NSCH). A multivariable logistic regression model was fit to investigate predisposing, enabling, and need factors associated with caregiver's (i.e., parent or other guardian) perceived access to mental health services for their children. Approximately 50.8% of caregivers perceived obtaining mental health services for their children to be somewhat difficult, very difficult, or impossible. Children meeting criteria for having a medical home had lower odds of experiencing such difficulties (adjusted [a]OR = 0.38; 95% CI: 0.30-0.49). Further, compared to children who sometimes or never had health insurance coverage for mental or behavioral health needs, children who were always insured (aOR: 0.19; 95% CI 0.14, 0.25) and those who usually had coverage (aOR: 0.38; 95% CI 0.28, 0.51) had lower odds of experiencing perceived difficulties in obtaining care. The results indicate several enabling and need predictors of perceived access to mental health services--highlighting potential structural barriers to care access. Efforts to address access challenges should adopt a multifaceted approach and be tailored to families living in poverty, those with limited health coverage, and minoritized children with less than optimal general health.
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Affiliation(s)
- Asos Mahmood
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
- Department of Medicine-General Internal Medicine, College of Medicine, University of Tennessee Health Science Center, 956 Court Ave Avenue, Ste D222A, Memphis, TN, 38103, USA.
| | - Satish Kedia
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Hassan Arshad
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Xichen Mou
- Division of Epidemiology, Biostatistics, Environmental Health, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, OH, USA
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3
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Rajan M, Abramson EL, Pinheiro LC, Kern LM. Association between Gaps in Care Coordination and Emergency Department Visits Among Children without Chronic Conditions or Special Needs. Matern Child Health J 2024:10.1007/s10995-024-03942-2. [PMID: 38904902 DOI: 10.1007/s10995-024-03942-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE Prior studies and have shown that gaps in care coordination (CC) increase the risk of emergency department (ED) visits among children with special healthcare needs. This study aims to determine if gaps in CC are associated with an increased risk of ED visits among children without special needs (non-CSHCN). STUDY DESIGN We conducted a cross-sectional study using the National Survey of Children's Health (2018-2019), representing children up to age 17. A "gap" in CC occurs if the adult proxy reported dissatisfaction with communication between providers or difficulty getting the help needed to coordinate care for the child. Using logistic regression models adjusting for age and sex, we measured the association between a gap in CC and 1 or more ED visits during the past 12 months overall and stratified by any special needs. Adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) were calculated. RESULTS Between 2018 and 2019, 15% of respondents reported a gap in CC and 19.4% of children had at least one ED visit. Among non-CSHCN, these rates were 11% and 17%. In this population, a gap in CC was independently associated with an increased odds of ED use (AOR: 2.14; 95% CI 1.82, 2.52). CONCLUSIONS FOR PRACTICE Self-reported gaps in ambulatory CC were associated with increased odds of ED visits even among non-CSHCN children with minor illnesses, suggesting that providers need to be aware of potential pitfalls in CC for all children, and ensure that pertinent information is available where needed.
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Affiliation(s)
- Mangala Rajan
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, Room LH-348, New York, NY, 10021, USA.
| | - Erika L Abramson
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, Room LH-348, New York, NY, 10021, USA
| | - Laura C Pinheiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, Room LH-348, New York, NY, 10021, USA
| | - Lisa M Kern
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, Room LH-348, New York, NY, 10021, USA
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Millar K, Rodd C, Rempel G, Cohen E, Sibley KM, Garland A. The Clinical Definition of Children With Medical Complexity: A Modified Delphi Study. Pediatrics 2024; 153:e2023064556. [PMID: 38804054 DOI: 10.1542/peds.2023-064556] [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: 10/04/2023] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Children with medical complexity (CMC) comprise a subgroup of children with severe chronic diseases. A conceptual definition for CMC has been formulated, but there is no agreement on criteria to fulfill each of the 4 proposed domains: diagnostic conditions, functional limitations, health care use, and family-identified needs. Our objective with this study was to identify a standardized definition of CMC. METHODS Through a scoping review of the CMC literature, we identified potential criteria to fulfill each domain. These were incorporated into an electronic survey that was completed by a geographic and professionally varied panel of 81 American and Canadian respondents with expertise in managing CMC (response rate 70%) as part of a 4-iteration Delphi procedure. Respondents were asked to vote for the inclusion of each criterion in the definition, and for those with quantitative components (eg, hospitalization rates), to generate a consensus threshold value for meeting that criterion. The final criteria were analyzed by a committee and collapsed when situations of redundancy arose. RESULTS Of 1411 studies considered, 132 informed 55 criteria for the initial survey, which was presented to 81 respondents. Consensus for inclusion was reached on 48 criteria and for exclusion on 1 criterion. The committee collapsed those 48 criteria into 39 final criteria, 1 for diagnostic conditions, 2 for functional limitations, 13 for health care use, and 23 for family needs. CONCLUSIONS These results represent the first consensus-based, standardized definition of CMC. Standardized identification is needed to advance understanding of their epidemiology and outcomes, as well as to rigorously study treatment strategies and care models.
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Affiliation(s)
| | | | | | - Eyal Cohen
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | - Allan Garland
- Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Çimke S, Yıldırım Gürkan D, Polat S. Research on Family-Centered Care in pediatric patients: A Bibliometric Analysis. J Pediatr Nurs 2024; 76:199-206. [PMID: 38479074 DOI: 10.1016/j.pedn.2024.02.017] [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: 12/11/2023] [Revised: 02/01/2024] [Accepted: 02/19/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE This study is conducted as a bibliometric analysis to determine the trends in studies related to family-centered care in children. MATERIALS AND METHODS The Web of Science database was used to collect study data. A search was conducted on Web of Science using the keywords "family-centered care", "family centered care", "family-centred care", "family centred care", "family-integrated care", "family integrated care", "patient and family centered care", "patient- and family-centered care" and "child" or "pediatric" or "pediatrics" or "child" or "newborn" or "neonatal" or "adolescent" together. The VOSviewer program was used for data analysis and visualization. The analysis included the number of publications by year, distribution by journals, most cited studies, countries with the highest publication output, most frequently used keywords, and co-authorship dimensions, presented with visual maps. RESULTS A total of 2525 studies conducted from 1980 onwards were analyzed. The analysis revealed that the initial publications related to the subject emerged in 1980, and the United States was identified as the country with the highest number of publications, based on the Web of Science database. The Journal of Pediatric Nursing: Nursing Care of Children and Families (JPN) was determined as the journal with the highest number of publications, while the journal receiving the most citations was PEDIATRICS. CONCLUSION The study found an increasing importance given to the Family-Centered Care Approach since the 1980s, with a majority of studies being descriptive in nature. It was determined that the studies were concentrated in the USA indicating a lack of global interest in the Family-Centered. PRACTICAL IMPLICATIONS Nursing researchers can build upon this study in the field of family-centered care by conducting more specific and in-depth investigations. This contributes to adding new information to the nursing literature and filling gaps in this area.
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Affiliation(s)
- Sevim Çimke
- Faculty of Health Sciences, Yozgat Bozok University, Turkey.
| | | | - Sevinç Polat
- Faculty of Health Sciences, Yozgat Bozok University, Turkey
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Espeleta HC, Schelbe L, Ruggiero KJ, Klika JB. Initial Health Outcomes of a Community-Based Collaboration for Children in Foster Care. HEALTH & SOCIAL WORK 2024; 49:25-33. [PMID: 38148103 PMCID: PMC10825506 DOI: 10.1093/hsw/hlad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/29/2023] [Accepted: 05/02/2023] [Indexed: 12/28/2023]
Abstract
Children entering foster care have complex health needs that can persist across the lifespan. Efforts to improve access to primary care services exist; however, few have been tested. This study evaluated the Missoula Foster Child Health Program, a tri-agency, community-based collaboration in Montana, to determine its impact on health outcomes for youth in care. Demographic, health outcome, and child welfare data were collected from 485 children (50 percent male, 50 percent female, aged 0-18). At program admission, children had unmet service needs, lacking a primary care provider (30 percent), a dental provider (58 percent), and required vaccinations (33 percent). Three-quarters of children had at least one health condition, and one-third had a behavioral health concern. Overall, children in the program had significant decreases in physical and behavioral health problems from admission to discharge. Older children and those with fewer placements were more likely to have positive health changes. Data are promising, representing positive health outcomes of a community-based model for children in care.
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Affiliation(s)
- Hannah C Espeleta
- PhD, is assistant professor, College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Lisa Schelbe
- PhD, MSW, is associate professor, College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Kenneth J Ruggiero
- PhD, is professor, College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - J Bart Klika
- PhD, is chief research officer, Prevent Child Abuse America, Chicago, IL, USA
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Rajan M, Pinheiro LC, Abramson EL, Kern LM. Adverse Social Determinants of Health and Gaps in Care Coordination Among Children. J Ambul Care Manage 2024; 47:3-13. [PMID: 37994509 DOI: 10.1097/jac.0000000000000481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Gaps in care coordination (CC) can have detrimental impacts on children's health. It is unclear how much adverse social determinants of health (SDoH) may affect CC gaps. We determined whether exposure to adverse SDoH is associated with experiencing more gaps in CC using a representative national sample of children. Children with inadequate or no health insurance (adjusted odds ratio [aOR] = 2.41; 95% confidence interval [CI], 2.19-2.66) and living in disadvantaged neighborhoods (aOR = 1.53; 95% CI, 1.33-1.75) have a higher likelihood of having gaps in CC, as do those with higher counts of adverse SDoH (aOR = 2.17; 95% CI, 1.85-2.53). Thus, interventions to improve CC for children should consider adverse SDoH.
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Eom TH, Kim YH. Clinical practice guidelines for attention-deficit/hyperactivity disorder: recent updates. Clin Exp Pediatr 2024; 67:26-34. [PMID: 37321571 PMCID: PMC10764666 DOI: 10.3345/cep.2021.01466] [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: 09/24/2021] [Revised: 02/10/2023] [Accepted: 04/17/2023] [Indexed: 06/17/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders found in children and adolescents. The American Academy of Pediatrics (AAP) first published a clinical practice guideline on ADHD in 2000, which was revised in 2011 and republished together with an accompanying process-of-care algorithm. More recently, the 2019 clinical practice guideline revision was published. Since the 2011 guideline, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), was released. In addition, the Society of Developmental and Behavioral Pediatrics (SDBP) recently released another clinical practice guideline for complex ADHD. Although there are nonessential changes reflected in these updates, a number of changes have still been made; for example, the DSM-5 criteria lowered the diagnostic threshold for ADHD in older teens and adults. Additionally, the criteria were revised to facilitate application to older teens and adults, and a comorbid diagnosis with autism spectrum disorder is now allowed. Meanwhile, the 2019 AAP guideline added the recommendation related to comorbid conditions with ADHD. Lastly, SDBP developed a complex ADHD guideline, covering areas such as comorbid conditions, moderate-to-severe impairment, treatment failure, and diagnostic uncertainty. In addition, other national ADHD guidelines have been published, as have European guidelines for managing ADHD during the coronavirus disease 2019 pandemic. To facilitate ADHD management in a primary care, it is important to provide and review clinical guidelines and recent updates. In this article, we will review and summarize the recent clinical guidelines and their updates.
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Affiliation(s)
- Tae Hoon Eom
- Department of Pediatrics, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young-Hoon Kim
- Department of Pediatrics, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
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Ong N, Lucien A, Long J, Weise J, Burgess A, Walton M. What do parents think about the quality and safety of care provided by hospitals to children and young people with an intellectual disability? A qualitative study using thematic analysis. Health Expect 2023; 27:e13925. [PMID: 38014873 PMCID: PMC10768875 DOI: 10.1111/hex.13925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 11/13/2023] [Accepted: 11/19/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVES Children with intellectual disability experience patient safety issues resulting in poor care experiences and health outcomes. This study sought to identify patient safety issues that pertain to children aged 0-16 years with intellectual disability admitted to two tertiary state-wide children's hospitals and a children's palliative care centre; to describe and understand these factors to modify the Australian Patient Safety Education Framework to meet the particular needs for children and young people with intellectual disability. DESIGN, SETTING AND PARTICIPANTS Parents of children with intellectual disability from two paediatric hospitals and a palliative care unit participated in semi-structured interviews to elicit their experiences of their child's care in the context of patient safety. Thirteen interviews were conducted with parents from various backgrounds with children with intellectual, developmental and medical diagnoses. RESULTS Eight themes about safety in hospital care for children and young people with intellectual disability emerged from thematic analyses: Safety is not only being safe but feeling safe; Negative dismissive attitudes compromise safety, quality and care experience; Parental roles as safety advocates involve being heard, included and empowered; Need for purposeful and planned communication and care coordination to build trust and improve care; Systems, processes and environments require adjustments to prevent patient safety events; Inequity in care due to lack of resources and skills, Need for training in disability-specific safety and quality issues and Core staff attributes: Kindness, Patience, Flexibility and Responsiveness. Parents highlighted the dilemma of being dismissed when raising concerns with staff and being required to provide care with little support. Parents also reported a lack of comprehensive care coordination services. They noted limitations within the healthcare system in accommodating reasonable adjustments for a family and child-centred context. CONCLUSIONS The development of an adapted Patient Safety Education Framework for children with intellectual disability should consider ways for staff to transform attitudes and reduce bias which leads to adaptations for safer and better care. In addition, issues that apply to quality and safety for these children can be generalised to all children in the hospital. PATIENT AND PUBLIC CONTRIBUTION Parent advocates in the project advisory team were shown the questions to determine their appropriateness for the interviews.
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Affiliation(s)
- Natalie Ong
- School of Public HealthUniversity of SydneyCamperdownNew South WalesAustralia
- Child Development UnitChildren's Hospital at Westmead, Sydney Children's Hospitals NetworkWestmeadNew South WalesAustralia
| | - Abbie Lucien
- UNSW MedicineUniversity of New South WalesKensingtonNew South WalesAustralia
| | - Janet Long
- Australian Institute of Health Innovation, Faculty of Medicine and Health SciencesMacquarie UniversityMacquarie ParkNew South WalesAustralia
| | - Janelle Weise
- Department of Developmental Disability Neuropsychiatry (3DN), UNSW MedicineUniversity of New South WalesRandwickNew South WalesAustralia
| | - Annette Burgess
- Medical Education, Education Office, Sydney Medical SchoolUniversity of SydneyCamperdownNew South WalesAustralia
| | - Merrilyn Walton
- School of Public HealthUniversity of SydneyCamperdownNew South WalesAustralia
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Ming DY, Wong W, Jones KA, Antonelli RC, Gujral N, Gonzales S, Rogers U, Ratliff W, Shah N, King HA. Feasibility of Implementation of a Mobile Digital Personal Health Record to Coordinate Care for Children and Youth With Special Health Care Needs in Primary Care: Protocol for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e46847. [PMID: 37728977 PMCID: PMC10551780 DOI: 10.2196/46847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Electronic health record (EHR)-integrated digital personal health records (PHRs) via Fast Healthcare Interoperability Resources (FHIR) are promising digital health tools to support care coordination (CC) for children and youth with special health care needs but remain widely unadopted; as their adoption grows, mixed methods and implementation research could guide real-world implementation and evaluation. OBJECTIVE This study (1) evaluates the feasibility of an FHIR-enabled digital PHR app for CC for children and youth with special health care needs, (2) characterizes determinants of implementation, and (3) explores associations between adoption and patient- or family-reported outcomes. METHODS This nonrandomized, single-arm, prospective feasibility trial will test an FHIR-enabled digital PHR app's use among families of children and youth with special health care needs in primary care settings. Key app features are FHIR-enabled access to structured data from the child's medical record, families' abilities to longitudinally track patient- or family-centered care goals, and sharing progress toward care goals with the child's primary care provider via a clinician dashboard. We shall enroll 40 parents or caregivers of children and youth with special health care needs to use the app for 6 months. Inclusion criteria for children and youth with special health care needs are age 0-16 years; primary care at a participating site; complex needs benefiting from CC; high hospitalization risk in the next 6 months; English speaking; having requisite technology at home (internet access, Apple iOS mobile device); and an active web-based EHR patient portal account to which a parent or caregiver has full proxy access. Digital prescriptions will be used to disseminate study recruitment materials directly to eligible participants via their existing EHR patient portal accounts. We will apply an intervention mixed methods design to link quantitative and qualitative (semistructured interviews and family engagement panels with parents of children and youth with special health care needs) data and characterize implementation determinants. Two CC frameworks (Pediatric Care Coordination Framework; Patient-Centered Medical Home) and 2 evaluation frameworks (Consolidated Framework for Implementation Research; Technology Acceptance Model) provide theoretical foundations for this study. RESULTS Participant recruitment began in fall 2022, before which we identified >300 potentially eligible patients in EHR data. A family engagement panel in fall 2021 generated formative feedback from family partners. Integrated analysis of pretrial quantitative and qualitative data informed family-centered enhancements to study procedures. CONCLUSIONS Our findings will inform how to integrate an FHIR-enabled digital PHR app for children and youth with special health care needs into clinical care. Mixed methods and implementation research will help strengthen implementation in diverse clinical settings. The study is positioned to advance knowledge of how to use digital health innovations for improving care and outcomes for children and youth with special health care needs and their families. TRIAL REGISTRATION ClinicalTrials.gov NCT05513235; https://clinicaltrials.gov/study/NCT05513235. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46847.
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Affiliation(s)
- David Y Ming
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Willis Wong
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Richard C Antonelli
- Department of Pediatrics, Boston Children's Hospital, Harvard School of Medicine, Boston, MA, United States
| | - Nitin Gujral
- Innovation and Digital Health Accelerator, Boston Children's Hospital, Boston, MA, United States
| | - Sarah Gonzales
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Ursula Rogers
- AI Health, Duke University School of Medicine, Durham, NC, United States
| | - William Ratliff
- Duke Institute for Health Innovation, Duke University School of Medicine, Durham, NC, United States
| | - Nirmish Shah
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Heather A King
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veteran Affairs Health Care System, Durham, NC, United States
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Barger B, Salmon A, Moore Q. Medical Home, Developmental Monitoring/Screening, and Early Autism Identification. J Autism Dev Disord 2023:10.1007/s10803-023-06044-0. [PMID: 37477840 DOI: 10.1007/s10803-023-06044-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/22/2023]
Abstract
Developmental monitoring/screening predict early identified autism spectrum disorders (ASD), but studies have not yet robustly controlled for a key health care service impacting early identification: medical home. National Surveys of Children's Health (NSCH; 2016-2020) were used to determine the relationship between medical home, developmental monitoring/screening, and identified ASD. NSCH overall medical home variable had a minimal relationship with ASD (under 5 years of age, under 5 identified in last year, under 5 identified over a year prior). Usual source of care was positively, and care coordination negatively, associated with ASD identified in last year, suggesting the overall medical home variable may mask variance from subscales. Research is needed to determine how medical home relates to identification in applied settings.
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Affiliation(s)
- Brian Barger
- Center for Leadership in Disability, School of Public Health, Georgia State University, 75 Piedmont Rd., Atlanta, GA, 30303, USA.
- Population Health Sciences, School of Public Health, Georgia State University, Atlanta, USA.
| | - Ashley Salmon
- Center for Leadership in Disability, School of Public Health, Georgia State University, 75 Piedmont Rd., Atlanta, GA, 30303, USA
| | - Quentin Moore
- Center for Leadership in Disability, School of Public Health, Georgia State University, 75 Piedmont Rd., Atlanta, GA, 30303, USA
- Population Health Sciences, School of Public Health, Georgia State University, Atlanta, USA
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12
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Wang W, Su F, Wang S, Lei Y, Gao L, Yin X, Yu H. Bio-straw or not? Determinants of consumption intention under the plastic straw ban. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023:10.1007/s11356-023-27696-6. [PMID: 37208510 DOI: 10.1007/s11356-023-27696-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/12/2023] [Indexed: 05/21/2023]
Abstract
A new plastic ban has banned the use of single-use non-degradable plastic drinking straws in China's food and beverage industry by the end of 2020. However, this has caused widespread discussion and complaints on social media. What are consumers' reactions and what factors influence consumers to choose bio-straws (substitutes for plastic straws) are unclear. Therefore, this research collected 4367 effective comments (177,832 words in total) on "bio-straws" from social media and extracted keywords based on grounded theory to generate questionnaires. Structural equation modeling was used to analyze the consumption intention and influencing factors of 348 consumers regarding the ban. The results indicate the following: (1) consumer opinion on straws can be summarized into five main categories, namely, consumers' user experience, consumer subjectivity, policy awareness, policy acceptance, and consumption intention; (2) consumer subjectivity, policy awareness, and policy acceptance directly affect consumption intention significantly, while user experience affects consumption intention indirectly; and (3) user experience and consumer subjectivity play significant roles in mediating these relationships. From the perspective of consumers, this study provides an important basis for policymakers to formulate single-use plastic alternative policies in the future.
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Affiliation(s)
- Wenhuan Wang
- Fudan Tyndall Center, Department of Environmental Science & Engineering, Fudan University, Shanghai, 200438, China
- School of Public Administration of Zhejiang University of Technology, Hangzhou, 310023, China
| | - Fan Su
- School of Public Administration of Zhejiang University of Technology, Hangzhou, 310023, China
| | - Sichen Wang
- School of Public Administration of Zhejiang University of Technology, Hangzhou, 310023, China
| | - Yu Lei
- School of Public Administration of Zhejiang University of Technology, Hangzhou, 310023, China
| | - Lele Gao
- School of Public Administration of Zhejiang University of Technology, Hangzhou, 310023, China
| | - Xinran Yin
- School of Management of Zhejiang University of Technology, Hangzhou, 310023, China
| | - Huajun Yu
- Fudan Tyndall Center, Department of Environmental Science & Engineering, Fudan University, Shanghai, 200438, China.
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Medical Home Outcomes for School-Aged Children With Chronic Health Care Needs: A Mokken Analysis. Qual Manag Health Care 2023; 32:16-21. [PMID: 35383723 DOI: 10.1097/qmh.0000000000000366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES We examined the structure of the medical home construct as well as the association of having a medical home with school outcomes among children with chronic health conditions. METHODS The current study utilized a combination of structural equation modeling, item response theory, and Mokken scaling techniques to determine how components of a medical home may be prioritized. The components of an operationally defined medical home were the main measures along with number of missed school days and the degree of interference with a child's school. RESULTS Results of the current study provide a clear structure for the components of a medical home using Mokken scaling analyses. These components of a medical home are important as they were associated with fewer missed school days and a lower likelihood of a child's condition interfering with school as reported by parents. CONCLUSION With the results of the current study, providers working with schools can quickly discriminate (1) whether a child has a medical home and (2) understand how to guide parents toward a comprehensive medical home by understanding the hierarchy of medical home components.
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Rottermann K, Dittrich S, Dewald O, Teske A, Kwapil N, Bleck S, Purbojo A, Münch F. Mobility and freedom of movement: A novel out-of-hospital treatment for pediatric patients with terminal cardiac insufficiency and a ventricular assist device. Front Cardiovasc Med 2022; 9:1055228. [PMID: 36465431 PMCID: PMC9708718 DOI: 10.3389/fcvm.2022.1055228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/31/2022] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Due to rapid medical and technological progress, more and more pediatric patients with terminal cardiac insufficiency are being implanted with a ventricular assist device as a bridge to transplant without legal approval for hospital discharge. EXCOR® Active is a recently developed mobile driving unit for the EXCOR® ventricular assist device (EXCOR® VAD) with a long-lasting battery life that can manage small blood pumps, offering improved mobility for pediatric patients. This study strives to elaborate the requirements necessary for a safe home healthcare environment (HHE) for pediatric patients on EXCOR® VAD powered by the EXCOR® Active driving unit. MATERIALS AND METHODS Patient- and device-related preconditions (medical, ethical, psychological, technical, structural, organizational) were analyzed with regard to feasibility and safety in three individual patient cases. Included were pediatric patients with terminal cardiac insufficiency in a stable medical condition receiving in-hospital treatment with a univentricular or biventricular EXCOR® VAD powered by EXCOR® Active. Analysis was single-center, data was obtained 05/2020-02/2022. RESULTS A total of three patients on EXCOR® VAD were identified for HHE treatment with the EXCOR® Active driving unit. Switch was performed safely and increased mobility led to improved psychomotor development and improved quality of life. No complications directly related to HHE-treatment occurred. One patient recently underwent an orthotopic heart transplant, one patient remains in HHE, and one patient died due to a complication not related to the HHE. Ethical approval for off-label use was obtained and patients and parents were given the required technical training and psychological support. Caregivers and medical professionals involved in the patients' care at home were briefed intensely. Remote consultations were implemented and interdisciplinary in-hospital checks reduced to a long-term 4-week-scheme. CONCLUSION While it is challenging to discharge pediatric patients being treated with a paracorporeal ventricular assist device (EXCOR® VAD) from hospital, it is feasible and can be managed safely with the novel driving unit EXCOR® Active. A HHE may help to improve patients' psychomotor development, offer normalized social contacts and strengthen both patients' and parents' physical and mental resources. Legal approval and another study with a larger sample size are warranted.
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Affiliation(s)
- Kathrin Rottermann
- Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Sven Dittrich
- Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Oliver Dewald
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Andreas Teske
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Nicola Kwapil
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Steffen Bleck
- Department of Pediatric Cardiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Ariawan Purbojo
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Frank Münch
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
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15
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Using More Equitable Integrated Care Programs to Reduce Fragmentation in Home Care. Int J Integr Care 2022; 22:17. [PMID: 36213218 PMCID: PMC9503896 DOI: 10.5334/ijic.6553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/30/2022] [Indexed: 11/20/2022] Open
Abstract
Integrated care programs have been developed to deliver care across providers, settings, and support systems to meet the needs of community-dwelling older adults. This research asks how these programs are being used to combat issues of fragmentation in a home care sector fundamentally reshaped by neoliberalism. Data was collected through 118 key informant interviews in five Canadian integrated care programs and interpreted using a thematic analysis informed by Feminist Political Economy. This dissertation argues that integrated care programs are most useful as a policy solution to fragmented home care when they adopt policy techniques that promote equitable processes and outcomes.
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Cordova-Ramos EG, Tripodis Y, Garg A, Kalluri NS, Flores G, Parker MG. Linguistic Disparities in Child Health and Presence of a Medical Home Among United States Latino Children. Acad Pediatr 2022; 22:736-746. [PMID: 34571252 PMCID: PMC8942870 DOI: 10.1016/j.acap.2021.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/14/2021] [Accepted: 09/19/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The impact of household language on Latino-White and Latino intragroup disparities in child health and having a medical home in the United States is poorly understood. This study aimed to examine these disparities 1) between Whites and Latinos (overall and stratified by English-primary-language [EPL] and non-English-primary-language [NEPL] households); 2) within Latinos, stratified by household language; and 3) potential moderation of disparities by social determinants. METHODS Cross-sectional analysis of nationally representative sample of children 0 to 17 years old from the 2016-2018 National Survey of Children's Health. We evaluated associations of child race/ethnicity and household language with child health and presence of a medical home. Multivariable logistic regression was used to compare groups of interest, adjusting for sociodemographic factors and health needs. Moderation was assessed using interaction terms for household income, parental educational attainment, and child insurance coverage. RESULTS Among 81,514 children, 13.5% were NEPL Latino, and 19.4% were EPL Latino. Compared with EPL Whites, both EPL and NEPL Latinos had reduced odds of excellent/very good health (adjusted odds ratio [aOR]: 0.70; 95% confidence interval [CI]: 0.58-0.84; and aOR: 0.42; 95% CI: 0.33-0.53) and presence of a medical home (aOR: 0.62; 95% CI: 0.56-0.69; and aOR: 0.45; 95% CI: 0.37-0.54), respectively. Among Latinos, NEPL (vs EPL) was also associated with reduced odds of excellent/very good health (aOR: 0.61; 95% CI: 0.46-0.83), and presence of a medical home (aOR: 0.66; 95% CI: 0.48-0.78); these associations were magnified by adverse social determinants. CONCLUSIONS Striking Latino-White and within-Latino medical-home disparities persist in the United States, particularly for NEPL Latino children. Interventions should target social determinants and the rich sociocultural and linguistic diversity of the Latino population.
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Affiliation(s)
- Erika G. Cordova-Ramos
- Department of Pediatrics, Boston Medical Center, Boston, Boston University School of Medicine, MA
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Arvin Garg
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA
| | - Nikita S. Kalluri
- Department of Newborn Medicine, Boston Children’s Hospital, Harvard Medical School
| | - Glenn Flores
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, and Holtz Children’s Hospital, Jackson Health System, Miami, FL
| | - Margaret G. Parker
- Department of Pediatrics, Boston Medical Center, Boston, Boston University School of Medicine, MA
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17
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LeRouge C, Durneva P, Lyon V, Thompson M. Health Consumer Engagement, Enablement, and Empowerment in Smartphone-Enabled Home-Based Diagnostic Testing for Viral Infections: Mixed Methods Study. JMIR Mhealth Uhealth 2022; 10:e34685. [PMID: 35771605 PMCID: PMC9284354 DOI: 10.2196/34685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Health consumers are increasingly taking a more substantial role in decision-making and self-care regarding their health. A range of digital technologies is available for laypeople to find, share, and generate health-related information that supports their health care processes. There is also innovation and interest in home testing enabled by smartphone technology (smartphone-supported home testing [smart HT]). However, few studies have focused on the process from initial engagement to acting on the test results, which involves multiple decisions.
Objective
This study aimed to identify and model the key factors leading to health consumers’ engagement and enablement associated with smart HT. We also explored multiple levels of health care choices resulting from health consumer empowerment and activation from smart HT use. Understanding the factors and choices associated with engagement, enablement, empowerment, and activation helps both research and practice to support the intended and optimal use of smart HT.
Methods
This study reports the findings from 2 phases of a more extensive pilot study of smart HT for viral infection. In these 2 phases, we used mixed methods (semistructured interviews and surveys) to shed light on the situated complexities of health consumers making autonomous decisions to engage with, perform, and act on smart HT, supporting the diagnostic aspects of their health care. Interview (n=31) and survey (n=282) participants underwent smart HT testing for influenza in earlier pilot phases. The survey also extended the viral infection context to include questions related to potential smart HT use for SARS-CoV-2 diagnosis.
Results
Our resulting model revealed the smart HT engagement and enablement factors, as well as choices resulting from empowerment and activation. The model included factors leading to engagement, specifically various intrinsic and extrinsic influences. Moreover, the model included various enablement factors, including the quality of smart HT and the personal capacity to perform smart HT. The model also explores various choices resulting from empowerment and activation from the perspectives of various stakeholders (public vs private) and concerning different levels of impact (personal vs distant).
Conclusions
The findings provide insight into the nuanced and complex ways health consumers make decisions to engage with and perform smart HT and how they may react to positive results in terms of public-private and personal-distant dimensions. Moreover, the study illuminates the role that providers and smart HT sources can play to better support digitally engaged health consumers in the smart HT decision process.
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Affiliation(s)
- Cynthia LeRouge
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL, United States
- Primary Care Innovation Lab, Department of Family Medicine, University of Washington, Seattle, WA, United States
| | - Polina Durneva
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL, United States
| | - Victoria Lyon
- Primary Care Innovation Lab, Department of Family Medicine, University of Washington, Seattle, WA, United States
- Get-Grin Inc, Austin, TX, United States
| | - Matthew Thompson
- Primary Care Innovation Lab, Department of Family Medicine, University of Washington, Seattle, WA, United States
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18
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Kalomiris AE, Ely SL, Love SC, Mara CA, Cunningham NR. Child-Focused Cognitive Behavioral Therapy for Pediatric Abdominal Pain Disorders Reduces Caregiver Anxiety in Randomized Clinical Trial. THE JOURNAL OF PAIN 2022; 23:810-821. [PMID: 34902549 PMCID: PMC9086118 DOI: 10.1016/j.jpain.2021.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/16/2021] [Accepted: 12/02/2021] [Indexed: 12/12/2022]
Abstract
Pediatric functional abdominal pain disorders (FAPD) are associated with elevated anxiety in youth and their caregivers, both contributing to an adverse impact on functioning in youth with FAPD. While a CBT approach (ie, Aim to Decrease Anxiety and Pain Treatment [ADAPT]) is known to improve health outcomes for youth, it is unknown if child-focused treatment improves caregiver anxiety. This secondary analysis of a larger randomized clinical trial examined if child-focused CBT (ADAPT) for pain and anxiety also impacts caregiver anxiety and explored the relation between caregiver anxiety and child symptoms (ie, pain, disability, anxiety) after treatment. A total of 79 caregiver-child dyads were randomized to ADAPT plus treatment as usual (TAU) or TAU only. Caregiver anxiety and child outcomes (pain, disability, anxiety) were assessed at baseline and approximately 8 weeks later. Caregivers of children who completed ADAPT+TAU demonstrated lower anxiety compared to those who only received TAU. Moreover, regardless of treatment assignment, caregivers with greater anxiety had children who reported more pain and anxiety, but not functional disability at post-assessment. Results suggest a brief, child-focused intervention targeting pain and anxiety may also improve caregiver anxiety. As such, suggestions to improve future treatments are offered. PERSPECTIVE: Caregiver anxiety symptoms diminished after their child with functional abdominal pain completed a course of child-focused CBT targeting pain and anxiety. Further, caregiver anxiety was related to child-reported symptoms (pain and anxiety) after treatment. Therefore, improved caregiver mental health via a child-focused CBT may also improve pediatric outcomes.
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Affiliation(s)
- Anne E Kalomiris
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Samantha L Ely
- Department of Family Medicine, Michigan State University, Grand Rapids, Michigan
| | - Sarah C Love
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Constance A Mara
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of Cincinnati College of Medicine, Cincinnati, Ohio
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19
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Trace ME, Feygin YB, Williams PG, Winders Davis D, Brothers KB, Sullivan JE, Calhoun AW. Attention-Deficit/Hyperactivity Disorder Practice Patterns: A Survey of Kentucky Pediatric Providers. J Dev Behav Pediatr 2022; 43:233-239. [PMID: 34799539 DOI: 10.1097/dbp.0000000000001037] [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: 01/27/2021] [Accepted: 09/23/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Kentucky ranks among the highest in the nation for attention-deficit/hyperactivity disorder (ADHD) prevalence in children aged 4 to 17 years. In 2011, the American Academy of Pediatrics (AAP) released a clinical practice guideline based on the DSM-IV. A guideline revision based on the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) was released in October 2019. In this study, we assess and describe pediatric providers' ADHD practices using the 2011 guideline and DSM-5 diagnostic criteria. METHODS This was a cross-sectional, survey-based descriptive study. Kentucky Chapter of the AAP (KY AAP) members were anonymously surveyed. The results were examined for trends in routine practice. RESULTS Fifty-eight general pediatricians and pediatric residents responded to the survey, yielding a 38% (58/154) response rate. Among respondents performing routine diagnosis of ADHD (N = 51), 73% (37/51) used DSM-5 criteria. Most providers usually or always initially assessed for coexisting behavioral conditions (96%; 49/51), developmental conditions (78%; 39/51), and adverse childhood experiences (73%; 37/51). Among respondents performing routine management of ADHD (N = 55), only 11% (6/55) of respondents indicated that they titrated stimulant medications every 3 to 7 days. After initiation of medication, 78% of providers scheduled a follow-up visit within 2 to 4 weeks. During subsequent visits, only half indicated discussing behavioral interventions, screening for coexisting conditions, and reviewing follow-up teacher-rated ADHD scales. CONCLUSION Pediatricians in the KY AAP adhere to the DSM-5 criteria for diagnosing ADHD. Pediatric providers' practices would benefit from education in improvements in pharmacotherapy titration, surveillance of coexisting conditions associated with ADHD, discussion of psychosocial interventions, and school support strategies.
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Affiliation(s)
- Marie E Trace
- Center for Developmental Pediatrics, Cleveland Clinic Children's Hospital for Rehabilitation, Cleveland, OH
| | - Yana B Feygin
- Child and Adolescent Health Research Design and Support Unit, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY
| | - Patricia G Williams
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY
| | - Deborah Winders Davis
- Child and Adolescent Health Research Design and Support Unit, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY
| | - Kyle B Brothers
- Division of Pediatric Clinical and Translational Research, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY
| | - Janice E Sullivan
- Divisions of Pediatric Clinical and Translational Research and Pediatric Critical Care, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY
| | - Aaron W Calhoun
- Division of Pediatric Critical Care, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY
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20
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Guerra PDV, Flórez AM, Fernández CC, Candela RC, Malfaz FC. The Paediatric Palliative Care Unit has been transformed into Home Care Unit during the COVID-19 pandemic. Is this transformation for the foreseeable future? ANALES DE PEDIATRÍA (ENGLISH EDITION) 2022; 96:449-451. [PMID: 35550789 PMCID: PMC9013603 DOI: 10.1016/j.anpede.2021.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/10/2021] [Indexed: 12/02/2022] Open
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21
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Jain R, Kalra S, Pawaria S. A cross sectional survey on physical fitness, mental health and associated factors in mothers of children with special needs. COMPARATIVE EXERCISE PHYSIOLOGY 2022. [DOI: 10.3920/cep210017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Mothers are the primary caregivers of a child. While caring for a special needs child, workload of caring increases by manifold and taking care of these children increases physical & mental overload. There is a dearth of studies that have objectively evaluated mental health and fitness of this group. To study status of physical fitness, mental health and associated factors in mothers of special needs children a cross-sectional survey done on 100 mothers of special needs children from special schools in the Gurugram District, Haryana, India. The Harvard Step test was used to evaluate cardiac fitness. Standard tests were used to evaluate different components of musculoskeletal fitness. Depression was assessed by Beck Depression Inventory. Descriptive statistics were used for data analysis. The Karl Pearson correlation test was used to identify correlations between mental health and fitness components and sociodemographic characteristics. Mean age and body mass index of mothers was 36.15±2.56 years and 27.4±3.25 kg/m2, respectively. 50% of the subjects were overweight, 89% scored poor in cardiopulmonary fitness, 63% had very poor muscle endurance, and 69% had average muscular flexibility. 81% of the mothers had symptoms of clinical depression. Inverse and significant correlation was present between depression and cardiorespiratory fitness (r=-0.197), strength (r=-0.242), and endurance (r=0.209). Income, total number of children and duration of care giving were inversely correlated with depression. Positive correlation was found between type of disability and depression. There was an overall decrement in cardiorespiratory and musculoskeletal fitness. Mental health was found to be poor with a large percentage of participants showing symptoms of depression.
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Affiliation(s)
- R. Jain
- SGT University, Faculty of Physiotherapy, Budhera Village 122505 Gurugram, Haryana, India
| | - S. Kalra
- Delhi Pharmaceutical Science & Research University, School of Physiotherapy, Pushp Vihar, 110017 New Delhi, India
| | - S. Pawaria
- SGT University, Faculty of Physiotherapy, Budhera Village 122505 Gurugram, Haryana, India
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22
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Bayer ND, Hall M, Li Y, Feinstein JA, Thomson J, Berry JG. Trends in Health Care Use and Spending for Young Children With Neurologic Impairment. Pediatrics 2022; 149:183773. [PMID: 34854922 PMCID: PMC8762668 DOI: 10.1542/peds.2021-050905] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Children with neurologic impairment (NI) are a growing subset of children who frequently use health care. We examined health care use and spending trends across services for children with NI during their first 5 years of life. METHODS This was a retrospective study of 13 947 children with NI in the multistate IBM Medicaid MarketScan Database (2009-2017). We established birth cohorts of children with NI and analyzed claims from birth to 5 years. NI, identified by using International Classification of Diseases, 9th Revision, diagnosis codes, was defined as ≥1 neurologic diagnosis that was associated with functional and/or intellectual impairment. We measured annual health care use and per-member-per-year spending by inpatient, emergency department (ED), and outpatient services. Population trends in use and spending were assessed with logistic and linear regression, respectively. RESULTS During their first versus fifth year, 66.8% vs 5.8% of children with NI used inpatient services, and 67.8% vs 44.4% used ED services. Annual use in both categories decreased over 0-5 years (inpatient odds ratio: 0.35, 95% confidence interval: 0.34 to 0.36; ED odds ratio: 0.78, 95% confidence interval: 0.77 to 0.79). The use of outpatient services (primary care, specialty care, home health) decreased gradually. Per-member-per-year spending on inpatient services remained the largest spending category: $83 352 (90.2% of annual spending) in the first year and $1944 (25.5%) in the fifth year. CONCLUSIONS For children with early-onset NI from 0-5 years, use and spending on inpatient services decreased dramatically; ED and outpatient service use decreased more gradually. These findings may help systems, clinicians, and families optimize care by anticipating and adjusting for shifting use of health care services.
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Affiliation(s)
- Nathaniel D. Bayer
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Rochester and Golisano Children’s Hospital, Rochester, New York,Address correspondence to Nathaniel D. Bayer, MD, Division of Pediatric Hospital Medicine, Golisano Children’s Hospital and Department of Pediatrics, University of Rochester, 601 Elmwood Ave, Box 667, Rochester, NY 14642. E-mail:
| | | | - Yue Li
- Department of Public Health Sciences, University of Rochester, Rochester, New York
| | - James A. Feinstein
- Adult and Child Consortium for Health Outcomes Research & Delivery Science, University of Colorado and Children’s Hospital Colorado, Aurora, Colorado
| | - Joanna Thomson
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, College of Medicine University of Cincinnati, Cincinnati, Ohio
| | - Jay G. Berry
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
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23
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Yu J, Cook S, Imming C, Knezevich L, Ray K, Houtrow A, Rosenberg AR, Schenker Y. A Qualitative Study of Family Caregiver Perceptions of High-Quality Care at a Pediatric Complex Care Center. Acad Pediatr 2022; 22:107-115. [PMID: 34020106 PMCID: PMC9979253 DOI: 10.1016/j.acap.2021.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Pediatric complex care centers are an increasingly common approach to address the needs of children with medical complexity (CMC). We sought to better understand CMC caregivers' perceptions of what constitutes high-quality care at a complex care center. METHODS We conducted a cross-sectional qualitative study of family caregivers of CMC receiving care at a pediatric complex care center situated within a tertiary-care children's hospital. In-depth, semistructured interviews focused on caregivers' general experiences at the clinic, positive and negative experiences related to core components of the pediatric medical home, and recommendations for improvements. We thematically analyzed transcripts through a mixed inductive and deductive approach, using constant comparative methodology, with the pediatric medical home model as an organizing framework. RESULTS We conducted interviews with 20 participants (18 [90%] biological parents; 19 [95%] female; mean age 39 years) in outpatient settings. Caregivers described 2 major themes: 1) the value of having a clinician "quarterback" who is in-charge of their child's care and caregivers' go-to for questions and concerns, and 2) wanting clinicians who are personally invested in and willing to "go above and beyond" for their child. Participants discussed how and which components of the medical home model enable CMC clinicians to meet these needs. CONCLUSIONS Family caregivers of CMC want clinicians who take responsibility for managing their child's overall care and demonstrate personal commitment to ensuring their child's well-being. Multiple aspects of the medical home framework, rather than care coordination alone, help meet caregivers' perceptions of high-quality complex care.
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Affiliation(s)
- Justin Yu
- Department of Pediatrics, Division of Pediatric Hospital Medicine; University of Pittsburgh School of Medicine, Pittsburgh, PA,Palliative Research Center (PaRC), University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Stacey Cook
- Department of General Pediatrics, Division of Complex Care, Boston Children’s Hospital, Boston MA
| | - Christina Imming
- Department of Pediatrics, Division of Pediatric Hospital Medicine; University of Pittsburgh School of Medicine, Pittsburgh, PA,Complex Care Center of UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA,Department of Pediatrics, Division of General Academic Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Liana Knezevich
- Complex Care Center of UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | - Kristin Ray
- Department of Pediatrics, Division of General Academic Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Amy Houtrow
- Department of Physical Medicine and Rehabilitation, Division of Pediatric Rehabilitation Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Abby R. Rosenberg
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA,Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, WA
| | - Yael Schenker
- Palliative Research Center (PaRC), University of Pittsburgh School of Medicine, Pittsburgh, PA,Division of General Internal Medicine, Section of Palliative Care and Medical Ethics; University of Pittsburgh School of Medicine, Pittsburgh, PA
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24
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AlRasheed RM, Martin-Herz SP, Glidden DV, Okumura MJ. Adherence to Child Attention-Deficit/Hyperactivity Disorder Treatment Guidelines in Medical Homes-Results from a National Survey. J Dev Behav Pediatr 2021; 42:695-703. [PMID: 34034294 DOI: 10.1097/dbp.0000000000000973] [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: 08/01/2020] [Accepted: 04/01/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Having primary care delivered through a medical home is believed to improve mental health care delivery to children. Children with attention-deficit/hyperactivity disorder (ADHD) are commonly treated in pediatric practices, yet little is known about ADHD treatment patterns in medical homes. Our objective was to assess for treatment variation depending on parent-perceived medical home (PPMH) status. We hypothesized that having a PPMH would be associated with receiving ADHD treatments recommended by clinical guidelines. METHODS We used the 2016 National Survey of Children's Health-a nationally representative cross-sectional survey of children in the United States. Analyses included an unweighted sample of 4,252, representing 5.4 million children aged 3 to 17 years with parent-reported ADHD. Child characteristics were analyzed using descriptive statistics. Associations between ADHD treatment types and PPMH status were assessed using a multinomial logistic regression, adjusting for child characteristics. RESULTS Having a PPMH was associated with increased prevalence odds of children's receipt of medications alone for ADHD (vs no treatment). The prevalence odds of receiving behavioral treatment alone (vs medications alone) for ADHD decreased by 43% when children had a PPMH (95% confidence interval, 0.38-0.85, p = 0.01). PPMH status was not associated with a statistically significant difference in prevalence odds of receiving combination treatment (vs medications alone) for pediatric ADHD. CONCLUSION Having a PPMH was associated with children's receipt of ADHD medications alone, but not behavioral treatments. Our findings suggest that medical homes may need further improvement to ensure that children with ADHD receive treatments as recommended by clinical guidelines.
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Affiliation(s)
| | - Susanne P Martin-Herz
- Division of Developmental Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA
| | - David V Glidden
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Megumi J Okumura
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA
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25
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deJong NA, Wofford M, Song PH, Kappelman MD. Association of Care Coordination Experience and Health Services Use with Main Provider Type for Children with Inflammatory Bowel Disease. J Pediatr 2021; 234:142-148.e1. [PMID: 33798510 PMCID: PMC8238824 DOI: 10.1016/j.jpeds.2021.03.013] [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: 10/21/2020] [Revised: 01/29/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To describe care coordination experience for families of children with inflammatory bowel disease (IBD) and compare use of health services between families who identified a primary care physician (PCP) vs a gastroenterologist as a child's main provider. STUDY DESIGN This is a cross-sectional survey of care coordination experiences and health services use for children 6-19 years old receiving care in the IBD program at a children's hospital during 2018. English-speaking parents completed the Family Experiences with Coordination of Care Survey about their child's main provider and reported past-year health services. Bivariate testing and multivariate logistic regression explored differences in care coordination experience and health services by main provider, adjusted for demographic and clinical variables. RESULTS A total of 113 of 270 (42%) invited patients participated. Among 101 patients with complete data, 41% identified a PCP main provider. Performance on 5 of 16 Family Experiences with Coordination of Care indicators was higher for patients reporting a gastroenterologist vs a PCP main provider. However, having a PCP vs gastroenterologist main provider was associated with greater use of any past-year primary care services (adjusted proportion 94% vs 75%; P = .01) and of mental health services when needed (95% vs 60%; P < .01). Need for IBD-related hospitalization and emergency department visits did not differ between groups. CONCLUSIONS Children with IBD may experience trade-offs in care coordination quality and important, non-disease-focused health services based on whom parents perceive as the main provider. Efforts to enhance cross-team coordination among families and primary and specialty care teams are needed to improve overall care quality.
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Affiliation(s)
- Neal A. deJong
- Division of General Pediatrics and Adolescent Medicine, UNC School of Medicine
| | - Marie Wofford
- Department of Emergency Medicine, Carolinas Medical Center
| | - Paula H. Song
- Department of Health Administration, VCU College of Health Professions
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26
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Karkoska K, Todd K, Niss O, Clapp K, Fenchel L, Kalfa TA, Malik P, Quinn CT, Ware RE, McGann PT. Implementation of near-universal hydroxyurea uptake among children with sickle cell anemia: A single-center experience. Pediatr Blood Cancer 2021; 68:e29008. [PMID: 33742510 DOI: 10.1002/pbc.29008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/11/2021] [Accepted: 02/19/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Without early initiation of disease-modifying therapy, the acute and chronic complications of sickle cell anemia (SCA) begin early in childhood and progress throughout life. Hydroxyurea is a safe and effective medication that reduces or prevents most SCA-related complications. Despite recommendations to prescribe hydroxyurea for all children with SCA as young as 9 months, utilization remains low. PROCEDURE We completed a retrospective review of hydroxyurea-prescribing practices and associated clinical outcomes at our institution over a 10-year period before and after the 2014 National Heart, Lung, and Blood Institute (NHLBI) recommendations to use hydroxyurea for all children with SCA. RESULTS Hydroxyurea use more than doubled within our pediatric SCA population from 43% in 2010 to 95% in 2019. The age of hydroxyurea initiation was significantly younger during 2014-2019 compared to 2010-2013 (median 2 years vs. 6 years, p ≤ .001). With this change in clinical practice, nearly all (69/71 = 97%) children born after 2013 received disease-modifying therapy by the end of 2019, primarily hydroxyurea (93%). Concurrently, the number of SCA-related admissions significantly decreased from 67/100 patient-years in 2010 to 39/100 patient-years in 2019 (p < .001). CONCLUSION The early and universal prescription of hydroxyurea for children with SCA is the standard of care. Here, we demonstrate that a careful and deliberate commitment to follow this guideline in clinical practice is feasible and results in measurable improvements in clinical outcomes. Our approach and improved outcomes can serve as a model for other programs to expand their hydroxyurea use for more children with SCA.
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Affiliation(s)
- Kristine Karkoska
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kevin Todd
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Omar Niss
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kelly Clapp
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lynette Fenchel
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Theodosia A Kalfa
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Punam Malik
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Charles T Quinn
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Russell E Ware
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Patrick T McGann
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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27
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Yang F, Al Mahmud A, Wang T. User knowledge factors that hinder the design of new home healthcare devices: investigating thirty-eight devices and their manufacturers. BMC Med Inform Decis Mak 2021; 21:166. [PMID: 34020640 PMCID: PMC8139000 DOI: 10.1186/s12911-021-01464-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/07/2021] [Indexed: 11/18/2022] Open
Abstract
Background The demand for home healthcare devices arises; however, many home healthcare devices on the market are not designed to reflect the needs and features of the end-users. This study explored the user knowledge factors that hindered the design of new home healthcare devices and the interrelationships between the factors. Methods The abovementioned factors were identified from analysing the project documents of thirty-eight carefully selected home healthcare devices produced by five manufacturers; followed by interviewing the thirty stakeholders playing key roles in developing the devices. Results The design of the home healthcare devices was influenced by (1) the user insights utilised in formulating project strategies; (2) the sources of user information; (3) the execution of user research; and (4) the formulation of the manufacturers’ principal innovation processes. Conclusions The users’ characteristics and needs were not sufficiently reflected in developing new home healthcare devices. One root cause was that the end-users were not perceived by the manufacturers as a key success factor in most cases, given that most of the devices were initiated following the public sector’s requests. Actual or potential applications of this study include the facilitation of the appropriate application of human factors methods in developing new home healthcare devices and the improvement of the user performance of the end-devices. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01464-3.
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Affiliation(s)
- Fan Yang
- Guangzhou Academy of Fine Arts, Guangzhou, China.
| | | | - Tao Wang
- Guangzhou Academy of Fine Arts, Guangzhou, China
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28
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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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29
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Suen CG, Campbell K, Stoddard G, Carbone PS. Patient-Centered Outcomes in an Interdisciplinary Clinic for Complex Children with Autism. J Dev Behav Pediatr 2021; 42:182-190. [PMID: 33086336 PMCID: PMC7990680 DOI: 10.1097/dbp.0000000000000877] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 09/01/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the perspectives of caregivers of children with autism receiving care at the Neurobehavior Healthy Outcomes Medical Excellence (HOME) Program, an interdisciplinary clinic that provides primary care and behavioral/mental health services for patients with autism and other developmental disabilities, with those responding to the 2016 National Survey of Children's Health (NSCH). We focused on ratings related to shared decision-making, care coordination, family-centered care, and care within a medical home. METHODS We administered a subset of items from the 2016 NSCH to caregivers of children with autism enrolled in HOME and compared responses with the same items from a nationally representative group of caregivers of children with autism who completed the 2016 NSCH. We compared the proportions that reported receiving shared decision-making, care coordination, family-centered care, care within a medical home, and unmet needs among the 2 study groups using Poisson regression, controlling for age, sex, race/ethnicity, payor, autism severity, and intellectual disability (ID). RESULTS Compared with the NSCH cohort (n = 1151), children enrolled in HOME (n = 129) were older, more often female, had severe autism, and had co-occurring ID. Caregivers perceived that children receiving care within HOME more often received family-centered, coordinated care within a medical home compared with a national sample of children with autism. HOME enrollees also reported increased access to behavioral treatments and adult transition services with less financial burden compared with the national sample. CONCLUSION An interdisciplinary clinic model may best serve children with autism, especially those with higher severity symptoms and co-occurring conditions.
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Affiliation(s)
- Catherine G. Suen
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Kathleen Campbell
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Gregory Stoddard
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Paul S. Carbone
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
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30
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Del Villar Guerra P, Martínez Flórez A, Catalina Fernández C, Cancho Candela R, Centeno Malfaz F. [The Paediatric Palliative Care Unit has been transformed into Home Care Unit during the COVID-19 pandemic. Is this transformation for the foreseeable future?]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00008-4. [PMID: 33612454 PMCID: PMC7843067 DOI: 10.1016/j.anpedi.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/07/2021] [Accepted: 01/10/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Ana Martínez Flórez
- Servicio de Pediatría. Hospital Universitario Río Hortega, Valladolid, España
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31
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Frakking T, Michaels S, Orbell-Smith J, Le Ray L. Framework for patient, family-centred care within an Australian Community Hospital: development and description. BMJ Open Qual 2021; 9:bmjoq-2019-000823. [PMID: 32354755 PMCID: PMC7213886 DOI: 10.1136/bmjoq-2019-000823] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/31/2020] [Accepted: 04/18/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To describe the development of a patient and family-centred care (PFCC) conceptual framework within a small community Australian Hospital. METHODS A scoping review of scientific and grey literature and community hospital stakeholder discussions were used to identify and design a conceptual framework for PFCC across five core pillars of leadership, engagement, service delivery, learning and environment. RESULTS 107 publications were identified and 76 were included for data extraction. A draft framework was constructed and modified following consultation with hospital stakeholders across a small Australian Community Hospital. The 'Caring Together' framework outlines three core layers: (1) the focus of our care is the experiences of our consumers and staff; (2) concepts of leadership, environment, service delivery, engagement and learning; and (3) the overarching fundamental values of being heard, respected, valued and supported by staff and consumers at all levels in an organisation. CONCLUSIONS The conceptual Caring Together framework structures key PFCC concepts across organisational priority areas within an Australian healthcare setting and can be used to guide implementation of PFCC at other small hospital facilities. Changes to national and state healthcare funding may help facilitate improved hospital facility implementation of PFCC, and ultimately improve consumer healthcare satisfaction and clinical outcomes.
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Affiliation(s)
- Thuy Frakking
- Research Development Unit, Metro North Hospital and Health Service, Herston, Queensland, Australia .,School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Suzanne Michaels
- Engagement & Integration, Caboolture Hospital, Metro North Hospital and Health Service, Caboolture, Queensland, Australia
| | - Jane Orbell-Smith
- Education & Training, Caboolture Hospital, Metro North Hospital and Health Service, Caboolture, Queensland, Australia
| | - Lance Le Ray
- Executive Management, Caboolture Hospital, Metro North Hospital and Health Service, Caboolture, Queensland, Australia
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32
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Webb R, Whitham A, Tripodis Y, Long WE, Garg A. Does Parental Report of Having a Medical Home Attenuate the Negative Association Between Unmet Basic Needs and Health for Low-Income Children? Glob Pediatr Health 2020; 7:2333794X20985805. [PMID: 33457465 PMCID: PMC7783885 DOI: 10.1177/2333794x20985805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/23/2020] [Accepted: 12/08/2020] [Indexed: 12/02/2022] Open
Abstract
Background. It is unknown whether the medical home reduces the impact of adverse social determinants on low-income child health. Objective. To examine whether the medical home attenuates the association between unmet basic needs and health for low-income children. Design/Methods. Secondary data analysis of the 2011-12 NSCH restricted to <200% FPL children (n = 26 974). Multivariable logistic regression modeled child health with unmet basic needs to examine the effect modification of the medical home. Results. Low-income children with unmet needs had lower odds of "excellent/very good" health compared to children without unmet needs, regardless of the medical home [aOR = 0.78 (0.61-0.99) vs aOR = 0.77 (0.63-0.94), P = .01), respectively]. The medical home did not modify the negative association between unmet basic needs and "excellent/very good" child health (P = .97). Conclusion. Having a medical home per parental report did not attenuate the negative relationship between unmet basic needs and lowincome child health.
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Affiliation(s)
- Rebecca Webb
- Boston University School of Medicine,
Boston Medical Center, Boston, MA, USA
| | - Anna Whitham
- Boston University School of Medicine,
Boston Medical Center, Boston, MA, USA
| | | | | | - Arvin Garg
- Boston University School of Medicine,
Boston Medical Center, Boston, MA, USA
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33
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Multidisciplinary approach and psychosocial management of spinal muscular atrophy (SMA). Arch Pediatr 2020; 27:7S45-7S49. [DOI: 10.1016/s0929-693x(20)30277-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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34
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Wells R, Daniel P, Barger B, Rice CE, Bandlamudi M, Crimmins D. Impact of medical home-consistent care and child condition on select health, community, and family level outcomes among children with special health care needs. CHILDRENS HEALTH CARE 2020. [DOI: 10.1080/02739615.2020.1852085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Rebecca Wells
- Center for Leadership in Disability, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Patricia Daniel
- Center for Leadership in Disability, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Brian Barger
- Center for Leadership in Disability, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Catherine E. Rice
- Emory Autism Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Maitreyi Bandlamudi
- Center for Leadership in Disability, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Daniel Crimmins
- Center for Leadership in Disability, School of Public Health, Georgia State University, Atlanta, GA, USA
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35
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McClain MB, Shahidullah JD, Mezher KR, Haverkamp CR, Benallie KJ, Schwartz SE. School-Clinic Care Coordination for Youth with ASD: A National Survey of School Psychologists. J Autism Dev Disord 2020; 50:3081-3091. [PMID: 30877418 DOI: 10.1007/s10803-019-03985-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Many youth with autism spectrum disorder (ASD) may benefit from interdisciplinary care coordination. Communication and collaboration between the school and clinic settings is particularly important when youth with ASD are receiving both special education and clinic-based services. The responsibility of initiating coordinated care has historically been with the medical home (e.g., primary care clinicians), however, educational professionals (e.g., school psychologists) are also well positioned to assume a leadership role in care coordination. Little is known about the current state, feasibility, or effectiveness of school psychologists leading care coordination efforts. The current study utilizes a mixed-method approach to understand school psychologists' engagement in interdisciplinary collaboration across settings, a central tenet to coordinated care, in providing services to youth with ASD.
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Affiliation(s)
| | - Jeffrey D Shahidullah
- University of Texas at Austin Dell Medical School, Austin, USA.,School of Psychology at Rutgers University-New Brunswick, New Brunswick, USA
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36
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Ross SM, Bogart KR, Smit E, Hatfield B, Yun J, Logan SW. Physical Activity, Medical Home, and Health Behavior Counseling Among Adolescents with Special Health Care Needs: NSCH 2016-2017. Matern Child Health J 2020; 25:542-553. [PMID: 33216306 DOI: 10.1007/s10995-020-03089-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Aim 1 was to establish updated prevalence estimates for meeting national physical activity (PA) guidelines among adolescents with and without special healthcare needs (SHCN), 12-17 years old. To identify at-risk subgroups, our sub-aim was to compare the distribution of prevalence estimates across PA levels by SHCN subtypes, and in reference to peers without SHCN. Aim 2 was to examine the association between meeting PA guidelines, having a medical home, and receiving positive health behavior counseling in this population. METHODS Weighted prevalence estimates for meeting the 2018 National PA Guidelines (inactive, insufficiently active, sufficiently active: guidelines met) were calculated from a secondary analysis of the National Survey of Children's Health 2016-2017 ( n = 16,171, 27% SHCN). Adjusted odds ratios and 95% CIs were estimated from logistic regression models to measure the association between PA, medical home, and postive health behavior counseling. RESULTS Of adolescents with SHCN, 15% were reported to be meeting PA guidelines compared to 19% of peers without SHCN peers. Among adolescents with a medical home, regardless of SHCN status, those receiving positive health behavior counseling had 1.70 times the adjusted odds of meeting PA guidelines compared to peers without counseling. CONCLUSIONS FOR PRACTICE Adolescents with and without SHCN were more likely to meet PA guidelines if they had a medical home and received positive health behavior counseling, highlighting the value of comprehensive healthcare practices for PA promotion.
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Affiliation(s)
- Samantha M Ross
- Coaching and Teaching Studies, College of Physical Activity and Sport Sciences, West Virginia University, 375 Birch St (Room 247 PAS), Morgantown, WV, 26506, USA.
| | - Kathleen R Bogart
- School of Psychological Science, Oregon State University, 2950 SW Jefferson Way, Corvallis, OR, 97331, USA
| | - Ellen Smit
- Public Health, Epidemiology, School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Milam 135, Corvallis, OR, 97331, USA
| | - Bridget Hatfield
- Human Development and Family Studies, School of Social and Behavioral Health Sciences, Oregon State University, Waldo Hall 420, 2250 SW Jefferson Way, Corvallis, OR, 97331, USA
| | - Joonkoo Yun
- Department of Kinesiology, College of Health and Human Performance, East Carolina University, 60M Minges, Mail Stop 559, Greenville, NC, USA
| | - Samuel W Logan
- Kinesiology, Adapted Physical Activity, College of Public Health and Human Sciences, Oregon State University, Women's Building 203B, Corvallis, OR, 97331, USA
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The Compounding Effect of Race/Ethnicity and Disability Status on Children's Health and Health Care by Geography in the United States. Med Care 2020; 58:1059-1068. [PMID: 33177369 DOI: 10.1097/mlr.0000000000001428] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to examine the potential compounding effect of race/ethnicity, and disability status on children's health and health care, stratified by selected geographies. METHODS We used the 2011/2012 NSCH and the 2012 Boston Survey of Children's Health for our compounded disparity analysis. We used VanderWheel and Knol method to first predict combined risk ratios of race/ethnicity and disability and then compared them with the observed combined risk ratios. RESULTS We demonstrated that racial/ethnic minority children with disabilities experience additional disparities in health care access outcomes that are greater than the sum of the effects from either characteristic alone. Further, we demonstrate that disparities persist across all selected geographies irrespective of whether children lived in states or metropolitan cities with the best health care systems in the United States. CONCLUSIONS Despite reform efforts, our study demonstrates that racial/ethnic minority children with disabilities experience a double burden. Given the deleterious compounded disparities, public health and social service programs at all geographical levels should prioritize identifying participants that face this and tailor programs to meet their needs.
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38
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Barriteau CM, Murdoch A, Gallagher SJ, Thompson AA. A patient-centered medical home model for comprehensive sickle cell care in infants and young children. Pediatr Blood Cancer 2020; 67:e28275. [PMID: 32277797 DOI: 10.1002/pbc.28275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The patient-centered medical home (PCMH) has been proposed as a model for comprehensive care coordination and delivery for children with sickle cell disease (SCD), yet little is known regarding the implementation of PCMH core concepts on adherence to preventative care measures, health care utilization, and parent satisfaction. PROCEDURE We implemented the newborn cohort clinic (NCC) to explore the application of the PCMH model for infants and children with SCD from birth to age 3 years in 2011. In July 2017, we conducted a retrospective chart review to evaluate subjects currently or previously followed in the clinic. We surveyed parents in the NCC to assess their satisfaction with their experience. RESULTS A total of 112 patients have been managed in the NCC. All patients received penicillin prophylaxis, while 70% and 73% of patients, respectively, received the 23-valent pneumococcal vaccine and an initial transcranial Doppler by age 36 months. Most (92 of 112) of the subjects utilized the emergency department (569 encounters), with 86% of encounters for fever or other sickle cell-related complications. The majority of parents indicated satisfaction with the clinic, with 71% saying clinic providers always or usually spent enough time with their child, listened carefully to them (81%) and were sensitive to family values and customs (77%). CONCLUSIONS A comprehensive sickle cell clinic as a component of a PCMH is feasible and can achieve high levels of preventative care. Parents are largely satisfied with this model of care.
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Affiliation(s)
- Christina M Barriteau
- Division of Hematology and Oncology, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Alexandra Murdoch
- Division of Hematology and Oncology, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Shannon J Gallagher
- Division of General Surgery, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota, United States
| | - Alexis A Thompson
- Division of Hematology and Oncology, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
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39
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Impact of Medical Home on Health Care of Children With and Without Special Health Care Needs: Update from the 2016 National Survey of Children's Health. Matern Child Health J 2020; 23:1500-1507. [PMID: 31222602 DOI: 10.1007/s10995-019-02774-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective The medical home has been promoted as an optimal model of health care delivery for children. The purpose of this study was to examine the association between having access to a medical home and the health care experiences of children with and without special health care needs (SHCN) in the United States. Methods We analyzed data from the 2016 National Survey of Children's Health. We modeled logistic regressions to assess associations of having access to a medical home with health care experiences for 11,392 CSHCN and 38,820 non-CSHCN. Results We found that not having access to a medical home was negatively associated with preventive medical and dental care visits, greater unmet medical and dental needs, and hospital emergency room visits. Additionally, not having access to a medical home was negatively associated with the physical and oral health among CSHCN and oral health among non-CSHCN. However, we found no significant association between improved physical health status and having access to a medical home among non-CSHCN. Conclusions Results from our analysis suggest that having access to a medical home remains key determinant of improved health care experiences by CSHCN and non-CSHCN in the United States. Our findings underscore the need to develop policies and implement a more concerted program to increase access to health care delivered under the medical home model for CSHCN and non-CSHCN. Policymakers, health care administrators and physician groups can use these findings to inform future policy decisions and service delivery reforms.
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Cohen E, Coller RJ. Evaluating Integrated Care for Children: A Clarion Call or a Call for Clarity? Pediatrics 2020; 145:peds.2019-3282. [PMID: 31888958 DOI: 10.1542/peds.2019-3282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Eyal Cohen
- Department of Pediatrics and Child Health Evaluative Sciences, The Hospital for Sick Children, and .,Institute of Health, Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; and
| | - Ryan J Coller
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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Singh V, Pinkett-Davis M, Kalb LG, Azad G, Neely J, Landa R. A preliminary study of care coordination services within a specialized outpatient setting for youth with autism spectrum disorder. INTERNATIONAL JOURNAL OF CARE COORDINATION 2019. [DOI: 10.1177/2053434519893659] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
IntroductionParents of children with autism spectrum disorder often experience high levels of stress and challenges when organizing medical and behavioral services for their child. Care coordination could alleviate these challenges, however little is known about the effectiveness of this service. This study examined the need, feasibility, and acceptability of a care coordination program.MethodsFamilies of 176 children with autism, seen at a multidisciplinary autism clinic in the United States, participated in a prospective observational study. Families received a three-month structured care coordination program and completed pre- and post-program questionnaires that probed parents’ beliefs about the need and acceptability of the program through structured and open-ended questions.ResultsMost (≥90%) parents reported both a need for care coordination and satisfaction with the program. Qualitative themes identified valuable aspects and ways to improve the program.DiscussionParents raising a child with autism spectrum disorder experience an unmet need for care coordination. When provided, parents’ demonstrated high uptake of service and high levels of satisfaction with the program.
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Affiliation(s)
| | | | - Luther G. Kalb
- Kennedy Krieger Institute, USA
- Johns Hopkins Bloomberg School of Public Health, USA
| | - Gazi Azad
- Kennedy Krieger Institute, USA
- Johns Hopkins Bloomberg School of Public Health, USA
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Martone CM, Gjelsvik A, Brown JD, Rogers ML, Vivier PM. Adolescent Access to Patient-Centered Medical Homes. J Pediatr 2019; 213:171-179. [PMID: 31399246 DOI: 10.1016/j.jpeds.2019.06.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To analyze the distribution of patient-centered medical homes (PCMHs) among US adolescents, and to examine whether disparities exist among subgroups. STUDY DESIGN Data on adolescents ages 12-17 years (n = 34 601) from the 2011-2012 National Survey of Children's Health were used in this cross-sectional study to determine what proportion had access to a PCMH. Multivariable logistic regression was used to calculate the odds of having a PCMH, adjusting for sociodemographic characteristics and special health care needs. Comparisons were made to distribution of PCMH in 2007. RESULTS Although most US adolescents had a usual source of care (91%), only about one-half (51%) had access to a PCMH. Disparities in the prevalence of PCMHs were seen by race/ethnicity, poverty, and having special health care needs. There were lower adjusted odds in having a PCMH for Hispanic (aOR, 0.56; 95% CI, 0.45-0.68) and black adolescents (aOR, 0.55; 95% CI, 0.46-0.66) compared with white adolescents. Those living below 4 times the poverty level had lower adjusted odds of PCMH access. Adolescents with 3-5 special health care needs had lower adjusted odds (aOR, 0.43; 95% CI, 0.35-0.52) of having a PCMH compared with adolescents without any special health care needs. Other than receiving family centered care, every component of PCMH was slightly lower in 2011-2012 compared with 2007. CONCLUSIONS PCMH access was lower among minorities, those living in poverty, and those with multiple special health care needs. These disparities in PCMH access among these typically underserved groups call for further study and interventions that would make PCMHs more accessible to all adolescents.
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Affiliation(s)
| | - Annie Gjelsvik
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI; Department of Epidemiology, Brown University, Providence, RI; Department of Pediatrics, Alpert Medical School, Brown University, Providence, RI
| | - Joanna D Brown
- Department of Family Medicine, Alpert Medical School, Brown University, Providence, RI
| | - Michelle L Rogers
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI
| | - Patrick M Vivier
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI; Department of Pediatrics, Alpert Medical School, Brown University, Providence, RI; Department of Health Services, Policy, and Practice, Brown University, Providence, RI
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Wolraich ML, Hagan JF, Allan C, Chan E, Davison D, Earls M, Evans SW, Flinn SK, Froehlich T, Frost J, Holbrook JR, Lehmann CU, Lessin HR, Okechukwu K, Pierce KL, Winner JD, Zurhellen W. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics 2019; 144:e20192528. [PMID: 31570648 PMCID: PMC7067282 DOI: 10.1542/peds.2019-2528] [Citation(s) in RCA: 567] [Impact Index Per Article: 113.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is 1 of the most common neurobehavioral disorders of childhood and can profoundly affect children's academic achievement, well-being, and social interactions. The American Academy of Pediatrics first published clinical recommendations for evaluation and diagnosis of pediatric ADHD in 2000; recommendations for treatment followed in 2001. The guidelines were revised in 2011 and published with an accompanying process of care algorithm (PoCA) providing discrete and manageable steps by which clinicians could fulfill the clinical guideline's recommendations. Since the release of the 2011 guideline, the Diagnostic and Statistical Manual of Mental Disorders has been revised to the fifth edition, and new ADHD-related research has been published. These publications do not support dramatic changes to the previous recommendations. Therefore, only incremental updates have been made in this guideline revision, including the addition of a key action statement related to diagnosis and treatment of comorbid conditions in children and adolescents with ADHD. The accompanying process of care algorithm has also been updated to assist in implementing the guideline recommendations. Throughout the process of revising the guideline and algorithm, numerous systemic barriers were identified that restrict and/or hamper pediatric clinicians' ability to adopt their recommendations. Therefore, the subcommittee created a companion article (available in the Supplemental Information) on systemic barriers to the care of children and adolescents with ADHD, which identifies the major systemic-level barriers and presents recommendations to address those barriers; in this article, we support the recommendations of the clinical practice guideline and accompanying process of care algorithm.
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Affiliation(s)
- Mark L. Wolraich
- Section of Developmental and Behavioral Pediatrics, University of Oklahoma, Oklahoma City, Oklahoma
| | - Joseph F. Hagan
- Department of Pediatrics, The Robert Larner, MD, College of Medicine, The University of Vermont, Burlington, Vermont
- Hagan, Rinehart, and Connolly Pediatricians, PLLC, Burlington, Vermont
| | - Carla Allan
- Division of Developmental and Behavioral Health, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Eugenia Chan
- Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Dale Davison
- Children and Adults with Attention-Deficit/Hyperactivity Disorder, Lanham, Maryland
- Dale Davison, LLC, Skokie, Illinois
| | - Marian Earls
- Community Care of North Carolina, Raleigh, North Carolina
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Steven W. Evans
- Department of Psychology, Ohio University, Athens, Ohio
- Center for Intervention Research in Schools, Ohio University, Athens, Ohio
| | | | - Tanya Froehlich
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jennifer Frost
- Swope Health Services, Kansas City, Kansas
- American Academy of Family Physicians, Leawood, Kansas
| | - Joseph R. Holbrook
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christoph Ulrich Lehmann
- Departments of Biomedical Informatics and Pediatrics, Vanderbilt University, Nashville, Tennessee
| | | | | | - Karen L. Pierce
- American Academy of Child and Adolescent Psychiatry, Washington, District of Columbia
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Rustam A, Wang Y, Zameer H. Does foreign ownership affect corporate sustainability disclosure in Pakistan? A sequential mixed methods approach. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:31178-31197. [PMID: 31463751 DOI: 10.1007/s11356-019-06250-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/16/2019] [Indexed: 06/10/2023]
Abstract
The objective of this study is to investigate the potential impacts of foreign ownership on the corporate sustainability disclosure of leading non-financial companies in the context of an emerging economy of Pakistan. The study employed data from the year 2006 to 2018 gathered from the Pakistan stock exchange. Further, the data on foreign ownership and corporate sustainability disclosure obtained from the firm's annual reports and the global reporting initiatives (GRI) database. This study employed a sequential mixed methods technique. The empirical results indicate that foreign ownership has a significant impact on total sustainability disclosure (TCSRI). Whereas having an individual assessment, we found that foreign ownership is positively associated with each component (economic, social, and environmental) disclosure respectively. Moreover, our findings prove that firm size and growth are positively related to foreign ownership, TCSRI, and its aspects. In contrast, the study reveals a negative relationship among financial leverage, TCSRI, and economic, social, and environmental sustainability exposure. Summing up, the study indicates that foreign ownership effectively improves sustainability governance mechanism, and at the same time, it is also found that higher financial leverage restricts the sustainability disclosure capacity of firms. Results from this study have technical, theoretical, and policy implications for regulatory institutions, corporate management, and investors in emerging economies. Hence, we put forward the policy implications that the regulatory institutions need to reconsider the policy guidelines subject to diversification of ownership and activism of foreign shareholders in both small/large size firms to enhance the sustainability disclosure practices. Also, reduce the increasing level of financial leverage, which is curbing the firm's economic, social, and environmental reporting activities.
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Affiliation(s)
- Adeela Rustam
- Nanjing University of Aeronautics and Astronautics, Nanjing, China.
| | - Ying Wang
- Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Hashim Zameer
- Nanjing University of Aeronautics and Astronautics, Nanjing, China
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Green C, Jung HY, Wu X, Abramson E, Walkup JT, Ford JS, Grinspan ZM. Do Children with Special Health Care Needs with Anxiety have Unmet Health Care Needs? An Analysis of a National Survey. Matern Child Health J 2019; 23:1220-1231. [PMID: 31292839 DOI: 10.1007/s10995-019-02759-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To describe differences in health care needs between Children with Special Health Care Needs (CSHCN) with and without anxiety and examine the association between anxiety and unmet health care needs. METHODS We analyzed data from the 2009/2010 national survey of CSHCN. The independent variable was anxiety. The main outcomes were health care needs and unmet needs. Covariates included demographics, other co-morbid conditions, and the presence and quality of a medical home. We used bivariate analyses and multivariable logistic regression to assess the relationships among anxiety, covariates, and the outcomes. We stratified our analysis by age (6-11 years, 12-17 years). Propensity score matched paired analysis was used as a sensitivity analysis. RESULTS Our final sample included 14,713 6-11 year-olds and 15,842 12-17-year-olds. Anxiety was present in 16% of 6-11 year-olds and 23% or 12-17 year-olds. In bivariate analyses, CSHCN with anxiety had increased health care needs and unmet needs, compared to CSHCN without anxiety. In multivariable analyses, only children 12-17 years old with anxiety had increased odds of having an unmet health care need compared to those children without anxiety (OR 1.44 [95% CI 1.17-1.78]). This was confirmed in the propensity score matching analysis (OR 1.12, [95% CI 1.02-1.22]). The specific unmet needs for older CSHCN with anxiety were mental health care (OR 1.54 [95% CI 1.09-2.17]) and well child checkups (OR 2.01 [95% CI 1.18-3.44]). CONCLUSION Better integration of the care for mental and physical health is needed to ensure CSHCN with anxiety have all of their health care needs met.
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Affiliation(s)
- Cori Green
- New York Presbyterian/Weill Cornell Medicine Department of Pediatrics, 525 East 68th Street, Room 628b, Box 139, New York, NY, 10065, USA.
| | - Hye-Young Jung
- New York Presbyterian/Weill Cornell Medicine Department of Healthcare Policy & Research, New York, NY, USA
| | - Xian Wu
- New York Presbyterian/Weill Cornell Medicine Department of Healthcare Policy & Research, New York, NY, USA
| | - Erika Abramson
- New York Presbyterian/Weill Cornell Medicine Department of Pediatrics, 525 East 68th Street, Room 628b, Box 139, New York, NY, 10065, USA.,New York Presbyterian/Weill Cornell Medicine Department of Healthcare Policy & Research, New York, NY, USA
| | - John T Walkup
- Ann & Robert H. Lurie Children's Hospital of Chicago/Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Zachary M Grinspan
- New York Presbyterian/Weill Cornell Medicine Department of Pediatrics, 525 East 68th Street, Room 628b, Box 139, New York, NY, 10065, USA.,New York Presbyterian/Weill Cornell Medicine Department of Healthcare Policy & Research, New York, NY, USA
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Yu JA, Schenker Y, Maurer SH, Cook SC, Kavlieratos D, Houtrow A. Pediatric palliative care in the medical neighborhood for children with medical complexity. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2019; 37:107-119. [PMID: 31045385 PMCID: PMC6657525 DOI: 10.1037/fsh0000414] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Children with medical complexity (CMC) are a medically fragile pediatric population that experience severe chronic illnesses resulting in significant health care needs, functional limitations, and health care utilization, and are at the highest risk for morbidity and mortality among all children. Furthermore, families and parents of CMC experience significant caregiver hardships and diminished quality of life. The field of pediatric palliative care has grown in recent years, in part to address the physical and psychosocial issues inherent to the care of these chronically ill children. However, as the prevalence and long-term survival of CMC increases with medical advancements, the demand for pediatric palliative care will likely exceed the capacity of current and future pediatric palliative care specialists. Therefore, alternative strategies to ensure access to essential aspects of palliative care must be considered. This article focuses on why and how high-quality palliative care should be integrated into the patient- and family-centered medical home, the ideal care delivery model for CMC and their families. We first discuss how palliative care principles naturally align with and complement the goals of the CMC medical home. Next, we detail what actions pediatric palliative care specialists can take to best support the CMC medical home as "medical neighbors." Lastly, we describe the fundamental aspects of pediatric palliative care that all clinicians caring for CMC should be able to provide, referred to as "primary pediatric palliative care." (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Justin A Yu
- Section of Palliative Care and Medical Ethics
| | | | - Scott H Maurer
- Division of Pediatric Hematology/Oncology and Blood and Marrow Transplantation, Department of Pediatrics, The University of Pittsburgh School of Medicine
| | - Stacey C Cook
- Department of Pediatrics, The University of Pittsburgh School of Medicine
| | | | - Amy Houtrow
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine and Rehabilitation, The University of Pittsburgh School of Medicine
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Karaa A, Goldstein A, Balcells C, Mann K, Stanley L, Yeske PE, Parikh S. Harmonizing care for rare diseases: How we developed the mitochondrial care network in the United States. Mol Genet Metab 2019; 127:122-127. [PMID: 31138493 DOI: 10.1016/j.ymgme.2019.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/18/2019] [Accepted: 05/20/2019] [Indexed: 11/26/2022]
Abstract
The mitochondrial medicine society (MMS) has previously highlighted the clinical landscape and physician practice patterns of mitochondrial medicine in the US and attempted to develop consensus criteria for diagnosis and management to improve patient coordinated care. Most recently, and in collaboration with US-based patient advocacy groups, we developed a clinical care network to formally unify US-based clinicians who provide medical care to individuals with mitochondrial disease; to define, design and implement best practices in mitochondrial medicine building on the current consensus guidelines and to improve patients' clinical outcomes. Here we review the steps taken in collaboration with several stakeholders to develop goals and expectations for a mitochondrial care network (MCN), criteria for MCN site selection and formal launch of the network.
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Affiliation(s)
- Amel Karaa
- Department of Genetics, Massachusetts General Hospital, Boston, MA, United States of America.
| | - Amy Goldstein
- Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | | | - Kira Mann
- MitoAction, Boston, MA, United States of America
| | - Laura Stanley
- Foundation for Mitochondrial Medicine, Atlanta, GA, United States of America
| | - Philip E Yeske
- United Mitochondrial Disease Foundation, Pittsburgh, PA, United States of America
| | - Sumit Parikh
- Neurogenetics, Center for Pediatric Neurology, Cleveland Clinic Children's Hospital, Cleveland, OH, United States of America
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Navigating a ‘Perfect Storm’ on the Path to Prevention of Type 2 Diabetes Mellitus After Gestational Diabetes: Lessons from Patient and Provider Narratives. Matern Child Health J 2019; 23:603-612. [DOI: 10.1007/s10995-018-2649-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Okumura MJ, Knauer HA, Calvin KE, Takayama JI. Caring for Children with Special Health Care Needs: Profiling Pediatricians and Their Health Care Resources. Matern Child Health J 2019; 22:1042-1050. [PMID: 29497983 DOI: 10.1007/s10995-018-2484-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background and Objectives Pediatricians face numerous challenges in providing care for children with special health care needs (CSHCN). Few studies have described health care resources available to support pediatricians to care for CSHCN. This study investigated available resources to care for CSHCN and factors associated with having a greater proportion of CSHCN in practice. Methods We conducted a statewide survey of active members of the American Academy of Pediatrics in California to study pediatric subspecialty care access, community and office resources and practice barriers. We performed a logistic regression model on having an "above average proportion" of CSHCN in practice, adjusting for demographics, practice type (rural vs. suburban/urban) and medical resources, care satisfaction, and ease of subspecialty access. Results Our response rate was 50.2% (n = 1290); 75% of respondents reported providing some primary care services, with many primary care pediatricians caring for a high proportion of CSHCN. Pediatricians reported an average of 28% CSHCN in their practices. Rural pediatricians lacked subspecialty access (10-59% reporting no access to the various subspecialties). Factors relating to higher CSHCN in practice included being in academic medical centers and satisfaction in caring for CSHCN. Conclusions Pediatricians report lack of access to mental health services, care coordination and case management. Academic medical centers and higher physician satisfaction in care delivery for CSHCN are associated with more CSHCN in practice. Promoting ways to support pediatricians, such as practice collaboration with behavioral specialists, may be necessary to encourage primary care pediatricians to provide medical homes for CSHCN.
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Affiliation(s)
- Megumi J Okumura
- Division of General Pediatrics, University of California, 3333 California Street, STE 245, San Francisco, CA, 94118, USA. .,Division of General Internal Medicine, University of California, San Francisco, CA, USA. .,Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, 94118, USA.
| | - Heather A Knauer
- Division of General Pediatrics, University of California, 3333 California Street, STE 245, San Francisco, CA, 94118, USA.,School of Public Health, University of California, 50 University Hall #7360, Berkeley, CA, 94720-7360, USA
| | - Kris E Calvin
- American Academy of Pediatrics, California Foundation, American Academy of Pediatrics, 921 11th Street Suite 1100, Sacramento, CA, 95814, USA
| | - John I Takayama
- Division of General Pediatrics, University of California, 3333 California Street, STE 245, San Francisco, CA, 94118, USA
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Post-Trial Sustainability and Scalability of the Benefits of a Medical Home for High-Risk Children with Medical Complexity. J Pediatr 2019; 206:232-239.e3. [PMID: 30522751 PMCID: PMC6402793 DOI: 10.1016/j.jpeds.2018.10.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/18/2018] [Accepted: 10/19/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To assess the sustainability of the benefits relative to usual care of a medical home providing comprehensive care for high-risk children with medical complexity (≥2 hospitalizations or ≥1 pediatric intensive care unit [PICU] admission in the year before enrollment) after we made comprehensive care our standard practice and expanded the program. STUDY DESIGN We conducted pre-post comparisons of the rate of children with serious illness (death, PICU admission, or >7-day hospitalization) and health-system costs observed after program expansion (March 2014-June 2015) to those during the clinical trial (March 2011-August 2013) for each of the trial's treatment groups (usual care, n = 96, and comprehensive care, n = 105; primary analyses), and among all children given comprehensive care (nPost-trial = 233, including trial usual care children who transitioned to comprehensive care post-trial and newly enrolled medically complex children, and nTrial = 105; secondary analyses). We also analyzed the findings for the trial patients as a 2-phase stepped-wedge study. RESULTS In intent-to-treat analyses, rates of children with serious illness and costs were reduced or unchanged post-trial vs trial for the trial's usual care group (rate ratio [RR], 0.36; 95% CI, 0.20-0.64; cost ratio [CR], 0.68; 95% CI, 0.28-1.68), the trial's comprehensive care group (RR, 0.74; 95% CI, 0.39-1.41; CR, 0.67; 95% CI, 0.51-0.89), and among all children given comprehensive care (RR, 0.97; 95% CI, 0.61-1.52; CR, 0.75; 95% CI, 0.61-0.93). Conservative stepped-wedge analyses identified overall benefits with comprehensive care across both study periods (RR, 0.46; 95% CI, 0.30-0.72; CR, 0.64; 95% CI, 0.43-0.99). CONCLUSIONS Major benefits of comprehensive care did not diminish with post-trial program expansion.
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