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Forrest CB, Chen CP, Perrin EM, Stille CJ, Cooper R, Harris K, Luo Q, Maltenfort MG, Parlett LE. Pediatric Medical Subspecialist Use in Outpatient Settings. JAMA Netw Open 2024; 7:e2350379. [PMID: 38175643 PMCID: PMC10767594 DOI: 10.1001/jamanetworkopen.2023.50379] [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: 09/12/2023] [Accepted: 11/16/2023] [Indexed: 01/05/2024] Open
Abstract
Importance A first step toward understanding whether pediatric medical subspecialists are meeting the needs of the nation's children is describing rates of use and trends over time. Objectives To quantify rates of outpatient pediatric medical subspecialty use. Design, Setting, and Participants This repeated cross-sectional study of annual subspecialist use examined 3 complementary data sources: electronic health records from PEDSnet (8 large academic medical centers [January 1, 2010, to December 31, 2021]); administrative data from the Healthcare Integrated Research Database (HIRD) (14 commercial health plans [January 1, 2011, to December 31, 2021]); and administrative data from the Transformed Medicaid Statistical Information System (T-MSIS) (44 state Medicaid programs [January 1, 2016, to December 31, 2019]). Annual denominators included 493 628 to 858 551 patients younger than 21 years with a general pediatric visit in PEDSnet; 5 million beneficiaries younger than 21 years enrolled for at least 6 months in HIRD; and 35 million Medicaid or Children's Health Insurance Program beneficiaries younger than 19 years enrolled for any amount of time in T-MSIS. Exposure Calendar year and type of medical subspecialty. Main Outcomes and Measures Annual number of children with at least 1 completed visit to any pediatric medical subspecialist in an outpatient setting per population. Use rates excluded visits in emergency department or inpatient settings. Results Among the study population, the proportion of girls was 51.0% for PEDSnet, 51.1% for HIRD, and 49.3% for T-MSIS; the proportion of boys was 49.0% for PEDSnet, 48.9% for HIRD, and 50.7% for T-MSIS. The proportion of visits among children younger than 5 years was 37.4% for PEDSnet, 20.9% for HIRD, and 26.2% for T-MSIS; most patients were non-Hispanic Black (29.7% for PEDSnet and 26.1% for T-MSIS) or non-Hispanic White (44.9% for PEDSnet and 43.2% for T-MSIS). Annual rates for PEDSnet ranged from 18.0% to 21.3%, which were higher than rates for HIRD (range, 7.9%-10.4%) and T-MSIS (range, 7.6%-8.6%). Subspecialist use increased in the HIRD commercial health plans (annual relative increase of 2.4% [95% CI, 1.6%-3.1%]), but rates were essentially flat in the other data sources (PEDSnet, -0.2% [95% CI, -1.1% to 0.7%]; T-MSIS, -0.7% [95% CI, -6.5% to 5.5%]). The flat PEDSnet growth reflects a balance between annual use increases among those with commercial insurance (1.2% [95% CI, 0.3%-2.1%]) and decreases in use among those with Medicaid (-0.9% [95% CI, -1.6% to -0.2%]). Conclusions and Relevance The findings of this cross-sectional study suggest that among children, 8.6% of Medicaid beneficiaries, 10.4% of those with commercial insurance, and 21.3% of those whose primary care is received in academic health systems use pediatric medical subspecialty care each year. There was a small increase in rates of subspecialty use among children with commercial but not Medicaid insurance. These data may help launch innovations in the primary-specialty care interface.
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Affiliation(s)
- Christopher B. Forrest
- Applied Clinical Research Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Candice P. Chen
- Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Eliana M. Perrin
- Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Maryland
| | - Christopher J. Stille
- Deparment of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
| | - Ruth Cooper
- Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine, Washington, DC
| | | | - Qian Luo
- Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Mitchell G. Maltenfort
- Applied Clinical Research Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Harahsheh AS, Hamburger EK, de Winter JP. Empowering pediatric providers more: mastering management of common complaints. Eur J Pediatr 2023; 182:4767-4770. [PMID: 37589776 DOI: 10.1007/s00431-023-05158-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Ashraf S Harahsheh
- Division of Cardiology, Department of Pediatrics, Children's National Hospital, 111 Michigan Ave, N.W., Washington, DC, 20010, USA.
| | - Ellen K Hamburger
- Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, 20052, USA
| | - J Peter de Winter
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Leuven Child and Youth Institute, KU Leuven, Leuven, Belgium
- Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp, The Netherlands
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3
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Alturkestani RN, Bahafzalla RA, Safhi MA, Hasanain AM, Bahaidarah SA. Outpatient pediatric cardiology consultations in a tertiary academic hospital. J Family Med Prim Care 2023; 12:1303-1307. [PMID: 37649738 PMCID: PMC10465035 DOI: 10.4103/jfmpc.jfmpc_65_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 09/01/2023] Open
Abstract
Objectives Cardiac diseases in the pediatric population can be congenital or acquired. If the diagnosis and treatment are early, the chance for survival increases. Thus, this study aimed to determine the indications for pediatric cardiology consultations in a single tertiary hospital in Jeddah, Saudi Arabia. Materials and Methods This study was conducted in 2020-2021 at a tertiary center in Jeddah, Saudi Arabia. Patients younger than 14 years of age who were referred by outpatient clinics or those who presented to the emergency department and needed outpatient cardiac evaluation were included in this study. Inpatient referrals were excluded. The Statistical Package for the Social Sciences version 21 was used for statistical analyses. Results A total of 416 referred patients were included in this study. New patients accounted for 74% of the referrals, while known patients accounted for 26%. The median age was 2.728 years, with 56.3% being male participants. The three most common reasons for referral were: evaluation of cardiac function (21.6%), follow-up evaluation of fetal/neonatal diagnosis (19.5%), and heart murmurs (16.8%). Conclusion Most of the referrals were new patients. Of those who underwent echocardiography, 48.2% had abnormal results. We recommend further studies to help guide the direction of the residents' education and to provide better patient healthcare services.
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Affiliation(s)
- Razan N Alturkestani
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Rafeef A. Bahafzalla
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Maha A. Safhi
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Anhar M. Hasanain
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Saud A. Bahaidarah
- Department of Pediatrics, Pediatric Cardiology Unit, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
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Culnane E, Efron D, Williams K, Marraffa C, Antolovich G, Prakash C, Loftus H. Carer perspectives of a transition to adult care model for adolescents with an intellectual disability and/or autism spectrum disorder with mental health comorbidities. Child Care Health Dev 2023; 49:281-291. [PMID: 35947107 DOI: 10.1111/cch.13040] [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: 11/12/2021] [Revised: 03/23/2022] [Accepted: 08/07/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transition to adult care for adolescents with an intellectual disability and/or autism spectrum disorder with coexisting mental health disorders, often termed 'dual disability', is complex. It requires a family-centred approach, with collaboration among health, disability and social services and early planning. AIM To describe carer perspectives of transition to adult care and the outcomes of a transition support intervention, Fearless, Tearless Transition, for adolescents with dual disabilities piloted at a tertiary children's hospital. METHODS Carers of adolescents with a dual disability were invited to complete a survey at the commencement of their participation in the Fearless, Tearless Transition model, and again at the conclusion of the project. Within this intervention, carers and adolescents were encouraged to attend dedicated transition clinics and participate in a shared care general practitioner (GP) and paediatrician process. RESULTS One hundred and fifty-one carers of adolescents with dual disabilities were included in Fearless, Tearless Transition. Of this cohort, 138 adolescents and their carers received support in a dedicated transition clinic with 99 carers completing the initial survey at the commencement of the model. Eighty-two per cent of carers reported moderate to high levels of anxiety about transitioning from paediatric to adult care with 39% feeling 'unprepared' about transition. Eighty-one per cent reported having inadequate access to respite care with 47% reporting a lack of access to services in the community and 56% expressing dissatisfaction with their GPs. One hundred and two families participated in the shared care process with 80 GPs and 33 paediatricians. Twenty-two carers completed the second survey reporting a modest but significant improvement in preparedness for transition to adult care. CONCLUSION This study highlights the potential to improve transition outcomes for adolescents with dual disabilities and their carers through early, centralized transition planning, consistent methods of assessing adolescent and carer needs and shared care.
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Affiliation(s)
- Evelyn Culnane
- Transition Support Service, Department of Adolescent Medicine, The Royal Children's Hospital (RCH) Melbourne, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Daryl Efron
- University of Melbourne, Melbourne, Victoria, Australia.,Department of General Medicine, The Royal Children's Hospital (RCH) Melbourne, Melbourne, Victoria, Australia.,Centre for Community Child Health, The Royal Children's Hospital (RCH) Melbourne, Melbourne, Victoria, Australia
| | - Katrina Williams
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Catherine Marraffa
- University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Neurodevelopment and Disability, The Royal Children's Hospital (RCH) Melbourne, Melbourne, Victoria, Australia
| | - Giuliana Antolovich
- University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Neurodevelopment and Disability, The Royal Children's Hospital (RCH) Melbourne, Melbourne, Victoria, Australia
| | - Chidambaram Prakash
- Department of Mental Health, The Royal Children's Hospital (RCH) Melbourne, Melbourne, Victoria, Australia
| | - Hayley Loftus
- Transition Support Service, Department of Adolescent Medicine, The Royal Children's Hospital (RCH) Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Yousef HA, Abdel Wahab MM, Alsheikh S, Alghamdi R, Alghamdi R, Alkanaan N, Al-Qahtani M, Albuali WH, Almakhaita H, Aldossari M, Yousef AA. Characteristics of Pediatric Primary Healthcare Visits in a University-Based Primary Healthcare Center in Saudi Arabia. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1743. [PMID: 36421192 PMCID: PMC9688705 DOI: 10.3390/children9111743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 10/03/2023]
Abstract
This study aimed to identify the characteristics of pediatric primary health care (PHC) visits and evaluate the outcomes of patients presenting with complaints along with their referral and consultation capabilities. This was a retrospective medical record-based study. The study population included any pediatric patient (≤14 years old), including females and males, Saudis, and non-Saudis. Research data were gathered for visits from 2016-2021. Sampling was performed using a stratified random sample based on age groups, followed by simple random sampling with proportional allocation to different age groups. The number of pediatric visits included was 1439 (males, 52.2%). The most common age group was toddlers, and 60% of the total sample was from Saudi Arabia. The most common cause of visits was vaccination (32%), followed by general checkups and/or a well-baby visit (25.4%), and fever (11.2%). Approximately 10% of visits needed referral to other subspecialties. Approximately 50% of visits with complaints concerning ophthalmology, cardiology, and surgical intervention were referred to a specialized department. More awareness needs to be raised about the important role of PHC services in the pediatric age group, as it was capable of handling approximately 90% of their cases.
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Affiliation(s)
- Haneen A. Yousef
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Moataza M. Abdel Wahab
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Shahad Alsheikh
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Rizam Alghamdi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Raghad Alghamdi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Najla Alkanaan
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Mohammad Al-Qahtani
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
- Department of Paediatrics, King Fahd Hospital of the University, Shura Street, Al Aqrabiyah, Al Khobar 34445, Saudi Arabia
| | - Waleed H. Albuali
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
- Department of Paediatrics, King Fahd Hospital of the University, Shura Street, Al Aqrabiyah, Al Khobar 34445, Saudi Arabia
| | - Huda Almakhaita
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Mae Aldossari
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Abdullah A. Yousef
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
- Department of Paediatrics, King Fahd Hospital of the University, Shura Street, Al Aqrabiyah, Al Khobar 34445, Saudi Arabia
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6
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Harahsheh AS. Subspecialty referrals and consultation: it's time to partner with primary care paediatricians. Cardiol Young 2022; 32:1-4. [PMID: 35971911 DOI: 10.1017/s1047951122002578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Ashraf S Harahsheh
- Division of cardiology, Children's National Hospital, Washington, DC, USA and Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
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7
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Stave EA, Greenberg L, Hamburger E, Ottolini M, Agrawal D, Lewis K, Barber JR, Bost JE, Harahsheh AS. An educational intervention to facilitate appropriate subspecialty referrals: a study assessing resident communication skills. BMC MEDICAL EDUCATION 2022; 22:533. [PMID: 35804336 PMCID: PMC9270829 DOI: 10.1186/s12909-022-03592-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Our goal was to improve pediatric residents' advanced communication skills in the setting of referral to address the entrustable professional activity of subspecialty referral identified by the American Board of Pediatrics. To accomplish this aim, we created a referral and consultation curriculum to teach and assess core communication skills in subspecialty referral involving an adolescent with syncope, an anxiety-provoking symptom that is rarely associated with serious pathology. METHODS We utilized blended multimodal educational interventions to improve resident communication skills in referral of patients. Trainees participated in 1) an interactive online module on syncope focusing on "red-flag" symptoms that would warrant a subspecialty cardiology referral and 2) a 4-h intervention with Standardized Parents (SPs), focusing on the case-based application of communication skills. Communication skills were assessed by two pre- and post- Objective Structured Clinical Examination encounters of patients with syncope, with an SP evaluation using a 20-item checklist. Analysis was performed with Sign test and McNemar's test. Trainees provided feedback on a Critical Incident Questionnaire, which was analyzed qualitatively. RESULTS Sixty-four residents participated. There was an overall improvement in communication skills based on SP scores (82.7 ± 10.9% to 91.7 ± 5.0%, p < 0.001), and 13/20 items demonstrated significant improvement post-intervention. Residents' improved performance enabled them to address patient/family emotions, explain referral logistics, and clarify concerns to agree on a plan. CONCLUSIONS By participating in this curriculum, residents' communication skills improved immediately post-intervention. Further research is needed to assess if this intervention improves patient care by providing residents with enduring skills to judiciously manage the referral process.
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Affiliation(s)
- Elise A Stave
- Pediatrics, Children's National Hospital, Washington, DC, USA
| | - Larrie Greenberg
- Pediatrics, Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Ellen Hamburger
- Pediatrics, Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Dewesh Agrawal
- Pediatrics, Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Karen Lewis
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - John R Barber
- Pediatrics, Children's National Hospital, Washington, DC, USA
| | - James E Bost
- Pediatrics, Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Ashraf S Harahsheh
- Pediatrics, Children's National Hospital, Washington, DC, USA.
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
- Division of Cardiology, Children's National Hospital, 111 Michigan Ave, Washington, DC, NW, 20010, USA.
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Schraeder K, Allemang B, Felske AN, Scott CM, McBrien KA, Dimitropoulos G, Samuel S. Community based Primary Care for Adolescents and Young Adults Transitioning From Pediatric Specialty Care: Results from a Scoping Review. J Prim Care Community Health 2022; 13:21501319221084890. [PMID: 35323055 PMCID: PMC8961382 DOI: 10.1177/21501319221084890] [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] [Indexed: 11/23/2022] Open
Abstract
Background: Ongoing primary care during adolescence is recommended by best practice
guidelines for adolescents and young adults (AYAs; ages 12-25) with chronic
conditions. A synthesis of the evidence on the roles of Primary Care
Physicians (PCPs) and benefits of primary care is needed to support existing
guidelines. Methods: We used Arksey and O’Malley’s scoping review framework, and searched
databases (MEDLINE, EMBASE, PsychINFO, CINAHL) for studies that (i) were
published in English between 2004 and 2019, (ii) focused on AYAs with a
chronic condition(s) who had received specialist pediatric services, and
(iii) included relevant findings about PCPs. An extraction tool was
developed to organize data items across studies (eg, study design,
participant demographics, outcomes). Results: Findings from 58 studies were synthesized; 29 (50%) studies focused
exclusively on AYAs with chronic health conditions (eg, diabetes, cancer),
while 19 (33%) focused exclusively on AYAs with mental health conditions.
Roles of PCPs included managing medications, “non-complex” mental health
conditions, referrals, and care coordination, etc. Frequency of PCP
involvement varied by AYAs; however, female, non-Black, and older AYAs, and
those with severe/complex conditions appeared more likely to visit a PCP.
Positive outcomes were reported for shared-care models targeting various
conditions (eg, cancer, concussion, mental health). Conclusion: Our findings drew attention to the importance of effective collaboration
among multi-disciplinary specialists, PCPs, and AYAs for overcoming multiple
barriers to optimal transitional care. Highlighting the need for further
study of the implementation of shared care models to design strategies for
care delivery during transitions to adult care.
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Affiliation(s)
- Kyleigh Schraeder
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Brooke Allemang
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Ashley N Felske
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cathie M Scott
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kerry A McBrien
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Susan Samuel
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Bluhm P, Eldem I, Abraham A, Almekdash MH, O'Suoji C. Evaluation of Pediatric Hematology Referrals at a Tertiary University Hospital in West Texas. J Pediatr Hematol Oncol 2021; 43:e1069-e1072. [PMID: 33902065 DOI: 10.1097/mph.0000000000002159] [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: 09/05/2020] [Accepted: 03/03/2021] [Indexed: 11/25/2022]
Abstract
One in 40 pediatric office visits in the United States result in referral to subspecialty care, mostly for secondary opinion. The aim of this study was to evaluate the necessity of pediatric hematology referrals from Eastern New Mexico and West Texas to a tertiary university hospital. Retrospective data was obtained from chart review based on referrals made to the Southwest Cancer Center in Lubbock, TX for abnormal complete blood count or coagulation tests. Necessity of referrals were assessed according to patient laboratory values before referral, at initial visit, and whether therapy was started by the primary care physician (PCP). One hundred one patients met the study criteria during the period in review. The most common reasons of referral were iron deficiency anemia, leukopenia or leukocytosis and other types of anemia. About 33% of the referrals were determined to be manageable by a PCP as either the correct therapy had been already started before referral and/or the laboratory values were back to normal at the time of the first subspecialty visit. The total estimated cost of unnecessary referrals, including clinic visits and laboratories were $82,888 excluding mileage costs, days of work-school missed, and child care. Incorporation of referral guidelines, improving communication between PCP and subspecialties, and utilizing age-sex appropriate values in the interpretation of results could prevent excessive subspecialty referrals.
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Affiliation(s)
| | | | | | | | - Chibuzo O'Suoji
- Department of Pediatrics, Division of Hematology and Oncology, Texas Tech University Health Sciences Center, Lubbock, TX
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10
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Alassaf A, Gharaibeh L, Ibrahim S, Odeh R. Etiologies, profile patterns and characteristics of children with short stature in Jordan. J Pediatr Endocrinol Metab 2021; 34:559-565. [PMID: 33851794 DOI: 10.1515/jpem-2020-0672] [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: 11/25/2020] [Accepted: 02/02/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Childhood growth influences their social and psychological behavior, and abnormal growth may reflect underlying pathological etiologies. It is important to diagnose children with short stature as early as possible to be able to manage treatable causes. We aim to study etiologies and characteristics of short stature in children in Jordan. METHODS This is a cross-sectional retrospective review of the medical records of children diagnosed with short stature at a referral university hospital. Clinical characteristics, auxological, laboratory, and radiological investigations were collected and analyzed. RESULTS Among a total of 551 children diagnosed with short stature, the number of boys was significantly higher than girls, 304 (55.2%) and 247 (44.8%), respectively with a p-value of 0.015. Average age at presentation for all patients was 10.24 ± 3.23, with no significant difference between boys and girls. Pathological etiology was higher than normal variants 55.7 and 44.3%, respectively with p=0.007. Constitutional delay of growth and puberty (CDGP) was the most frequent cause in the normal variant group, 59.8%. Among the pathological group, the most common etiology was growth hormone deficiency (32.2%) with mean age of presentation of 9.40 years and was not significantly different from the age in other etiological groups, 9.44 years and p=0.931. CONCLUSIONS Growth monitoring of children should start at an early age for boys and girls. Referral to the pediatric endocrine clinic should be considered when growth problems are suspected for accurate diagnosis and etiology profiling.
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Affiliation(s)
- Abeer Alassaf
- Department of Pediatrics, The University of Jordan, Amman, Jordan
| | - Lobna Gharaibeh
- Pharmacological and Diagnostic Research Center, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, Jordan
| | - Sarah Ibrahim
- Department of Pediatrics, The University of Jordan, Amman, Jordan
| | - Rasha Odeh
- Department of Pediatrics, The University of Jordan, Amman, Jordan
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Harahsheh AS, Hamburger EK, Saleh L, Crawford LM, Sepe E, Dubelman A, Baram L, Kadow KM, Driskill C, Prestidge K, Bost JE, Berkowitz D. Promoting Judicious Primary Care Referral of Patients with Chest Pain to Cardiology: A Quality Improvement Initiative. Med Decis Making 2021; 41:559-572. [PMID: 33655790 DOI: 10.1177/0272989x21991445] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To decrease referrals to cardiology of patients ages 7 to 21 years with low-probability cardiac pathology who presented to primary care with chest pain by 50% within 24 months. STUDY DESIGN A multidisciplinary team designed and implemented an initiative consisting of 1) a decision support tool (DST), 2) educational sessions, 3) routine feedback to improve use of referral criteria, and 4) patient family education. Four pediatric practices, comprising 34 pediatricians and 7 nurse practitioners, were included in this study. We tracked progress via statistical process control charts. RESULTS A total of 421 patients ages 7 to 21 years presented with chest pain to their pediatrician. The utilization of the DST increased from baseline of 16% to 68%. Concurrently, the percentage of low-probability cardiology referrals in pediatric patients ages 7 to 21 years who presented with chest pain decreased from 17% to 5% after our interventions. At a median follow-up time of 0.9 years (interquartile range, 0.3-1.6 years), no patient had a life-threatening cardiac event. CONCLUSION Our health care improvement initiative to reduce low-probability cardiology referrals for children presenting to primary care practices with chest pain was feasible, effective, and safe.
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Affiliation(s)
- Ashraf S Harahsheh
- Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA.,Children's National Hospital, Washington, DC, USA
| | - Ellen K Hamburger
- Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA.,Children's National Pediatricians & Associates, Washington, DC, USA
| | - Lena Saleh
- Children's National Hospital, Washington, DC, USA
| | | | - Edward Sepe
- Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA.,Children's National Pediatricians & Associates, Washington, DC, USA
| | - Ariel Dubelman
- Children's National Pediatricians & Associates, Washington, DC, USA
| | - Lena Baram
- Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA.,Children's National Pediatricians & Associates, Washington, DC, USA
| | - Kathleen M Kadow
- Children's National Pediatricians & Associates, Washington, DC, USA
| | | | - Kathy Prestidge
- Children's National Pediatricians & Associates, Washington, DC, USA
| | - James E Bost
- Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA.,Division of Biostatistics and Study Methodology, Children's National Hospital, Washington, DC, USA
| | - Deena Berkowitz
- Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA.,Children's National Hospital, Washington, DC, USA
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12
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Schraeder K, Allemang B, Scott C, McBrien K, Dimitropoulos G, Felske A, Samuel S. Primary care during the transition to adult care for adolescents involved with pediatric specialty services: a scoping review protocol. Syst Rev 2021; 10:46. [PMID: 33531077 PMCID: PMC7856752 DOI: 10.1186/s13643-021-01593-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/18/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Of the 15-20% of youth in North America affected by a chronic health condition (e.g., type 1 diabetes, cystic fibrosis) and/or mental health or neurodevelopmental disorder (e.g., depression, eating disorder, Attention Deficit-Hyperactivity Disorder), many often require lifelong specialist healthcare services. Ongoing primary care during childhood and into young adulthood is recommended by best practice guidelines. To date, it is largely unknown if, how, and when primary care physicians (PCPs; such as family physicians) collaborate with specialists as AYAs leave pediatric-oriented services. The proposed scoping review will synthesize the available literature on the roles of PCPs for AYAs with chronic conditions leaving pediatric specialty care and identify potential benefits and challenges of maintaining PCP involvement during transition. METHODS Arksey and O'Malley's original scoping review framework will be utilized with guidance from Levac and colleagues and the Joanna Briggs Institute. A search of databases including MEDLINE (OVID), EMBASE, PsycINFO, and CINAHL will be conducted following the development of a strategic search strategy. Eligible studies will (i) be published in English from January 2004 onwards, (ii) focus on AYAs (ages 12-25) with a chronic condition(s) who have received specialist services during childhood, and (iii) include relevant findings about the roles of PCPs during transition to adult services. A data extraction tool will be developed and piloted on a subset of studies. Both quantitative and qualitative data will be synthesized. DISCUSSION Key themes about the roles of PCPs for AYAs involved with specialist services will be identified through this review. Findings will inform the development and evaluation of a primary-care based intervention to improve transition care for AYAs with chronic conditions.
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Affiliation(s)
- Kyleigh Schraeder
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Brooke Allemang
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Cathie Scott
- PolicyWise for Children & Families, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kerry McBrien
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Ashley Felske
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Susan Samuel
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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13
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Madigan S, McArthur BA, Anhorn C, Eirich R, Christakis DA. Associations Between Screen Use and Child Language Skills: A Systematic Review and Meta-analysis. JAMA Pediatr 2020; 174:665-675. [PMID: 32202633 PMCID: PMC7091394 DOI: 10.1001/jamapediatrics.2020.0327] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/22/2020] [Indexed: 11/14/2022]
Abstract
Importance There is considerable public and scientific debate as to whether screen use helps or hinders early child development, particularly the development of language skills. Objective To examine via meta-analyses the associations between quantity (duration of screen time and background television), quality (educational programming and co-viewing), and onset of screen use and children's language skills. Data Sources Searches were conducted in MEDLINE, Embase, and PsycINFO in March 2019. The search strategy included a publication date limit from 1960 through March 2019. Study Selection Inclusion criteria were a measure of screen use; a measure of language skills; and statistical data that could be transformed into an effect size. Exclusion criteria were qualitative studies; child age older than 12 years; and language assessment preverbal. Data Extraction and Synthesis The following variables were extracted: effect size, child age and sex, screen measure type, study publication year, and study design. All studies were independently coded by 2 coders and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Main Outcomes and Measures Based on a priori study criteria, quantity of screen use included duration of screen time and background television, quality of screen use included co-viewing and exposure to educational programs, and onset of screen use was defined as the age children first began viewing screens. The child language outcome included assessments of receptive and/or expressive language. Results Participants totaled 18 905 from 42 studies included. Effect sizes were measured as correlations (r). Greater quantity of screen use (hours per use) was associated with lower language skills (screen time [n = 38; r = -0.14; 95% CI, -0.18 to -0.10]; background television [n = 5; r = -0.19; 95% CI, -0.33 to -0.05]), while better-quality screen use (educational programs [n = 13; r = 0.13; 95% CI, 0.02-0.24]; co-viewing [n = 12; r = 0.16; 95% CI, 0.07-.24]) were associated with stronger child language skills. Later age at screen use onset was also associated with stronger child language skills [n = 4; r = 0.17; 95% CI, 0.07-0.27]. Conclusions and Relevance The findings of this meta-analysis support pediatric recommendations to limit children's duration of screen exposure, to select high-quality programming, and to co-view when possible.
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Affiliation(s)
- Sheri Madigan
- University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
| | - Brae Anne McArthur
- University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
| | - Ciana Anhorn
- University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
| | - Rachel Eirich
- University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
| | - Dimitri A. Christakis
- Seattle Children’s Hospital Research Institute, University of Washington, Seattle
- Editor, JAMA Pediatrics
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14
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Bohnhoff JC, Taormina JM, Ferrante L, Wolfson D, Ray KN. Unscheduled Referrals and Unattended Appointments After Pediatric Subspecialty Referral. Pediatrics 2019; 144:peds.2019-0545. [PMID: 31704770 DOI: 10.1542/peds.2019-0545] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Incomplete subspecialty referrals, whether unscheduled or unattended, represent unmet patient needs and an opportunity to improve patient safety and experiences. Our objectives were to describe the rates of appointment scheduling and visit attendance after pediatric subspecialty referral and to examine patient and systems factors associated with scheduled referrals and attended appointments. METHODS We conducted a retrospective review of referrals within a network of 52 primary and urgent care sites from November 2016 to October 2017. We included referrals for children ≤17 years old referred to medical or surgical subspecialists. We examined patient and health systems factors associated with (1) appointment scheduling and (2) visit attendance. RESULTS Of 20 466 referrals, 13 261 (65%) resulted in an appointment scheduled within 90 days and 10 514 (51%) resulted in a visit attended within 90 days. In adjusted analyses, referral to surgical subspecialists was associated with an increased likelihood of appointment scheduling but a decreased likelihood of visit attendance. Compared with appointments scheduled within 7 days, appointments with intervals from referral to scheduled appointment exceeding 7 days were associated with decreasing likelihood of visit attendance (adjusted odds ratio 8-14 days 0.48; 95% confidence interval 0.37-0.61). Patient factors associated with decreased likelihood of both appointment scheduling and visit attendance included African American race, public insurance, and lower zip code median income. CONCLUSIONS Patient and system factors were associated with variation in appointment scheduling and visit attendance. Decreased interval to appointment was significantly associated with visit attendance. These factors represent targets for interventions to improve referral completion.
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Affiliation(s)
- James C Bohnhoff
- University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania;
| | - Jill M Taormina
- Children's Community Pediatrics, Pittsburgh, Pennsylvania; and
| | | | - David Wolfson
- Children's Community Pediatrics, Pittsburgh, Pennsylvania; and
| | - Kristin N Ray
- University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.,Children's Community Pediatrics, Pittsburgh, Pennsylvania; and.,Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
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15
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Sanville J, Gjelsvik A, Vivier P. Assessing the Association Between Maternal Education and Access to Pediatric Specialty Care. Clin Pediatr (Phila) 2019; 58:1478-1483. [PMID: 31544507 DOI: 10.1177/0009922819875528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Timely access to pediatric specialty care continues to be a pervasive issue. We aimed to identify factors associated with unmet pediatric specialty care needs by assessing the association with maternal level of education. Methods. A sample was extracted from the 2011-2012 National Survey of Children's Health, which identified a subset of patients with unmet specialty care needs. Logistic regression models determined the strength of association between our sample and maternal level of education. Results. An estimated 12.5% of US children had unmet specialty care needs. Independent of confounding variables, children with mothers educated at a level of high school or less were 41% more likely to have unmet specialty care needs compared to those with mothers who were educated at a level greater than high school. Conclusions. Maternal level of education can be used as a risk factor to assess whether a child will have unmet specialty care needs.
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Affiliation(s)
- Julie Sanville
- Brown University, Providence, RI, USA.,Hasbro Children's Hospital, Providence, RI, USA
| | | | - Patrick Vivier
- Brown University, Providence, RI, USA.,Hasbro Children's Hospital, Providence, RI, USA.,Hassenfeld Child Health Innovation Institute, Providence, RI, USA
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16
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Cottengim C, Parks S, Rhoda D, Andrew T, Nolte KB, Fudenberg J, Sens MA, Brustrom J, Payn B, Shapiro-Mendoza CK. Protocols, practices, and needs for investigating sudden unexpected infant deaths. Forensic Sci Med Pathol 2019; 16:91-98. [PMID: 31741206 DOI: 10.1007/s12024-019-00196-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2019] [Indexed: 12/01/2022]
Abstract
Understanding case identification practices, protocols, and training needs of medical examiners and coroners (MEC) may inform efforts to improve cause-of-death certification. We surveyed a U.S.-representative sample of MECs and described investigation practices and protocols used in certifying sudden unexpected infant deaths (SUID). We also identified MEC training and resource needs. Of the 377 respondents, use of the SUID Investigation Reporting Form or an equivalent was 89% for large, 87% for medium, and 52% for small jurisdictions. Routine completion of infant medical history, witness interviews, autopsy, photos or videos, and family social history for infant death investigations was ≥80%, but routine scene re-creation with a doll was 30% in small, 64% in medium, and 59% in large offices. Seventy percent of MECs reported infant death investigation training needs. Increased training and use of standardized practices may improve SUID cause-of-death certification, allowing us to better understand SUID.
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Affiliation(s)
- Carri Cottengim
- Maternal and Infant Health Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, N.E. MS S107-2, Chamblee, GA, 30341, USA.
| | - Sharyn Parks
- Maternal and Infant Health Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, N.E. MS S107-2, Chamblee, GA, 30341, USA
| | - Dale Rhoda
- Biostat Global Consulting, Worthington, OH, formerly at Battelle, Columbus, OH, USA
| | - Tom Andrew
- Office of Chief Medical Examiner, Concord, NH, USA
| | - Kurt B Nolte
- Office of the Medical Investigator, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - John Fudenberg
- Clark County Office of the Coroner/Medical Examiner, Las Vegas, NV, USA
| | - Mary Ann Sens
- Department of Pathology, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | | | - Betsy Payn
- University of Washington, Seattle, WA, USA
| | - Carrie K Shapiro-Mendoza
- Maternal and Infant Health Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, N.E. MS S107-2, Chamblee, GA, 30341, USA
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17
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Gammons S, Presley BK, White PC. Referrals for Elevated Thyroid Stimulating Hormone to Pediatric Endocrinologists. J Endocr Soc 2019; 3:2032-2040. [PMID: 31637344 PMCID: PMC6795018 DOI: 10.1210/js.2019-00244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 09/10/2019] [Indexed: 12/11/2022] Open
Abstract
Objective We aimed to determine the reproducibility of TSH testing in pediatric patients referred to pediatric endocrinologists and to identify the threshold TSH levels that would predict the presence of antithyroid autoantibodies and inform decisions by pediatric endocrinologists to initiate or continue treatment with levothyroxine. Study Design We analyzed a retrospective case series of 325 children aged 1 to 18 years referred for hypothyroidism to the endocrinology clinic at a tertiary care children’s hospital. The receiver operating characteristic area under curve (AUC) determined the ability of the initial TSH level to predict pediatric endocrinologists’ treatment decisions, presence of thyroid autoantibodies, and reproducibility of elevated TSH on repeat testing. Results Of 325 patients, 191 were treated. The treated patients were more likely to have had a higher referral TSH, positive autoantibodies, and abnormal thyroid gland examination findings. An initial TSH of 5 had a specificity of only 14% for a repeat TSH of ≥5. An initial TSH level of 11 had a specificity of 90% for a repeat TSH of ≥11, with sensitivity of 90%. TSH was a relatively poor predictor (AUC, 0.711) of the presence of autoantibodies with optimal classification at TSH >8.8 mIU/L. It was better (AUC, 0.878) at predicting whether endocrinologists started or continued treatment with levothyroxine, with optimal classification at 8.2 mIU/L. TSH levels combined with antibody status and thyroid examination findings had the best ability to predict treatment (AUC, 0.930). Conclusions TSH levels slightly above the reference range should not prompt referral to pediatric endocrinologists unless another basis for clinical concern is present.
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Affiliation(s)
- Sarah Gammons
- Division of Pediatric Endocrinology, UT Southwestern Medical Center, Dallas, Texas
| | - Brent K Presley
- Division of Pediatric Endocrinology, UT Southwestern Medical Center, Dallas, Texas
| | - Perrin C White
- Division of Pediatric Endocrinology, UT Southwestern Medical Center, Dallas, Texas
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18
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Nguyen T, Pavitt S, Wusthoff C, Rassbach C. Breaking a Cycle of Dependence to Improve Neurology Education: A Qualitative Study Exploring Pediatric Residents' Perspectives. Clin Pediatr (Phila) 2019; 58:1158-1165. [PMID: 31455089 DOI: 10.1177/0009922819870557] [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] [Indexed: 11/16/2022]
Abstract
Objective. To understand pediatric residents' experiences and attitudes toward learning neurology; and to identify facilitators and barriers to learning neurology during residency. Study Design. Qualitative study using focus groups of pediatric residents at Stanford during November 2017. Focus groups were audio-recorded and transcribed verbatim. Investigators independently coded the transcripts and reconciled codes to develop themes using constant comparison associated with grounded theory. Results. Eighteen pediatric residents participated in 3 focus groups. Four themes emerged: (1) residents feel unprepared and uncomfortable; (2) intrinsic and extrinsic factors contribute to residents' dependence on neurologists; (3) residents desire more teaching; and (4) residents are motivated to overcome their dependence on neurologists and optimize their learning. Conclusion. Pediatric residents are motivated to acquire more skills to assess and manage patients with neurological conditions. They recognize key factors that contribute to a cycle of dependence that impedes their learning and offer strategies to overcome these barriers.
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19
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National Referral and Treatment Patterns Among Mental Health Pediatric Primary Care Visits. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 47:86-93. [PMID: 31542836 DOI: 10.1007/s10488-019-00972-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The current study explored factors that predict referral from pediatric primary care to mental health specialty care among a nationally representative sample of visits (N = 2056). Results of a logistic regression indicated that patient visits that included rarer/serious diagnoses (e.g., bipolar disorder) were more likely to receive a referral in comparison to those with ADHD (OR = 4.75, SE = 1.37). Other characteristics associated with increased likelihood of referral were those with comorbid mental health conditions (OR = 2.20, SE = 0.84) and those from a metropolitan area (OR = 2.23, SE = 0.75). Implications are discussed.
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20
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Essaddam L, Kallali W, Cherifi E, Guedri R, Mattoussi N, Fitouri Z, Ben Becher S. Characteristics and etiologies of short stature in children: Experience of an endocrine clinic in a Tunisian tertiary care hospital. Int J Pediatr Adolesc Med 2019; 7:74-77. [PMID: 32642540 PMCID: PMC7335824 DOI: 10.1016/j.ijpam.2019.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/02/2019] [Indexed: 11/24/2022]
Abstract
Background Short stature is a common reason for referral to pediatric endocrinology clinics. It may be a manifestation of a pathological condition requiring early treatment. The aim of this study was to describe the characteristics and etiologies of short stature among children referred to the pediatric endocrinology clinic of the main pediatric tertiary care center in Tunisia. Methods Retrospective and descriptive study in the endocrinology unit of children referred for short stature between January 2012 and December 2016. Data on the patients' medical history, physical findings, laboratory tests, bone age and chromosomal analysis were collected. Results 470 children (266 males and 204 females) were referred during that period. 214 (45.5%) had normal height, and 80.8% of them were referred by general practitioners. The other 256 children (54.5%) had a confirmed short stature (mean age :7.2 years, mean height: -2.77 SDS). Endocrinological causes were the most common(43% GHD, 4% hypothyroidism) followed by intrauterine growth retardation IUGR (24%), genetic syndromes (8.4%), chronic pediatric diseases (7.8%), skeletal dysplasia (6.2%), normal variant of short stature (5%), and psychosocial deprivation (1.2%). Among non-endocrine causes, Turner syndrome was the most common genetic syndrome (4.4%), achondroplasia the main skeletal dysplasia (4%) and celiac disease the main chronic disease (3.4%). Conclusions ST is largely overestimated in our country. Therefore, it is important to insist on adequate measurement and analysis of growth parameters to avoid unnecessary investigations. GHD and IUGR were the most common causes. Celiac disease, though frequent in Tunisia, is not a common cause of short stature.
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Affiliation(s)
- Leïla Essaddam
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisia.,Children Hospital Béchir Hamza de Tunis, Jebbari, 1007, Tunis, Tunisia
| | - Wafa Kallali
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisia.,Children Hospital Béchir Hamza de Tunis, Jebbari, 1007, Tunis, Tunisia
| | - Emna Cherifi
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisia.,Children Hospital Béchir Hamza de Tunis, Jebbari, 1007, Tunis, Tunisia
| | - Rahma Guedri
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisia.,Children Hospital Béchir Hamza de Tunis, Jebbari, 1007, Tunis, Tunisia
| | - Nadia Mattoussi
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisia.,Children Hospital Béchir Hamza de Tunis, Jebbari, 1007, Tunis, Tunisia
| | - Zohra Fitouri
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisia.,Children Hospital Béchir Hamza de Tunis, Jebbari, 1007, Tunis, Tunisia
| | - Saayda Ben Becher
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisia.,Children Hospital Béchir Hamza de Tunis, Jebbari, 1007, Tunis, Tunisia
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21
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Drivers of referrals to a children's hospital neonatal-infant intensive care unit. J Perinatol 2019; 39:295-299. [PMID: 30573751 DOI: 10.1038/s41372-018-0297-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 10/01/2018] [Accepted: 11/27/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Evaluate the outreach program of a regional NICU for referral satisfaction, drivers and barriers, preferences for service methods, outreach communication, and education. STUDY DESIGN To point out prevalence assessment of preferences, referral reasons, satisfaction and general feedback by regional neonatologists implemented by electronic survey using either multiple-choice or Likert scale questions. Survey questions were derived via consensus of the outreach program team. RESULTS A 100% response rate was achieved from 136 neonatologists. Over 90% of the respondents indicated either increased or unchanged referral rates and answered "maybe" or "definitely satisfied" with the outreach program. Insurance, bed availability, excellence in subspecialty support, and communication from neonatologists were important referral factors. Research reputation was not a significant driver. Case conferences at referral hospitals and program newsletters were the preferred education methods. CONCLUSIONS Advanced subspecialty services, communication with referring neonatologists, and access to the referral system are important drivers of satisfaction for referrals to our quaternary NICU.
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22
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Zhu Y, Close K, Zeldin L, White B, Rozier R. Implementation of Oral Health Screening and Referral Guidelines in Primary Health Care. JDR Clin Trans Res 2018; 4:167-177. [DOI: 10.1177/2380084418810332] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To determine the oral health screening and referral practices of pediatric providers, their adherence to American Academy of Pediatrics oral health guidelines, and barriers to adherence. Methods: Providers in 10 pediatric practices participating in the North Carolina Quality Improvement Initiative, funded by the Child Health Insurance Program Reauthorization Act of 2009, were asked to complete a 91-item questionnaire. Questions on risk assessment and referral practices were based on those recommended by the American Academy of Pediatrics. Adherence to oral health guidelines was assessed by practitioners’ evaluation of 4 vignettes presenting screening results for an 18-mo-old child with different levels of risk and caries status. Respondents chose referral recommendations assuming adequate and inadequate dentist workforces. Logit models determined the association between barriers specified in Cabana’s framework and adherence (count of 6 to 8 adherent vignettes vs. 0 to 5). Results: Of 72 eligible providers, 53 (74%) responded. Almost everyone (98.1%) screened for dental problems; 45.2% referred in at least half of well-child visits. Respondents were aware of oral health guidelines, expressed strong agreement with them, and reported confidence in providing preventive oral health services. Yet they underreferred by an average of 42% per vignette for the 7 clinical vignette-workforce scenarios requiring an immediate referral. Frequently cited barriers were providers’ beliefs that 1) parents are poorly motivated to seek dental care, 2) oral health counseling has a small effect on parent behaviors, 3) there is a shortage of dentists in their community who will see infants and toddlers, and 4) information systems to support referrals are insufficient. Conclusion: Pediatric clinicians’ beliefs lead to a conscious decision not to refer many patients, even when children should be referred. Knowledge Transfer Statement: Evidence suggests that the primary care–dental referral process needs improvement. This study identifies barriers to delivering recommended preventive oral health services in pediatrics. The information can be used to improve the screening and referral process and, thus, the quality of preventive oral health services provided in primary care. Results also can guide researchers on the selection of interventions that need testing and might close gaps in the referral process and improve access to dental care.
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Affiliation(s)
- Y. Zhu
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - K. Close
- Oral Health Section, Division of Public Health, NC Department of Health and Human Services, Raleigh, NC, USA
| | - L.P. Zeldin
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - B.A. White
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
- Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, NC, USA
| | - R.G. Rozier
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
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23
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Dalal NN, Dzelebdzic S, Frank LH, Clauss SB, Mitchell SJ, Aljohani OA, Bradley-Hewitt T, Harahsheh AS. Recurrent Cardiology Evaluation for Innocent Heart Murmur: Echocardiogram Utilization. Clin Pediatr (Phila) 2018; 57:1436-1441. [PMID: 29993270 DOI: 10.1177/0009922818787280] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We conducted a retrospective study to identify electrocardiogram (ECG) and echocardiogram utilization among patients presenting for a follow-up cardiology evaluation with innocent heart murmur between 2012 and 2014. The 2014 echocardiogram Appropriate Use Criteria was applied. We observed high rates of ordering ECGs and echocardiograms on follow-up visits (79% and 36%); only 1 patient had an appropriate indication for echocardiogram while the rest had rarely appropriate indication. Having had an ECG done did not affect echocardiogram ordering behavior. Older patient age was the only factor associated with a higher likelihood for ordering echocardiograms on follow-up visit (odds ratio = 1.016, P = .021). In this small sample study, we noticed high rates of test utilization and low-probability utilization of echocardiogram in the recurrent evaluation of children with innocent heart murmur. A larger, multicenter prospective study to investigate patterns and drivers of test utilization in children with innocent heart murmur presenting for a follow-up cardiology visit is needed.
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Affiliation(s)
- Nupur N Dalal
- 1 Children's National Health System, Washington, DC, USA.,2 The George Washington University, Washington, DC, USA
| | | | - Lowell H Frank
- 1 Children's National Health System, Washington, DC, USA.,2 The George Washington University, Washington, DC, USA
| | - Sarah B Clauss
- 1 Children's National Health System, Washington, DC, USA.,2 The George Washington University, Washington, DC, USA
| | | | - Othman A Aljohani
- 1 Children's National Health System, Washington, DC, USA.,2 The George Washington University, Washington, DC, USA
| | - Tyler Bradley-Hewitt
- 1 Children's National Health System, Washington, DC, USA.,2 The George Washington University, Washington, DC, USA
| | - Ashraf S Harahsheh
- 1 Children's National Health System, Washington, DC, USA.,2 The George Washington University, Washington, DC, USA
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Schlappi C, Kulkarni V, Palabindela P, Bemrich-Stolz C, Howard T, Hilliard L, Lebensburger J. Outcomes in Mild to Moderate Isolated Thrombocytopenia. Pediatrics 2018; 142:peds.2017-3804. [PMID: 29891565 PMCID: PMC6317551 DOI: 10.1542/peds.2017-3804] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Incidental isolated mild to moderate thrombocytopenia is a frequent laboratory finding prompting a referral to pediatric hematology-oncology. We tested the hypothesis that patients with isolated asymptomatic mild thrombocytopenia would not progress to require an intervention from a pediatric hematologist-oncologist. METHODS This is a 5-year retrospective review of 113 patients referred to pediatric hematology-oncology for isolated thrombocytopenia. Initial, lowest, and current platelet counts along with clinical course and need for interventions were recorded. Thrombocytopenia was categorized as mild (platelet count: 101-140 × 103/μL), moderate (platelet count: 51-100 × 103/μL), severe (platelet count: 21-50 × 103/μL), and very severe (platelet count: ≤20 × 103/μL). RESULTS Eight of 48 patients (17%) referred for initial mild isolated thrombocytopenia progressed to moderate thrombocytopenia at 1 visit. At present, 2 of these patients have moderate thrombocytopenia, 17 remain with mild thrombocytopenia, and 29 patients have resolved thrombocytopenia. Nine of 65 patients (14%) referred for moderate thrombocytopenia progressed to severe or very severe thrombocytopenia on 1 occasion. At present, no patients have severe thrombocytopenia, 18 remain with moderate thrombocytopenia, 14 improved to mild thrombocytopenia, and 33 have resolved thrombocytopenia. Only 3 patients required interventions from a hematologist, whereas 10 patients required therapy from other subspecialties. CONCLUSIONS We only identified 3 patients (3%) with mild to moderate thrombocytopenia who required an intervention from a hematologist to improve platelet counts. Patients with isolated mild thrombocytopenia with a normal bleeding history and physical examination findings frequently have normalized their platelet counts within 1 month.
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Affiliation(s)
| | | | | | | | | | | | - Jeffrey Lebensburger
- Division of Pediatric Hematology Oncology. University of Alabama at Birmingham, Birmingham, Alabama
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Saengkaew T, McNeil E, Jaruratanasirikul S. Etiologies of short stature in a pediatric endocrine clinic in Southern Thailand. J Pediatr Endocrinol Metab 2017; 30:1265-1270. [PMID: 29127766 DOI: 10.1515/jpem-2017-0205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 09/25/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Short stature is one of the common disorders referred for investigation of an endocrine disorder. The etiologies of short stature vary and are commonly grouped into pathological and non-pathological disorders. The objective of the study was to determine the etiologies and describe the characteristics of short stature patients who attended the Pediatric Endocrinology Clinic and to compare factors between normal variant short stature (NVSS) and growth hormone deficiency (GHD). METHODS This was a retrospective review of 572 patients referred for evaluation of short stature between January 2004 and December 2015. Short stature was defined as height below -2 standard deviation score (SDS) by gender and age based on population data of Thai children. RESULTS In total, 521 patients were identified as having short stature. NVSS was the most common etiology (44.9%) and pathological short stature was found in 35.3% of the cases, of which 21.2% had GHD. The median age at presentation of NVSS patients was 8.6 years while that of pathological short stature patients was 2.1 years (p<0.001). Patients with NVSS had significantly higher median height SDS (HSDS) than patients with pathological diseases. The common etiologies in severe short patients, defined by HSDS ≤-3, were syndromic short stature (16.2%) and GHD (14.1%). In the moderate short stature group (HSDS between -2 and -3), constitutional delay of growth and puberty (CDGP) was the most common etiology (34.1%). CONCLUSIONS NVSS was the most common etiology of short stature, followed by syndromic short stature and GHD. Physical examination is crucial to identify GHD from syndromic short patients.
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Harahsheh AS, O’Byrne ML, Pastor B, Graham DA, Fulton DR. Pediatric Chest Pain-Low-Probability Referral: A Multi-Institutional Analysis From Standardized Clinical Assessment and Management Plans (SCAMPs®), the Pediatric Health Information Systems Database, and the National Ambulatory Medical Care Survey. Clin Pediatr (Phila) 2017; 56:1201-1208. [PMID: 28081617 PMCID: PMC6388765 DOI: 10.1177/0009922816684605] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We conducted a study to assess test characteristics of red-flag criteria for identifying cardiac disease causing chest pain and technical charges of low-probability referrals. Accuracy of red-flag criteria was ascertained through study of chest pain Standardized Clinical Assessment and Management Plans (SCAMPs®) data. Patients were divided into 2 groups: Group1 (concerning clinical elements) and Group2 (without). We compared incidence of cardiac disease causing chest pain between these 2 groups. Technical charges of Group 2 were analyzed using the Pediatric Health Information System database. Potential savings for the US population was estimated using National Ambulatory Medical Care Survey data. Fifty-two percent of subjects formed Group 1. Cardiac disease causing chest pain was identified in 8/1656 (0.48%). No heart disease was identified in patients in Group 2 ( P = .03). Applying red-flags in determining need for referral identified patients with cardiac disease causing chest pain with 100% sensitivity. Median technical charges for Group 2, over a 4-year period, were US2014$775 559. Eliminating cardiac testing of low-probability referrals would save US2014$3 775 182 in technical charges annually. Red-flag criteria were an effective screen for children with chest pain. Eliminating cardiac testing in children without red-flags for referral has significant technical charge savings.
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Affiliation(s)
- Ashraf S Harahsheh
- Department of Pediatrics- Division of Cardiology, Children’s National Health System/ George Washington University School of Medicine and Health Sciences, 111 Michigan Ave, N.W. Washington, DC 20010
| | - Michael L O’Byrne
- Department of Pediatrics- Division of Cardiology, Children’s National Health System/ George Washington University School of Medicine and Health Sciences, 111 Michigan Ave, N.W. Washington, DC 20010
| | - Bill Pastor
- Performance Improvement, Children’s National Health System, 111 Michigan Ave, N.W. Washington, DC 20010
| | - Dionne A. Graham
- Institute for Relevant Clinical Data Analytics and Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Ave. Boston, MA 02115
| | - David R. Fulton
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Ave. Boston, MA 02115
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Gutiérrez-Colina AM, Lee JL, Reed-Knight B, Hayutin L, Lewis JD, Blount RL. The Pediatric Symptom Checklist: Comparison of symptom profiles using three factor structures between pediatric gastroenterology and general pediatric patients. CHILDRENS HEALTH CARE 2017. [DOI: 10.1080/02739615.2016.1163493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Jennifer L. Lee
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Bonney Reed-Knight
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- GI Care for Kids, Atlanta, GA
| | - Lisa Hayutin
- Department of Psychology, University of Georgia, Athens, GA
| | - Jeffery D. Lewis
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- GI Care for Kids, Atlanta, GA
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Krause L, Seeling S, Prütz F, Rommel A. Prevalence and Trends in the Utilization of Gynecological Services by Adolescent Girls in Germany. Results of the German Health Survey for Children and Adolescents (KiGGS). Geburtshilfe Frauenheilkd 2017; 77:1002-1011. [PMID: 28959064 DOI: 10.1055/s-0043-118284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/10/2017] [Accepted: 08/10/2017] [Indexed: 10/18/2022] Open
Abstract
There is only limited data available on the utilization of gynecological services in Germany. Based on data from the German Health Survey for Children and Adolescents (KiGGS) of the Robert Koch Institute, a survey carried out across all of Germany, this study aimed to examine the utilization of gynecological services by girls in Germany. Data from the KiGGS Wave 1 survey (2009 - 2012) was used to analyze the factors which affect utilization. The KiGGS baseline study (2003 - 2006) was used to analyze trends. The database consisted of a subsample from the KiGGS Wave 1 survey (n = 2575), the initial follow-up survey conducted by telephone after the baseline study. Data are shown as prevalence and mean with 95% confidence intervals. Correlations with selected influencing factors were calculated using multivariate logistic regression models. Differences between study populations were considered significant if p < 0.05. At the time of the KiGGS Wave 1 survey, 53.9% of girls aged 14 to 17 years had visited a gynecologist at least once. This percentage increased significantly with each additional year of life. For 61.9% of 17-year-old girls who had previously visited a gynecologist at least once, the first visit to a gynecologist occurred at the age of 15 or 16 years. Growing up with siblings was associated with a lower prevalence of utilization, while middle socioeconomic status, risky alcohol consumption and daily consumption of tobacco, and the utilization of general medical services were associated with a higher 12-month prevalence for the utilization of gynecological services. The utilization of gynecological services has increased significantly compared to the KiGGS baseline survey. Among girls there is a high need for information on issues of sexual health. Gynecologists are important but they are not the only port of call. Information needs should be covered as part of a coordinated approach which includes the involvement of all relevant stakeholders. Initiatives such as the WHO Action Plan for Sexual and Reproductive Health and its recommendations should be incorporated.
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Affiliation(s)
- Laura Krause
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Germany
| | - Stefanie Seeling
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Germany
| | - Franziska Prütz
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Germany
| | - Alexander Rommel
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Germany
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Stille CJ, Honigfeld L, Heitlinger LA, Kuo DZ, Werner EJ. The Pediatric Primary Care-Specialist Interface: A Call For Action. J Pediatr 2017; 187:303-308. [PMID: 28595768 DOI: 10.1016/j.jpeds.2017.04.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/20/2017] [Accepted: 04/24/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Christopher J Stille
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
| | | | - Leo A Heitlinger
- St Luke's Pediatric Gastroenterology, St Luke's University Hospital, Bethlehem, PA; Clinical Professor of Pediatrics, Temple University School of Medicine, Philadelphia, PA
| | - Dennis Z Kuo
- Department of Pediatrics, University at Buffalo, Buffalo, NY
| | - Eric J Werner
- Division of Pediatric Hematology/Oncology, Eastern Virginia Medical School, Norfolk, VA
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Hughes AL, Roberson D, Bannos C, Trudell EK, Vernacchio L. Appropriateness of Tympanostomy Tubes in the Boston Metropolitan Area: Are the AAO-HNSF Guidelines Being Met? Otolaryngol Head Neck Surg 2017; 157:1041-1047. [DOI: 10.1177/0194599817721454] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Otitis media (OM) is the most common reason children receive general anesthesia, with bilateral tympanostomy tube (TT) insertion the second most common surgery in children. Prior research suggests overuse of TT. As part of a project designed to improve appropriateness of OM referrals, we evaluated appropriateness of TT insertion in a patient cohort. Methods Patients younger than 9 years with initial otolaryngology (ORL) visits in academic and private office settings for OM from January 1, 2012, to August 31, 2013, were identified through claims database. A detailed retrospective chart review of patients undergoing TT insertion was performed to determine appropriateness of TT insertion per the 2013 American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF) guidelines. Results A total of 120 patients undergoing TT insertion were randomly chosen for detailed chart review; 32 patients were excluded. Sixty-six (75%) of 88 patients available for analysis met AAO-HNSF guidelines for TT. Recurrent acute OM with middle ear effusion was the most common indication (56%). Other indications included chronic OME and TT in at-risk patients with speech, learning, or behavioral delays. Of the 22 patients undergoing TT insertion not meeting AAO-HNSF guidelines, 11(50%) had abnormal exams, but were 1 to 2 infections short of meeting guidelines; 7 (33%) had normal exams but met criteria for number of infections. Discussion Contrary to prior publications, 75% of patients undergoing TT insertion had an appropriate indication per AAO-HNSF guidelines. In only 5% was TT insertion a substantial departure from guidelines. Implications for Practice The study outcomes suggest appropriate clinical decision making, improved guideline adherence, and better guideline applicability from the previously published 1994 and 2004 guidelines.
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Affiliation(s)
- Amy L. Hughes
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - David Roberson
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Cassandra Bannos
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Emily K. Trudell
- Pediatric Physicians’ Organization at Children’s, Brookline, Massachusetts, USA
| | - Louis Vernacchio
- Pediatric Physicians’ Organization at Children’s, Brookline, Massachusetts, USA
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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A survey of management of congenital nasolacrimal duct obstruction by pediatric primary health care providers in Spain. Eur J Ophthalmol 2017; 27:502-505. [PMID: 28009409 DOI: 10.5301/ejo.5000915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To survey the management of congenital nasolacrimal duct obstruction (CNLDO) by pediatric primary health care providers in Spain. METHODS This was a descriptive study using a web-based questionnaire to evaluate the perceptions of the members of the Pediatric Primary Care Society in Castilla-León, Spain (APAPCYL), regarding management of CNLDO. The questionnaire contained 14 direct questions and was sent by e-mail to all the pediatricians. All the responses were analyzed by the frequency of occurrence and percentages. RESULTS Ninety physicians responded to the questionnaire. Massage 2 or 3 times a day was the initial treatment advised by 60.47% of pediatricians. Nearly half of the pediatricians recommended continuing massage until symptoms resolved. Fewer than 50% of children required referral to an ophthalmologist. Reasons for an ophthalmic consult included persistence of symptoms among 87.21% of pediatricians and parental/guardian request among 10.5% of pediatricians. According to 45.6% of pediatricians, their knowledge about CNLDO is limited, and 92.2% would like to receive further training on CNLDO. CONCLUSIONS Massage was the main initial treatment for managing CNLDO among pediatricians. The outcomes of this survey indicated that massage fails in fewer than 50% of patients and an ophthalmic referral is required for these cases.
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Al-Abdulrazzaq D, Al-Taiar A, Hassan K, Al-Twari B, Al-Osaimi A, Al-Busairi I. Referral pattern of children with short stature to a pediatric endocrine clinic in Kuwait. J Pediatr Endocrinol Metab 2016; 29:1055-61. [PMID: 27442364 DOI: 10.1515/jpem-2016-0098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 06/08/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of the study was to describe the referral pattern, baseline characteristics, and etiological profile of children referred with short stature in Kuwait. METHODS This is a cross-sectional retrospective review of children referred to the Endocrine Clinic with short stature. Short stature was defined as height or length below the 3rd centile or <-2 standard deviation score (SDS). RESULTS A total of 221 children were referred with no gender difference (p=0.346). Almost one fifth of these children had normal stature. Median (interquartile) age was 7.7 (4.7, 10.3) years and mean height SDS was -2.67 (0.68). The most common diagnoses were normal variants of growth, growth hormone deficiency (GHD). CONCLUSIONS Our study highlights the need to improve the referral process in order to avoid unnecessary investigations and alleviate parental anxiety. There is no gender bias in short stature referrals in Kuwait. There is a need of further investigation of short stature in the region.
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Gleason N, Prasad PA, Ackerman S, Ho C, Monacelli J, Wang M, Collado D, Gonzales R. Adoption and impact of an eConsult system in a fee-for-service setting. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2016; 5:40-45. [PMID: 27469441 DOI: 10.1016/j.hjdsi.2016.05.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 05/04/2016] [Accepted: 05/18/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Nathaniel Gleason
- Division of General Internal Medicine, University of California, San Francisco, United States.
| | - Priya A Prasad
- Division of General Internal Medicine, University of California, San Francisco, United States
| | - Sara Ackerman
- Division of General Internal Medicine, University of California, San Francisco, United States
| | - Chanda Ho
- California Pacific Medical Center, Division of Hepatology, United States
| | | | - Michael Wang
- Division of General Internal Medicine, University of California, San Francisco, United States
| | - Don Collado
- Division of General Internal Medicine, University of California, San Francisco, United States
| | - Ralph Gonzales
- Division of General Internal Medicine, University of California, San Francisco, United States
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Advances in Motivational Interviewing for Pediatric Obesity: Results of the Brief Motivational Interviewing to Reduce Body Mass Index Trial and Future Directions. Pediatr Clin North Am 2016; 63:539-62. [PMID: 27261549 PMCID: PMC6754172 DOI: 10.1016/j.pcl.2016.02.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Rates of childhood obesity in the United States remain at historic highs. The pediatric primary care office represents an important yet underused setting to intervene with families. One factor contributing to underuse of the primary care setting is lack of effective available interventions. One evidence-based method to help engage and motivate patients is motivational interviewing, a client-centered and goal-oriented style of counseling used extensively to increase autonomous motivation and modify health behaviors. This article summarizes the methods and results from a large trial implemented in primary care pediatric office and concludes with recommendations for improving the intervention and increasing its dissemination.
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Zimmerman DR, Amitai Y, Grossman Z, Stein-Zamir C. Referral patterns of Israeli pediatricians of common primary care office procedures. Isr J Health Policy Res 2015; 4:50. [PMID: 26664670 PMCID: PMC4674934 DOI: 10.1186/s13584-015-0046-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 09/04/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Pediatric primary care is the cornerstone of health care services for children. Performance of common office procedures is an integral part of primary care. Ideally, the community-based primary care pediatrician provides comprehensive health care services and only refers a small minority of patients for consultation. However, knowledge regarding Israeli pediatricians' practices of office procedures is scant. OBJECTIVES To describe primary care pediatricians' patterns in the provision of common office procedures and to analyze factors associated with performance or referral. METHODS DESIGN Self-completed structured questionnaire consisting of 1) demographic variables; 2) practice characteristics description; 3) List of ten procedures (treatment of subungual hematoma, laceration suturing and adhesive closure, elbow subluxation/reduction , urinary bladder catheterization, supra-pubic aspiration, inguinal hernia reduction, umbilical granuloma and labial fusion treatment, and short lingual frenulum management) followed by questions regarding referral practice for each procedure; and 4) causes and indications for referral when relevant. PARTICIPANTS Primary care pediatricians attending anational pediatric conferences. ANALYSIS Descriptive statistics and association assessment. RESULTS The questionnaire was completed by 162 primary care pediatricians, 58.7 % male; mean age 53 ± 9 years, 88.4 % board certified. Of the respondents, 57 % worked in group practices and the remainder solo; salaried employees 68.2 %, independent contractors 31.8 %. Referral rate varied by procedure; least likely to be referred was labial fusion (7.7 %) and most likely was short lingual frenulum (81.3 %). For most procedures, the most frequent non-performance cause was lack of expertise followed by lack of appropriate conditions. The overall number of procedures in which the response selected was out-of-clinic referral was not associated with demographic or employment characteristics. However, association was found for certain specific procedures (e.g. experience with catheterization, gender with suturing and adhesive closure). CONCLUSIONS Many common office procedures are referred out of primary care pediatric community settings in Israel. Considerable variability was found among procedures. Lack of experience or lack of appropriate conditions were frequently reported causes for referral and need to be addressed in reducing unnecessary referral with its attendant costs and patient inconvenience. Possible approaches include updates in pediatric residency training, focused in-service training, time allocation and work environment reorganization.
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Affiliation(s)
- Deena R. Zimmerman
- />Jerusalem District Health Office - Ministry of Health, 86 Jaffa Road, Jerusalem, 94341 Israel
| | - Yona Amitai
- />Meuchedet Health Services, 31 Yitzchak Mirsky St., Jerusalem, 97284 Israel
| | - Zahi Grossman
- />Department of Management, Bar Ilan University, Max and Anna Webb St., Ramat Gan, 52900 Israel
| | - Chen Stein-Zamir
- />Braun School of Public Health and Community Medicine Hebrew University in Jerusalem, Ein Karem, PO Box 12272, Jerusalem 91120 Israel
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Feyissa EA, Cornell E, Chandhok L, Wang D, Ionita C, Schwab J, Kostyun R, Wilion F, Rubin K. Impact of Co-management at the Primary-Subspecialty Care Interface on Follow-up and Referral Patterns for Patients With Concussion. Clin Pediatr (Phila) 2015; 54:969-75. [PMID: 25573946 DOI: 10.1177/0009922814566929] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Co-management is a collaborative care model that consists of structured tools to define and document care delivered by 2 or more providers. We evaluated the impact of implementing co-management at the interface between pediatric primary care providers (PCPs) and subspecialists. METHODS Participating PCPs (n = 9) were trained on management of concussion using the co-management tools. Co-managed patients with concussion were prospectively enrolled (n = 148) and compared to a retrospective audit of non-co-managed patients (n = 50). RESULTS PCPs using co-management demonstrated adherence to the tools. PCPs were significantly more likely to provide follow-up care to patients when using the co-management tools. All participating PCPs reported that co-management enhanced their expertise in caring for patients with concussion. CONCLUSIONS Co-management can enhance PCPs' capacity to independently manage the care of patients with concussion. Co-management led to an observed change in practice that merits further exploration in terms of cost, quality, and clinical outcomes.
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Affiliation(s)
- Eminet Abebe Feyissa
- Office for Community Child Health, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Erin Cornell
- Department of Research, Connecticut Children's Medical Center, Hartford, CT, USA
| | | | - David Wang
- Elite Sports Medicine, Connecticut Children's Medical Center, Hartford, CT, USA
| | | | - Jennifer Schwab
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Regina Kostyun
- Elite Sports Medicine, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Felicia Wilion
- ProHealth Physicians Inc, Children's Medical Group, Bloomfield, CT, USA
| | - Karen Rubin
- Division of Endocrinology, Connecticut Children's Medical Center, Hartford, CT, USA
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Wang MH. Persistent Urinary Incontinence: A Case Series of Missed Ectopic Ureters. Urol Case Rep 2015; 3:223-5. [PMID: 26793560 PMCID: PMC4714319 DOI: 10.1016/j.eucr.2015.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 07/07/2015] [Accepted: 07/09/2015] [Indexed: 12/01/2022] Open
Abstract
Ectopic ureter is a rare cause of urinary incontinence in children. Symptomatic cases are unlikely to resolve spontaneously, and incontinence are often associated with significant psychological impact on these children. This case series of 2 older children with missed ectopic ureters by the urologic community outline workup for persistent urinary incontinence, with emphasis on history, physical, embryology review, and radiographic evaluations.
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Affiliation(s)
- Ming-Hsien Wang
- Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Schaefer GB, Larson IA, Bolick J, Williamson-Dean L. What is the role of clinical genetics in the patient-centered medical home?: A commentary from the Medical Home Workgroup of the Heartland Regional Genetics and Newborn Screening Collaborative. Genet Med 2015; 18:440-2. [PMID: 26291599 DOI: 10.1038/gim.2015.113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 07/02/2015] [Indexed: 11/09/2022] Open
Affiliation(s)
- Gerald Bradley Schaefer
- University of Arkansas for Medical Sciences and Arkansas Children's Hospital Research Institute, Little Rock, Arkansas, USA
| | - Ingrid A Larson
- Division of General Academic Pediatrics, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - JoAnn Bolick
- University of Arkansas for Medical Sciences and Arkansas Children's Hospital Research Institute, Little Rock, Arkansas, USA
| | - Lori Williamson-Dean
- University of Arkansas for Medical Sciences and Arkansas Children's Hospital Research Institute, Little Rock, Arkansas, USA
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Madigan S, Wade M, Plamondon A, Browne D, Jenkins JM. Birth Weight Variability and Language Development: Risk, Resilience, and Responsive Parenting. J Pediatr Psychol 2015; 40:869-77. [DOI: 10.1093/jpepsy/jsv056] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 05/18/2015] [Indexed: 11/14/2022] Open
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40
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Mallon D, Vernacchio L, Trudell E, Antonelli R, Nurko S, Leichtner AM, Lightdale JR. Shared care: a quality improvement initiative to optimize primary care management of constipation. Pediatrics 2015; 135:e1300-7. [PMID: 25896837 PMCID: PMC4411778 DOI: 10.1542/peds.2014-1962] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pediatric constipation is commonly managed in the primary care setting, where there is much variability in management and specialty referral use. Shared Care is a collaborative quality improvement initiative between Boston Children's Hospital and the Pediatric Physician's Organization at Children's (PPOC), through which subspecialists provide primary care providers with education, decision-support tools, pre-referral management recommendations, and access to advice. We investigated whether Shared Care reduces referrals and improves adherence to established clinical guidelines. METHODS We reviewed the primary care management of patients 1 to 18 years old seen by a Boston Children's Hospital gastroenterologist and diagnosed with constipation who were referred from PPOC practices in the 6 months before and after implementation of Shared Care. Charts were assessed for patient factors and key components of management. We also tracked referral rates for all PPOC patients for 29 months before implementation and 19 months after implementation. RESULTS Fewer active patients in the sample were referred after implementation (61/27,365 [0.22%] vs 90/27,792 [0.36%], P = .003). The duration of pre-referral management increased, and the rate of fecal impaction decreased after implementation. No differences were observed in documentation of key management recommendations. Analysis of medical claims showed no statistically significant change in referrals. CONCLUSIONS A multifaceted initiative to support primary care management of constipation can alter clinical care, but changes in referral behavior and pre-referral management may be difficult to detect and sustain. Future efforts may benefit from novel approaches to provider engagement and systems integration.
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Affiliation(s)
- Daniel Mallon
- Divisions of Gastroenterology, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;
| | - Louis Vernacchio
- General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;,Pediatric Physicians’ Organization at Children’s, Brookline, Massachusetts; and
| | - Emily Trudell
- Pediatric Physicians’ Organization at Children’s, Brookline, Massachusetts; and
| | - Richard Antonelli
- General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Samuel Nurko
- Divisions of Gastroenterology, and ,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Alan M. Leichtner
- Divisions of Gastroenterology, and ,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Jenifer R. Lightdale
- Divisions of Gastroenterology, and ,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;,Division of Pediatric Gastroenterology, University of Massachusetts Memorial Children’s Medical Center, Worcester, Massachusetts
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Ray KN, Demirci JR, Bogen DL, Mehrotra A, Miller E. Optimizing Telehealth Strategies for Subspecialty Care: Recommendations from Rural Pediatricians. Telemed J E Health 2015; 21:622-9. [PMID: 25919585 DOI: 10.1089/tmj.2014.0186] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Telehealth offers strategies to improve access to subspecialty care for children in rural communities. Rural pediatrician experiences and preferences regarding the use of these telehealth strategies for children's subspecialty care needs are not known. We elicited rural pediatrician experiences and preferences regarding different pediatric subspecialty telehealth strategies. MATERIALS AND METHODS Seventeen semistructured telephone interviews were conducted with rural pediatricians from 17 states within the United States. Interviewees were recruited by e-mails to a pediatric rural health listserv and to rural pediatricians identified through snowball sampling. Themes were identified through thematic analysis of interview transcripts. Institutional Review Board approval was obtained. RESULTS Rural pediatricians identified several telehealth strategies to improve access to subspecialty care, including physician access hotlines, remote electronic medical record access, electronic messaging systems, live video telemedicine, and telehealth triage systems. Rural pediatricians provided recommendations for optimizing the utility of each of these strategies based on their experiences with different systems. Rural pediatricians preferred specific telehealth strategies for specific clinical contexts, resulting in a proposed framework describing the complementary role of different telehealth strategies for pediatric subspecialty care. Finally, rural pediatricians identified additional benefits associated with the use of telehealth strategies and described a desire for telehealth systems that enhanced (rather than replaced) personal relationships between rural pediatricians and subspecialists. CONCLUSIONS Rural pediatricians described complementary roles for different subspecialty care telehealth strategies. Additionally, rural pediatricians provided recommendations for optimizing individual telehealth strategies. Input from rural pediatricians will be crucial for optimizing specific telehealth strategies and designing effective telehealth systems.
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Affiliation(s)
- Kristin N Ray
- 1 Department of Pediatrics, University of Pittsburgh School of Medicine , Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jill R Demirci
- 1 Department of Pediatrics, University of Pittsburgh School of Medicine , Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Debra L Bogen
- 1 Department of Pediatrics, University of Pittsburgh School of Medicine , Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ateev Mehrotra
- 2 Department of Healthcare Policy and Medicine, Harvard Medical School , Boston, Massachusetts.,3 RAND Corporation , Boston, Massachusetts
| | - Elizabeth Miller
- 1 Department of Pediatrics, University of Pittsburgh School of Medicine , Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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Resnicow K, McMaster F, Bocian A, Harris D, Zhou Y, Snetselaar L, Schwartz R, Myers E, Gotlieb J, Foster J, Hollinger D, Smith K, Woolford S, Mueller D, Wasserman RC. Motivational interviewing and dietary counseling for obesity in primary care: an RCT. Pediatrics 2015; 135:649-57. [PMID: 25825539 PMCID: PMC4379459 DOI: 10.1542/peds.2014-1880] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Few studies have tested the impact of motivational interviewing (MI) delivered by primary care providers on pediatric obesity. This study tested the efficacy of MI delivered by providers and registered dietitians (RDs) to parents of overweight children aged 2 through 8. METHODS Forty-two practices from the Pediatric Research in Office Settings Network of the American Academy of Pediatrics were randomly assigned to 1 of 3 groups. Group 1 (usual care) measured BMI percentile at baseline and 1- and 2-year follow-up. Group 2 (provider only) delivered 4 MI counseling sessions to parents of the index child over 2 years. Group 3 (provider + RD) delivered 4 provider MI sessions plus 6 MI sessions from a RD. The primary outcome was child BMI percentile at 2-year follow up. RESULTS At 2-year follow-up, the adjusted BMI percentile was 90.3, 88.1, and 87.1 for groups 1, 2, and 3, respectively. The group 3 mean was significantly (P = .02) lower than group 1. Mean changes from baseline in BMI percentile were 1.8, 3.8, and 4.9 across groups 1, 2, and 3. CONCLUSIONS MI delivered by providers and RDs (group 3) resulted in statistically significant reductions in BMI percentile. Research is needed to determine the clinical significance and persistence of the BMI effects observed. How the intervention can be brought to scale (in particular, how to train physicians to use MI effectively and how best to train RDs and integrate them into primary care settings) also merits future research.
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Affiliation(s)
- Kenneth Resnicow
- Department of Health Behavior & Health Education, School of Public Health, and
| | - Fiona McMaster
- Department of Health Behavior & Health Education, School of Public Health, and
| | - Alison Bocian
- Pediatric Research in Office Settings, Department of Research, American Academy of Pediatrics, Elk Grove Village, Illinois
| | - Donna Harris
- Pediatric Research in Office Settings, Department of Research, American Academy of Pediatrics, Elk Grove Village, Illinois
| | - Yan Zhou
- Department of Health Behavior & Health Education, School of Public Health, and
| | | | - Robert Schwartz
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Esther Myers
- Academy of Nutrition and Dietetics, Chicago, Illinois; and
| | - Jaquelin Gotlieb
- Pediatric Research in Office Settings, Department of Research, American Academy of Pediatrics, Elk Grove Village, Illinois
| | - Jan Foster
- Academy of Nutrition and Dietetics, Chicago, Illinois; and
| | - Donna Hollinger
- University of Iowa, College of Public Health, Iowa City, Iowa
| | - Karen Smith
- University of Iowa, College of Public Health, Iowa City, Iowa
| | - Susan Woolford
- Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Dru Mueller
- University of Iowa, College of Public Health, Iowa City, Iowa
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Fiks AG, Zhang P, Localio AR, Khan S, Grundmeier RW, Karavite DJ, Bailey C, Alessandrini EA, Forrest CB. Adoption of electronic medical record-based decision support for otitis media in children. Health Serv Res 2015; 50:489-513. [PMID: 25287670 PMCID: PMC4369219 DOI: 10.1111/1475-6773.12240] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Substantial investment in electronic health records (EHRs) has provided an unprecedented opportunity to use clinical decision support (CDS) to increase guideline adherence. To inform efforts to maximize adoption, we characterized the adoption of an otitis media (OM) CDS system, the impact of performance feedback on adoption, and the effects of adoption on guideline adherence. STUDY SETTING A total of 41,391 OM visits with 108 clinicians at 16 pediatric practices between February 2009 and August 2010. STUDY DESIGN Prospective cohort study of EHR-based CDS adoption during OM visits, comparing clinicians receiving performance feedback to none. CDS was available to all physicians; use was voluntary. DATA COLLECTION Extraction from a common EHR. PRINCIPAL FINDINGS Clinicians and practices used the CDS system for a mean of 21 percent (range: 0-85 percent) and 17 percent (0-51 percent) of eligible OM visits, respectively. Clinicians who received performance feedback reports summarizing CDS use and guideline adherence had a relative increase in CDS use of 9.0 percentage points compared to others (p = .001). CDS adoption was associated with increased OM guideline adherence. Effects were greatest among clinicians with the lowest adherence prior to the study. CONCLUSIONS Performance feedback increased CDS adoption, but additional strategies are needed to integrate CDS into primary care workflows.
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Affiliation(s)
- Alexander G Fiks
- Address correspondence to Alexander G. Fiks, M.D., M.S.C.E., The Children's Hospital of Philadelphia, 3535 Market Street, Room 1546, Philadelphia, PA 19104; e-mail:
| | - Peixin Zhang
- Alexander G. Fiks, M.D., M.S.C.E., The Children's Hospital of Philadelphia3535 Market Street, Room 1546, Philadelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., is with the The Pediatric Research Consortium, PolicyLab, and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Peixin Zhang, Ph.D., and Christopher B. Forrest, M.D., Ph.D., are with the Division of General Pediatrics, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- A. Russell Localio, Ph.D., is with the Department of Biostatistics and Epidemiology, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Saira Khan, M.P.H., is with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel HillChapel Hill, NC
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., and Dean J. Karavite, M.S.I., are with the Center for Biomedical Informatics (CBMI), The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., Charles Bailey, M.D., Ph.D., and Christopher B. Forrest, M.D., Ph.D., are also with the Department of Pediatrics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Evaline A. Alessandrini, M.D., M.S.C.E., is with the James M. Anderson Center for Health Systems Excellence and Division of Emergency Medicine, Cincinnati Children's Hospital Medical CenterCincinnati, OH
- Alexander G. Fiks, M.D., M.S.C.E., and Christopher B. Forrest, M.D., Ph.D., are with the Leonard Davis Institute of Health Economics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
| | - A Russell Localio
- Alexander G. Fiks, M.D., M.S.C.E., The Children's Hospital of Philadelphia3535 Market Street, Room 1546, Philadelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., is with the The Pediatric Research Consortium, PolicyLab, and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Peixin Zhang, Ph.D., and Christopher B. Forrest, M.D., Ph.D., are with the Division of General Pediatrics, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- A. Russell Localio, Ph.D., is with the Department of Biostatistics and Epidemiology, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Saira Khan, M.P.H., is with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel HillChapel Hill, NC
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., and Dean J. Karavite, M.S.I., are with the Center for Biomedical Informatics (CBMI), The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., Charles Bailey, M.D., Ph.D., and Christopher B. Forrest, M.D., Ph.D., are also with the Department of Pediatrics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Evaline A. Alessandrini, M.D., M.S.C.E., is with the James M. Anderson Center for Health Systems Excellence and Division of Emergency Medicine, Cincinnati Children's Hospital Medical CenterCincinnati, OH
- Alexander G. Fiks, M.D., M.S.C.E., and Christopher B. Forrest, M.D., Ph.D., are with the Leonard Davis Institute of Health Economics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
| | - Saira Khan
- Alexander G. Fiks, M.D., M.S.C.E., The Children's Hospital of Philadelphia3535 Market Street, Room 1546, Philadelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., is with the The Pediatric Research Consortium, PolicyLab, and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Peixin Zhang, Ph.D., and Christopher B. Forrest, M.D., Ph.D., are with the Division of General Pediatrics, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- A. Russell Localio, Ph.D., is with the Department of Biostatistics and Epidemiology, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Saira Khan, M.P.H., is with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel HillChapel Hill, NC
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., and Dean J. Karavite, M.S.I., are with the Center for Biomedical Informatics (CBMI), The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., Charles Bailey, M.D., Ph.D., and Christopher B. Forrest, M.D., Ph.D., are also with the Department of Pediatrics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Evaline A. Alessandrini, M.D., M.S.C.E., is with the James M. Anderson Center for Health Systems Excellence and Division of Emergency Medicine, Cincinnati Children's Hospital Medical CenterCincinnati, OH
- Alexander G. Fiks, M.D., M.S.C.E., and Christopher B. Forrest, M.D., Ph.D., are with the Leonard Davis Institute of Health Economics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
| | - Robert W Grundmeier
- Alexander G. Fiks, M.D., M.S.C.E., The Children's Hospital of Philadelphia3535 Market Street, Room 1546, Philadelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., is with the The Pediatric Research Consortium, PolicyLab, and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Peixin Zhang, Ph.D., and Christopher B. Forrest, M.D., Ph.D., are with the Division of General Pediatrics, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- A. Russell Localio, Ph.D., is with the Department of Biostatistics and Epidemiology, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Saira Khan, M.P.H., is with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel HillChapel Hill, NC
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., and Dean J. Karavite, M.S.I., are with the Center for Biomedical Informatics (CBMI), The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., Charles Bailey, M.D., Ph.D., and Christopher B. Forrest, M.D., Ph.D., are also with the Department of Pediatrics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Evaline A. Alessandrini, M.D., M.S.C.E., is with the James M. Anderson Center for Health Systems Excellence and Division of Emergency Medicine, Cincinnati Children's Hospital Medical CenterCincinnati, OH
- Alexander G. Fiks, M.D., M.S.C.E., and Christopher B. Forrest, M.D., Ph.D., are with the Leonard Davis Institute of Health Economics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
| | - Dean J Karavite
- Alexander G. Fiks, M.D., M.S.C.E., The Children's Hospital of Philadelphia3535 Market Street, Room 1546, Philadelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., is with the The Pediatric Research Consortium, PolicyLab, and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Peixin Zhang, Ph.D., and Christopher B. Forrest, M.D., Ph.D., are with the Division of General Pediatrics, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- A. Russell Localio, Ph.D., is with the Department of Biostatistics and Epidemiology, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Saira Khan, M.P.H., is with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel HillChapel Hill, NC
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., and Dean J. Karavite, M.S.I., are with the Center for Biomedical Informatics (CBMI), The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., Charles Bailey, M.D., Ph.D., and Christopher B. Forrest, M.D., Ph.D., are also with the Department of Pediatrics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Evaline A. Alessandrini, M.D., M.S.C.E., is with the James M. Anderson Center for Health Systems Excellence and Division of Emergency Medicine, Cincinnati Children's Hospital Medical CenterCincinnati, OH
- Alexander G. Fiks, M.D., M.S.C.E., and Christopher B. Forrest, M.D., Ph.D., are with the Leonard Davis Institute of Health Economics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
| | - Charles Bailey
- Alexander G. Fiks, M.D., M.S.C.E., The Children's Hospital of Philadelphia3535 Market Street, Room 1546, Philadelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., is with the The Pediatric Research Consortium, PolicyLab, and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Peixin Zhang, Ph.D., and Christopher B. Forrest, M.D., Ph.D., are with the Division of General Pediatrics, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- A. Russell Localio, Ph.D., is with the Department of Biostatistics and Epidemiology, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Saira Khan, M.P.H., is with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel HillChapel Hill, NC
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., and Dean J. Karavite, M.S.I., are with the Center for Biomedical Informatics (CBMI), The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., Charles Bailey, M.D., Ph.D., and Christopher B. Forrest, M.D., Ph.D., are also with the Department of Pediatrics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Evaline A. Alessandrini, M.D., M.S.C.E., is with the James M. Anderson Center for Health Systems Excellence and Division of Emergency Medicine, Cincinnati Children's Hospital Medical CenterCincinnati, OH
- Alexander G. Fiks, M.D., M.S.C.E., and Christopher B. Forrest, M.D., Ph.D., are with the Leonard Davis Institute of Health Economics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
| | - Evaline A Alessandrini
- Alexander G. Fiks, M.D., M.S.C.E., The Children's Hospital of Philadelphia3535 Market Street, Room 1546, Philadelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., is with the The Pediatric Research Consortium, PolicyLab, and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Peixin Zhang, Ph.D., and Christopher B. Forrest, M.D., Ph.D., are with the Division of General Pediatrics, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- A. Russell Localio, Ph.D., is with the Department of Biostatistics and Epidemiology, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Saira Khan, M.P.H., is with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel HillChapel Hill, NC
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., and Dean J. Karavite, M.S.I., are with the Center for Biomedical Informatics (CBMI), The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., Charles Bailey, M.D., Ph.D., and Christopher B. Forrest, M.D., Ph.D., are also with the Department of Pediatrics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Evaline A. Alessandrini, M.D., M.S.C.E., is with the James M. Anderson Center for Health Systems Excellence and Division of Emergency Medicine, Cincinnati Children's Hospital Medical CenterCincinnati, OH
- Alexander G. Fiks, M.D., M.S.C.E., and Christopher B. Forrest, M.D., Ph.D., are with the Leonard Davis Institute of Health Economics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
| | - Christopher B Forrest
- Alexander G. Fiks, M.D., M.S.C.E., The Children's Hospital of Philadelphia3535 Market Street, Room 1546, Philadelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., is with the The Pediatric Research Consortium, PolicyLab, and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Peixin Zhang, Ph.D., and Christopher B. Forrest, M.D., Ph.D., are with the Division of General Pediatrics, The Children's Hospital of PhiladelphiaPhiladelphia, PA
- A. Russell Localio, Ph.D., is with the Department of Biostatistics and Epidemiology, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Saira Khan, M.P.H., is with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel HillChapel Hill, NC
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., and Dean J. Karavite, M.S.I., are with the Center for Biomedical Informatics (CBMI), The Children's Hospital of PhiladelphiaPhiladelphia, PA
- Alexander G. Fiks, M.D., M.S.C.E., Robert W. Grundmeier, M.D., Charles Bailey, M.D., Ph.D., and Christopher B. Forrest, M.D., Ph.D., are also with the Department of Pediatrics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
- Evaline A. Alessandrini, M.D., M.S.C.E., is with the James M. Anderson Center for Health Systems Excellence and Division of Emergency Medicine, Cincinnati Children's Hospital Medical CenterCincinnati, OH
- Alexander G. Fiks, M.D., M.S.C.E., and Christopher B. Forrest, M.D., Ph.D., are with the Leonard Davis Institute of Health Economics, Perelman School of Medicine of the University of PennsylvaniaPhiladelphia, PA
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Cornell E, Chandhok L, Rubin K. Implementation of referral guidelines at the interface between pediatric primary and subspecialty care. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2015; 3:74-9. [PMID: 26179727 DOI: 10.1016/j.hjdsi.2015.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 12/26/2014] [Accepted: 02/08/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND In pediatric medicine, inadequate access to subspecialty care is widespread. Referral Guidelines are structured tools that describe criteria for subspecialty referral and may decrease medically unnecessary referrals and thereby improve access. PROBLEM Variation in referral rates and suboptimal communication around pediatric subspecialty referrals leads to inappropriate and ineffective use of scarce clinical resources. GOALS Connecticut Children׳s Medical Center prioritized the development of collaborative care tools at the interface between primary and subspecialty care, including Referral Guidelines. STRATEGY A comprehensive set of Referral Guidelines was developed and consisted of background information on a given condition, strategies for initial evaluation and management, instructions for how and when to refer, and what the patient and family could expect at the visit with the subspecialist. A key component of the initiative was the integral role of the PCP during development. RESULTS Twenty-eight Referral Guidelines have been developed among 15 subspecialty areas. A novel process for active dissemination of Referral Guidelines was piloted in one medical subspecialty area and led to a reduction in overall referrals and an increase in the proportion of referrals meeting the necessary criteria.
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Affiliation(s)
- Erin Cornell
- Connecticut Children׳s Medical Center, Hartford, CT, USA
| | | | - Karen Rubin
- Connecticut Children׳s Medical Center, Hartford, CT, USA.
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45
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Auger KA, Simon TD, Cooperberg D, Gay J, Kuo DZ, Saysana M, Stille CJ, Fisher ES, Wallace S, Berry J, Coghlin D, Jhaveri V, Kairys S, Logsdon T, Shaikh U, Srivastava R, Starmer AJ, Wilkins V, Shen MW. Summary of STARNet: Seamless Transitions and (Re)admissions Network. Pediatrics 2015; 135:164-75. [PMID: 25489017 PMCID: PMC4279069 DOI: 10.1542/peds.2014-1887] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The Seamless Transitions and (Re)admissions Network (STARNet) met in December 2012 to synthesize ongoing hospital-to-home transition work, discuss goals, and develop a plan to centralize transition information in the future. STARNet participants consisted of experts in the field of pediatric hospital medicine quality improvement and research, and included physicians and key stakeholders from hospital groups, private payers, as well as representatives from current transition collaboratives. In this report, we (1) review the current knowledge regarding hospital-to-home transitions; (2) outline the challenges of measuring and reducing readmissions; and (3) highlight research gaps and list potential measures for transition quality. STARNet met with the support of the American Academy of Pediatrics' Quality Improvement Innovation Networks and the Section on Hospital Medicine.
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Affiliation(s)
- Katherine A. Auger
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Tamara D. Simon
- Division of Hospital Medicine, Department of Pediatrics, University of Washington and Seattle Children’s Hospital, Seattle, Washington
| | - David Cooperberg
- St. Christopher’s Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - James Gay
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Dennis Z. Kuo
- Arkansas Children’s Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Michele Saysana
- Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Christopher J. Stille
- General Academic Pediatrics, University of Colorado School of Medicine/Children’s Hospital Colorado, Aurora, Colorado
| | - Erin Stucky Fisher
- University of California San Diego School of Medicine, San Diego, California
| | - Sowdhamini Wallace
- Section of Hospital Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
| | - Jay Berry
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital; Harvard Medical School, Boston, Massachusetts
| | - Daniel Coghlin
- Hasbro Children’s Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Vishu Jhaveri
- Blue Cross Blue Shield of Arizona representing Blue Cross Blue Shield Association, Phoenix, Arizona
| | - Steven Kairys
- Jersey Shore Medical Center, Neptune Township, New Jersey
| | - Tina Logsdon
- Children’s Hospital Association, Overland Park, Kansas
| | - Ulfat Shaikh
- University of California Davis Health System, Sacramento, California
| | - Rajendu Srivastava
- Division of Inpatient Medicine, Department of Pediatrics, Primary Children’s Hospital, University of Utah, Salt Lake City, Utah; and
| | - Amy J. Starmer
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital; Harvard Medical School, Boston, Massachusetts
| | - Victoria Wilkins
- Division of Inpatient Medicine, Department of Pediatrics, Primary Children’s Hospital, University of Utah, Salt Lake City, Utah; and
| | - Mark W. Shen
- Dell Medical School, University of Texas Austin, Austin, Texas
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Bisgaier J, Rhodes KV, Polsky D. Factors associated with increased specialty care access in an urban area: the roles of local workforce capacity and practice location. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2014; 39:1173-1183. [PMID: 25248959 DOI: 10.1215/03616878-2829214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This article explores how a specialty type's local workforce capacity and a specialty practice's location relate to the likelihood of denying care to children covered by Medicaid and the Children's Health Insurance Program (CHIP) while accepting private insurance. Data on discriminatory denials of care to children with public insurance came from an audit study involving 273 practices across seven medical specialties serving children in Cook County, Illinois. These data were linked to physician workforce data and neighborhood poverty data to test for associations with discriminatory denials of public insurance, after adjusting for control variables. In a large metropolitan county, discriminatory denials of specialty care access for publicly insured children were attenuated for specialty types with greater local workforce capacity (odds ratio [OR]: 0.74, 95 percent; confidence interval [CI]: 0.57-0.98) and for practices located in higher-poverty neighborhoods (OR: 0.95, 95 percent; CI: 0.93-0.98). Although limited as a single-site study, our findings support the widespread consensus that payment rates are the strongest driver of decisions to serve patients enrolled in public insurance programs. At a time when state and federal budgets are under strain, ensuring access equity for children covered by Medicaid and CHIP may require policies focused on economic levers tailored based on practice location.
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Ritzema AM, Sladeczek IE, Ghosh S, Karagiannakis A, Manay-Quian N. Improving Outcomes for Children With Developmental Disabilities Through Enhanced Communication and Collaboration Between School Psychologists and Physicians. CANADIAN JOURNAL OF SCHOOL PSYCHOLOGY 2014. [DOI: 10.1177/0829573514536529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A renewed call for enhanced communication and collaboration between school psychology and medicine is envisioned, in light of a transdisciplinary model, where school psychologists, family physicians, and other health professionals transcend disciplinary boundaries. Recommendations for optimal communication and collaboration are described, as well as challenges inherent in such an endeavor. School psychologist–physician collaboration has the potential to result in significant improvements in outcomes for families and children with developmental disabilities. A case illustration highlights the major points mirrored in the discussion, and conclusions are drawn regarding necessary components for meaningful change to occur.
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Affiliation(s)
| | | | - Shuvo Ghosh
- McGill University/Montreal Children’s Hospital, Montréal, Québec, Canada
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Lynch S. Social workers in pediatric primary care: communication, gender, and scope of practice. SOCIAL WORK IN HEALTH CARE 2014; 53:115-134. [PMID: 24483332 DOI: 10.1080/00981389.2013.851141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
While many child mental health issues manifest themselves in primary care, few pediatricians have received mental health training, and their communication with social workers may be limited due to unfamiliarity with mental health professions. The purpose of this study was to use ethnographic interviews to investigate factors affecting communication satisfaction between social workers and pediatricians. The study found that scope of practice issues were a communication barrier. This barrier is significant because health reform may lead social workers and pediatricians to collaborate more frequently in the future.
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Affiliation(s)
- Sean Lynch
- a Department of Psychiatry , University of Florida , Jacksonville , Florida , USA
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van de Pol AC, van der Gugten AC, van der Ent CK, Schilder AGM, Benthem EM, Smit HA, Stellato RK, de Wit NJ, Damoiseaux RA. Referrals for recurrent respiratory tract infections including otitis media in young children. Int J Pediatr Otorhinolaryngol 2013; 77:906-10. [PMID: 23566424 DOI: 10.1016/j.ijporl.2013.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 02/25/2013] [Accepted: 03/02/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE (a) To establish whether disease-related, child-related, and physician-related factors are independently associated with specialist referral in young children with recurrent RTI, and (b) to evaluate whether general practitioners (GPs) follow current guidelines regarding these referrals. METHODS Electronic GP records of children under 24 month of age, born 2002-2008, were reviewed for RTI episodes using ICPC codes. Child-related factors were extracted from the prospective WHISTLER birth-cohort in which a considerable part of children had been enrolled. To evaluate guideline adherence, referral data were compared to national guideline recommendations. RESULTS Consultations for 2532 RTI episodes (1041 children) were assessed. Seventy-eight children were referred for recurrent RTI (3.1% of RTI episodes; 7.5% of children). Disease factors were the main determinants of referral: number (OR 1.7 [CI 1.7-1.7]) and severity of previous RTI episodes (OR 2.2 [CI 1.6-2.8]), and duration of RTI episode (OR 1.7 [CI 1.7-1.8]). The non-disease factors daycare attendance (OR 1.3 [CI 1.0-1.7]) and 5-10 years working experience as a GP compared with <5 years (OR 0.37 [CI 0.27-0.50]) were also associated. Fifty-seven percent of referrals for recurrent RTI were made in accordance with national guidelines. CONCLUSIONS Referral of children for recurrent RTI was primarily determined by frequency, severity, and duration of RTIs; the influence of non-disease factors was limited. Just over half of referrals were made in accordance with guidelines.
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Affiliation(s)
- Alma C van de Pol
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
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