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Assaf RR, Assaf RD, Padlipsky PS, Young KDA. A family-centered approach to social needs awareness in the pediatric emergency department. PEC INNOVATION 2024; 4:100283. [PMID: 38689830 PMCID: PMC11059452 DOI: 10.1016/j.pecinn.2024.100283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 02/01/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024]
Abstract
Objective We aimed to understand family preferences around reporting and receiving health-related social needs (HRSN) information by assessment modality during pediatric emergency department (PED) visits. Methods Families were randomized into paper (control), cell phone, or tablet modality groups by their child's exam room. Nurses alerted families to complete a single HRSN assessment during routine workflow. We used logistic regression and McNemar's test to assess discordance in modality preference. Results Forty-seven percent of families disclosed at least one HRSN across a total 611 assessments. Disclosure of HRSN was similar by modality. Twenty-three percent of those assigned tablet preferred cell phone (p < 0.001). Two-thirds of families preferred receiving digitally formatted community resources (email or text). There was no difference in preferred timing of HRSN assessment completion. Conclusions Assessment modality did not appear to influence family HRSN disclosure. Families were generally satisfied with all HRSN assessment modalities but demonstrated a particular preference in using personal cell phones over tablets. Digitally formatted community referrals also pose numerous advantages over conventional paper handouts. Innovation Use of personal cell phones is a novel, streamlined method of HRSN interventions in the clinical setting, performing similar to more conventional modalities, with a preference among families when compared to tablets.
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Affiliation(s)
- Raymen Rammy Assaf
- Emergency Medicine Specialists of Orange County, Children's Hospital Orange County, Orange, USA
- Department of Pediatrics, University of California, Irvine (UCI) School of Medicine, Irvine, USA
| | - Ryan David Assaf
- Benioff Homelessness and Housing Initiative, Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, USA
| | - Patricia Sencer Padlipsky
- Department of Emergency Medicine, Harbor-University of California, Los Angeles (UCLA) Medical Center, Torrance, USA
| | - Kelly Dee Ann Young
- Department of Emergency Medicine, Harbor-University of California, Los Angeles (UCLA) Medical Center, Torrance, USA
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Islam F, Fiori KP, Rinke ML, Acholonu R, Luke MJ, Cabrera KI, Chandhoke S, Friedland SE, McKenna KJ, Braganza SF, Philips K. Implementing Inpatient Social Needs Screening in an Urban Tertiary Care Children's Hospital. Hosp Pediatr 2024:e2023007486. [PMID: 38742306 DOI: 10.1542/hpeds.2023-007486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND AND OBJECTIVES The American Academy of Pediatrics recommends screening for unmet social needs, and the literature on inpatient screening implementation is growing. Our aim was to use quality improvement methods to implement standardized social needs screening in hospitalized pediatric patients. METHODS We implemented inpatient social needs screening using the Model for Improvement. An interprofessional team trialed interventions in a cyclical manner using plan-do-study-act cycles. Interventions included a structured screening questionnaire, standardized screening and referrals workflows, electronic health record (EHR) modifications, and house staff education, deliberate practice, and feedback. The primary outcome measure was the percentage of discharged patients screened for social needs. Screening for social needs was defined as a completed EHR screening questionnaire or a full social work evaluation. Process and balancing measures were collected to capture data on screening questionnaire completion and social work consultations. Data were plotted on statistical process control charts and analyzed for special cause variation. RESULTS The mean monthly percentage of patients screened for social needs improved from 20% at baseline to 51% during the intervention period. Special cause variation was observed for the percentage of patients with completed social needs screening, EHR-documented screening questionnaires, and social work consults. CONCLUSIONS Social needs screening during pediatric hospitalization can be implemented by using quality improvement methods. The next steps should be focused on sustainability and the spread of screening. Interventions with greater involvement of interdisciplinary health care team members will foster process sustainability and allow for the spread of screening interventions to the wider hospitalized pediatric population.
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Affiliation(s)
- Fahmida Islam
- Department of Pediatrics, Children's Hospital at Montefiore, Montefiore Medical Center
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Kevin P Fiori
- Department of Pediatrics
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Michael L Rinke
- Department of Pediatrics, Children's Hospital at Montefiore, Montefiore Medical Center
| | - Rhonda Acholonu
- Department of Pediatrics, Children's Hospital at Montefiore, Montefiore Medical Center
| | - Michael J Luke
- Department of Pediatrics, Children's Hospital at Montefiore, Montefiore Medical Center
| | - Keven I Cabrera
- Department of Pediatrics, Children's Hospital at Montefiore, Montefiore Medical Center
| | - Swati Chandhoke
- Department of Pediatrics, Children's Hospital at Montefiore, Montefiore Medical Center
| | - Sarah E Friedland
- Department of Pediatrics, Children's Hospital at Montefiore, Montefiore Medical Center
| | - Kevin J McKenna
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Sandra F Braganza
- Department of Pediatrics
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Kaitlyn Philips
- Department of Pediatrics, Children's Hospital at Montefiore, Montefiore Medical Center
- Department of Pediatrics, Hackensack Meridian Children's Health, Hackensack School of Medicine, Hackensack, New Jersey
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Vasan A, Negro D, Yazdani M, Benitez L, Virudachalam S, Kenyon CC, Fiks AG. Caregiver Preferences for Primary Care Clinic-Based Food Assistance: A Discrete Choice Experiment. Acad Pediatr 2024; 24:619-626. [PMID: 38403156 DOI: 10.1016/j.acap.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE The American Academy of Pediatrics recommends that pediatric providers screen families for food insecurity and connect them to appropriate resources. However, it is unclear how clinics can best provide families with resources consistent with their needs and preferences. In this study, we elicited caregiver preferences for clinic-based food assistance. METHODS We conducted a cross-sectional discrete choice experiment in which caregivers at 2 pediatric primary care clinics were asked to choose between hypothetical food programs. Programs varied across 4 categories: 1) resources provided (eg, food delivery, food in clinic, assistance enrolling in benefits); 2) support staff providing resources (eg, social worker, community health worker, physician, or nurse); 3) outreach modality (eg, phone, email, text); and 4) outreach frequency. Multinomial logistic regression was used to assess caregiver preferences within each category and the relative importance of each category to caregiver decisions. RESULTS We surveyed 142 caregivers who were predominantly Black (87%) and Medicaid-insured (90%). Caregiver preferences for food programs were most strongly influenced by the food resources provided. Caregivers preferred food delivery over other forms of food supports, such as food provided in clinic. They preferred assistance from a benefits enrollment specialist, community health worker, or social worker to assistance from a physician or nurse. CONCLUSIONS Pediatric clinics serving families at risk of food insecurity should use caregiver preferences to inform the design of family-centered interventions. Clinics should consider connecting caregivers with food delivery programs, and pediatric payors should adopt reimbursement models that support multidisciplinary team-based care to address food insecurity.
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Affiliation(s)
- Aditi Vasan
- Department of Pediatrics (A Vasan, DR Negro, S Virudachalam, CC Kenyon, and AG Fiks), Perelman School of Medicine, University of Pennsylvania, Philadelphia; PolicyLab and Clinical Futures, Department of Pediatrics, (A Vasan, DR Negro, M Yazdani, L Benitez, S Virudachalam, CC Kenyon, and AG Fiks), Children's Hospital of Philadelphia, Pa.
| | - DanaRose Negro
- Department of Pediatrics (A Vasan, DR Negro, S Virudachalam, CC Kenyon, and AG Fiks), Perelman School of Medicine, University of Pennsylvania, Philadelphia; PolicyLab and Clinical Futures, Department of Pediatrics, (A Vasan, DR Negro, M Yazdani, L Benitez, S Virudachalam, CC Kenyon, and AG Fiks), Children's Hospital of Philadelphia, Pa.
| | - Mishaal Yazdani
- PolicyLab and Clinical Futures, Department of Pediatrics, (A Vasan, DR Negro, M Yazdani, L Benitez, S Virudachalam, CC Kenyon, and AG Fiks), Children's Hospital of Philadelphia, Pa.
| | - Lindsay Benitez
- PolicyLab and Clinical Futures, Department of Pediatrics, (A Vasan, DR Negro, M Yazdani, L Benitez, S Virudachalam, CC Kenyon, and AG Fiks), Children's Hospital of Philadelphia, Pa; Sidney Kimmel Medical College at Jefferson University (L Benitez), Philadelphia, Pa.
| | - Senbagam Virudachalam
- Department of Pediatrics (A Vasan, DR Negro, S Virudachalam, CC Kenyon, and AG Fiks), Perelman School of Medicine, University of Pennsylvania, Philadelphia; PolicyLab and Clinical Futures, Department of Pediatrics, (A Vasan, DR Negro, M Yazdani, L Benitez, S Virudachalam, CC Kenyon, and AG Fiks), Children's Hospital of Philadelphia, Pa.
| | - Chén C Kenyon
- Department of Pediatrics (A Vasan, DR Negro, S Virudachalam, CC Kenyon, and AG Fiks), Perelman School of Medicine, University of Pennsylvania, Philadelphia; PolicyLab and Clinical Futures, Department of Pediatrics, (A Vasan, DR Negro, M Yazdani, L Benitez, S Virudachalam, CC Kenyon, and AG Fiks), Children's Hospital of Philadelphia, Pa.
| | - Alexander G Fiks
- Department of Pediatrics (A Vasan, DR Negro, S Virudachalam, CC Kenyon, and AG Fiks), Perelman School of Medicine, University of Pennsylvania, Philadelphia; PolicyLab and Clinical Futures, Department of Pediatrics, (A Vasan, DR Negro, M Yazdani, L Benitez, S Virudachalam, CC Kenyon, and AG Fiks), Children's Hospital of Philadelphia, Pa.
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Assaf RR, Assaf RD, Doucet HB, Graff D. Social Care Education and Training Among US Pediatric Emergency Medicine Fellowship Programs. Pediatr Emerg Care 2024:00006565-990000000-00425. [PMID: 38563810 DOI: 10.1097/pec.0000000000003168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVE The aim of the study is to assess the association of social determinants of health (SDOH) education and social needs training on pediatric emergency medicine (PEM) physician perception and practices of social care. METHODS Data were derived from the 2021 National Social Care Practices Survey of PEM program directors (PDs) and fellows. Ordinal and binary logistic regression modeling were completed for educational/training factors and social care perspective and practice outcomes. RESULTS A national sample of 44 PDs (49% response rate) and 109 fellows (28%) participated. A minority of fellows received SDOH education and social needs training during fellowship. Fellows and PDs with SDOH education had a 3.1 odds (95% confidence interval CI, 1.4-6.9) of screening for social needs, with 4.4 odds among fellows (95% CI, 1.2-20.7). Those with social needs training were more comfortable assessing social risk, with 2.4 odds overall (95% CI, 1.2-4.7) and 3.1 odds among fellows (95% CI, 1.4-6.7). They also had 2.4 odds overall (95% CI, 1.1-4.9) of screening for social needs, with a 2.9 odds among fellows (95% CI, 1.3-6.8). CONCLUSIONS Social care education and training appear to be associated with comfort assessing social risk and social needs screening tendency among both PEM PDs and fellows. Key areas for educational interventions are identified among PEM fellows, who are uniquely positioned as clinical leaders and patient advocates.
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Affiliation(s)
| | | | - Hannah Barber Doucet
- Hasbro Children's Hospital, Alpert Medical School at Brown University, Providence, RI
| | - Danielle Graff
- Norton Children's Hospital, University of Louisville, School of Medicine, Louisville, KT
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Amjad S, Tromburg C, Adesunkanmi M, Mawa J, Mahbub N, Campbell S, Chari R, Rowe BH, Ospina MB. Social Determinants of Health and Pediatric Emergency Department Outcomes: A Systematic Review and Meta-Analysis of Observational Studies. Ann Emerg Med 2024; 83:291-313. [PMID: 38069966 DOI: 10.1016/j.annemergmed.2023.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 10/03/2023] [Accepted: 10/20/2023] [Indexed: 03/24/2024]
Abstract
STUDY OBJECTIVE Social determinants of health contribute to disparities in pediatric health and health care. Our objective was to synthesize and evaluate the evidence on the association between social determinants of health and emergency department (ED) outcomes in pediatric populations. METHODS This review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity Extension guidelines. Observational epidemiological studies were included if they examined at least 1 social determinant of health from the PROGRESS-Plus framework in relation to ED outcomes among children <18 years old. Effect direction plots were used for narrative results and pooled odds ratios (pOR) with 95% confidence intervals (CI) for meta-analyses. RESULTS Fifty-eight studies were included, involving 17,275,090 children and 103,296,839 ED visits. Race/ethnicity and socioeconomic status were the most reported social determinants of health (71% each). Black children had 3 times the odds of utilizing the ED (pOR 3.16, 95% CI 2.46 to 4.08), whereas visits by Indigenous children increased the odds of departure prior to completion of care (pOR 1.58, 95% CI 1.39 to 1.80) compared to White children. Public insurance, low income, neighborhood deprivation, and proximity to an ED were also predictors of ED utilization. Children whose caregivers had a preferred language other than English had longer length of stay and increased hospital admission. CONCLUSION Social determinants of health, particularly race, socioeconomic deprivation, proximity to an ED, and language, play important roles in ED care-seeking patterns of children and families. Increased utilization of ED services by children from racial minority and lower socioeconomic status groups may reflect barriers to health insurance and access to health care, including primary and subspecialty care, and/or poorer overall health, necessitating ED care. An intersectional approach is needed to better understand the trajectories of disparities in pediatric ED outcomes and to develop, implement, and evaluate future policies.
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Affiliation(s)
- Sana Amjad
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Courtney Tromburg
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Adesunkanmi
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Jannatul Mawa
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Nazif Mahbub
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Sandra Campbell
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | - Radha Chari
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Brian H Rowe
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Maria B Ospina
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada; Department of Public Health Sciences, Queen's University; Kingston, Ontario, Canada.
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Tepe KA, Auger KA, Rodas Marquez S, Atarama D, Sauers-Ford HS. Evaluating Screening to Assess Endorsement of Food Insecurity in the Inpatient Setting. Hosp Pediatr 2024; 14:e201-e205. [PMID: 38454835 DOI: 10.1542/hpeds.2023-007164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE Rates of food insecurity (FI) from screening in the inpatient setting is often not reflective of community prevalence, indicating that screening likely misses families with FI. We aimed to determine the combination of FI screening questions and methods that would result in identifying a percentage of FI families that matched or exceeded our area prevalence (approximately 20%). METHODS Research staff approached eligible English- and Spanish-speaking families across 4 inpatient units once weekly and screened for FI using a randomly selected method (face-to-face, phone, paper, and tablet). We asked questions from the 6-Item USDA Survey, Hunger Vital Sign screener, and questions utilized by our social workers. RESULTS We screened 361 families; 19.4% (N = 70) endorsed FI. Differences in rates were not significant by method. Differences in FI rates based on screening questions were: 17.7% for the 6-item USDA survey, 16.0% for Hunger Vital Sign, and 3.1% for the social work questions. When considering method and screening questions together, the 6-Item USDA on paper had the highest positivity rate of 20.9%. A higher percentage of Spanish-speaking families endorsed FI (61.1%) compared to 17.2% of English-speaking families (P < .01). Positivity also varied significantly by self-identified race (P < .01). Caregivers that identified as Hispanic or Latino were significantly more likely to endorse FI than those that did not (P < .01). CONCLUSIONS The positivity rate for FI while screening inpatient families using the 6-Item screening questions on paper matched our community prevalence of FI (approximately 20%).
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Affiliation(s)
| | - Katherine A Auger
- Division of Hospital Medicine
- James Anderson Center
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Denise Atarama
- Division of Nutritional Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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McCrory MC, Akande M, Slain KN, Kennedy CE, Winter MC, Stottlemyre MG, Wakeham MK, Barnack KA, Huang JX, Sharma M, Zurca AD, Pinto NP, Dziorny AC, Maddux AB, Garg A, Woodruff AG, Hartman ME, Timmons OD, Heidersbach RS, Cisco MJ, Sochet AA, Wells BJ, Halvorson EE, Saha AK. Child Opportunity Index and Pediatric Intensive Care Outcomes: A Multicenter Retrospective Study in the United States. Pediatr Crit Care Med 2024; 25:323-334. [PMID: 38088770 DOI: 10.1097/pcc.0000000000003427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVES To evaluate for associations between a child's neighborhood, as categorized by Child Opportunity Index (COI 2.0), and 1) PICU mortality, 2) severity of illness at PICU admission, and 3) PICU length of stay (LOS). DESIGN Retrospective cohort study. SETTING Fifteen PICUs in the United States. PATIENTS Children younger than 18 years admitted from 2019 to 2020, excluding those after cardiac procedures. Nationally-normed COI category (very low, low, moderate, high, very high) was determined for each admission by census tract, and clinical features were obtained from the Virtual Pediatric Systems LLC (Los Angeles, CA) data from each site. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Among 33,901 index PICU admissions during the time period, median patient age was 4.9 years and PICU mortality was 2.1%. There was a higher percentage of admissions from the very low COI category (27.3%) than other COI categories (17.2-19.5%, p < 0.0001). Patient admissions from the high and very high COI categories had a lower median Pediatric Index of Mortality 3 risk of mortality (0.70) than those from the very low, low, and moderate COI groups (0.71) ( p < 0.001). PICU mortality was lowest in the very high (1.7%) and high (1.9%) COI groups and highest in the moderate group (2.5%), followed by very low (2.3%) and low (2.2%) ( p = 0.001 across categories). Median PICU LOS was between 1.37 and 1.50 days in all COI categories. Multivariable regression revealed adjusted odds of PICU mortality of 1.30 (95% CI, 0.94-1.79; p = 0.11) for children from a very low versus very high COI neighborhood, with an odds ratio [OR] of 0.996 (95% CI, 0.993-1.00; p = 0.05) for mortality for COI as an ordinal value from 0 to 100. Children without insurance coverage had an OR for mortality of 3.58 (95% CI, 2.46-5.20; p < 0.0001) as compared with those with commercial insurance. CONCLUSIONS Children admitted to a cohort of U.S. PICUs were often from very low COI neighborhoods. Children from very high COI neighborhoods had the lowest risk of mortality and observed mortality; however, odds of mortality were not statistically different by COI category in a multivariable model. Children without insurance coverage had significantly higher odds of PICU mortality regardless of neighborhood.
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Affiliation(s)
- Michael C McCrory
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Manzilat Akande
- Pediatrics, Oklahoma University Health Sciences Center, Oklahoma City, OK
| | - Katherine N Slain
- Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH
| | | | - Meredith C Winter
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | | | - Kyle A Barnack
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Jia Xin Huang
- Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA
- Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA
| | - Meesha Sharma
- Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA
- Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA
| | - Adrian D Zurca
- Pediatrics, Northwestern University Feinberg School of Medicine and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Neethi P Pinto
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Adam C Dziorny
- Pediatrics, University of Rochester School of Medicine, Rochester, NY
| | - Aline B Maddux
- Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Anjali Garg
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Charlotte Bloomberg Children's Center, Baltimore, MD
| | - Alan G Woodruff
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Mary E Hartman
- Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Otwell D Timmons
- Pediatrics, Atrium Health Levine Children's Hospital, Charlotte, NC
| | - R Scott Heidersbach
- Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Michael J Cisco
- Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA
| | - Anthony A Sochet
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Brian J Wells
- Department of Biostatistics and Data Science; Wake Forest University School of Medicine, Winston-Salem, NC
| | - Elizabeth E Halvorson
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Amit K Saha
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC
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Messineo E, Bouchelle Z, Strange A, Ciarlante A, VonHoltz L, Murray A, Cullen D. Phone Versus In-Person Navigation of Social Needs and Caregivers' Desire for Resources in the Pediatric Emergency Department. Acad Pediatr 2024; 24:461-468. [PMID: 38159598 DOI: 10.1016/j.acap.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To determine the association between in-person versus telephone-based contact by a resource navigator and caregivers' expressed desire for community-based resources to meet social needs in a pediatric emergency department (PED). METHODS This retrospective observational study used data from the PED in a large, metropolitan, academic children's hospital. Families were approached by resource navigators and offered community-based resources either in-person or by phone during waiting periods in the PED exam room. We used descriptive statistics and chi-square analysis to summarize demographics and mode of contact, and simple and multivariable logistic regression to estimate the association between desire for resources and mode of contact. RESULTS Contact was attempted among 4902 caregivers, with 2918 (59.5%) caregivers approached in-person, 1913 (39.0%) approached by phone, and 71 (1.5%) with no mode of contact recorded. Resource navigators successfully reached 2738 (93.8%) caregivers approached in-person and 1432 (74.9%) caregivers approached by phone. Of caregivers successfully reached, 782 (18.8%) desired resources; 526 (19.2%) in-person, and 256 (17.9%) by phone. Caregivers contacted by phone were no more or less likely to desire resources than caregivers contacted in-person in unadjusted (odds ratio (OR) = 0.92, 95% confidence interval (CI) = 0.78-1.08) and adjusted analyses (OR = 0.92, 95% CI = 0.77-1.09). CONCLUSIONS Within a large, urban PED, caregivers' expressed desire for community-based resources was no different whether a caregiver was engaged in-person or by phone. This suggests caregivers may be equally receptive to discussing social needs and community-based resources remotely versus in-person. More work is needed to examine if rates of resource connection differ by mode of contact.
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Affiliation(s)
- Elizabeth Messineo
- Children's Hospital at Montefiore (E Messineo), Montefiore Medical Center, Bronx, NY.
| | - Zoe Bouchelle
- National Clinician Scholars Program (Z Bouchelle), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Department of Pediatrics (Z Bouchelle, L VonHoltz, A Murray, and D Cullen), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; PolicyLab (Z Bouchelle and D Cullen), Children's Hospital of Philadelphia, Philadelphia, Pa; Leonard Davis Institute of Health Economics (Z Bouchelle, L VonHoltz, A Murray, and D Cullen), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
| | - Alder Strange
- Perelman School of Medicine (A Strange), University of Pennsylvania, Philadelphia, Pa.
| | - Alyssa Ciarlante
- Center for Healthcare Quality and Analytics (A Ciarlante), Children's Hospital of Philadelphia, Philadelphia, Pa.
| | - Lauren VonHoltz
- Department of Pediatrics (Z Bouchelle, L VonHoltz, A Murray, and D Cullen), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Leonard Davis Institute of Health Economics (Z Bouchelle, L VonHoltz, A Murray, and D Cullen), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
| | - Ashlee Murray
- Department of Pediatrics (Z Bouchelle, L VonHoltz, A Murray, and D Cullen), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Leonard Davis Institute of Health Economics (Z Bouchelle, L VonHoltz, A Murray, and D Cullen), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Center for Violence Prevention (A Murray), Children's Hospital of Philadelphia, Philadelphia, Pa.
| | - Danielle Cullen
- Department of Pediatrics (Z Bouchelle, L VonHoltz, A Murray, and D Cullen), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; PolicyLab (Z Bouchelle and D Cullen), Children's Hospital of Philadelphia, Philadelphia, Pa; Leonard Davis Institute of Health Economics (Z Bouchelle, L VonHoltz, A Murray, and D Cullen), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Clinical Futures (D Cullen), Children's Hospital of Philadelphia Research Institute, Philadelphia, Pa. Dr Messineo is now with 3450 Wayne Ave, Apt 11D, Bronx, NY, 10467..
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9
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Giannouchos TV, Ukert B, Pirrallo RG, Smith J, Kum HC, Wright B, Dietrich A. Determinants of Persistent, Multi-Year, Frequent Emergency Department Use Among Children and Young Adults in Three US States. Acad Pediatr 2024; 24:442-450. [PMID: 37673206 DOI: 10.1016/j.acap.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 07/11/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE This study examines the factors associated with persistent, multi-year, and frequent emergency department (ED) use among children and young adults. METHODS We conducted a retrospective secondary analysis using the 2012-2017 Healthcare Cost and Utilization Project State Emergency Department Databases for children and young adults aged 0-19 who visited any ED in Florida, Massachusetts, and New York. We estimated the association between persistent frequent ED use and individuals' characteristics using multivariable logistic regression models. RESULTS Among 1.3 million patients with 1.8 million ED visits in 2012, 2.9% (37,558) exhibited frequent ED use (≥4 visits in 2012) and accounted for 10.2% (181,138) of all ED visits. Longitudinal follow-up of frequent ED users indicated that 15.4% (5770) remained frequent users periodically over the next 1 or 2 years, while 2.2% (831) exhibited persistent frequent use over the next 3-5 years. Over the 6-year study period, persistent frequent users had 31,551 ED visits at an average of 38.0 (standard deviation = 16.2) visits. Persistent frequent ED use was associated with higher intensity of ED use in 2012, public health insurance coverage, inconsistent health insurance coverage over time, residence in non-metropolitan and lower-income areas, multimorbidity, and more ED visits for less medically urgent conditions. CONCLUSIONS Clinicians and policymakers should consider the diverse characteristics and needs of pediatric persistent frequent ED users compared to broader definitions of frequent users when designing and implementing interventions to improve health outcomes and contain ED visit costs.
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Affiliation(s)
- Theodoros V Giannouchos
- Department of Health Policy & Organization (TV Giannouchos), School of Public Health, The University of Alabama at Birmingham, Birmingham, Ala.
| | - Benjamin Ukert
- Department of Health Policy and Management (B Ukert, H-C Kum), School of Public Health, Texas A and M University, College Station, Tex
| | - Ronald G Pirrallo
- University of South Carolina School of Medicine (RG Pirrallo, J Smith, and A Dietrich), Greenville, SC; Department of Emergency Medicine (RG Pirrallo, J Smith, and A Dietrich), Prisma Health, Greenville, SC
| | - Jeremiah Smith
- University of South Carolina School of Medicine (RG Pirrallo, J Smith, and A Dietrich), Greenville, SC; Department of Emergency Medicine (RG Pirrallo, J Smith, and A Dietrich), Prisma Health, Greenville, SC
| | - Hye-Chung Kum
- Department of Health Policy and Management (B Ukert, H-C Kum), School of Public Health, Texas A and M University, College Station, Tex
| | - Brad Wright
- Department of Health Services Policy and Management (B Wright), Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Ann Dietrich
- University of South Carolina School of Medicine (RG Pirrallo, J Smith, and A Dietrich), Greenville, SC; Department of Emergency Medicine (RG Pirrallo, J Smith, and A Dietrich), Prisma Health, Greenville, SC
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10
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Burns J, Norton DM, Cooper PN, Day PE, Rao MY, Sanchez Parra CA, Kiener AJ. Food insecurity in children with heart disease. Curr Opin Pediatr 2024:00008480-990000000-00172. [PMID: 38655802 DOI: 10.1097/mop.0000000000001348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW This review discusses the epidemiology of food insecurity (FI) and its consequences in children with congenital heart disease. We aimed to highlight current interventions to screen and address food insecurity in the context of pediatric cardiology and to offer strategies for providers to engage in this meaningful work. RECENT FINDINGS Food insecurity is consistently associated with poor health outcomes in children. In the United States, 17.3% of households with children experience FI. Nonwhite and single-parent families are disproportionately affected. Interestingly, because of a low-quality diet, FI is associated with childhood obesity, putting affected children at increased risk for cardiovascular morbidity and mortality over time. Children with congenital heart disease are susceptible to poor outcomes due to unique altered metabolic demands, increased risk for growth impairment, frequent need for specialized feeding regimens, and additional morbidity associated with heart surgery in underweight children. SUMMARY Today, the burden of screening for FI is most commonly placed on general pediatricians. Considering the importance of nutrition to cardiovascular health and general wellbeing, and the ease with which screening can be performed, pediatric cardiologists and other subspecialists should take a more active role in FI screening.
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Affiliation(s)
- Joseph Burns
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
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11
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Williams S, Hill K, Mathew MS, Messiah SE. Disparities in Patient Family Social Determinants of Health in a Large Urban Pediatric Health System. J Pediatr Health Care 2024; 38:172-183. [PMID: 38429029 DOI: 10.1016/j.pedhc.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/20/2023] [Accepted: 11/18/2023] [Indexed: 03/03/2024]
Abstract
INTRODUCTION This analysis sought to identify disparities in social determinants of health (SDOH) outcomes at a Texas pediatric hospital. METHODS This retrospective study used electronic health records of pediatric patients families surveyed August -December 2022. Outcomes for health literacy, social support, food, transportation, energy, digital, and housing insecurity, and tobacco exposure were analyzed across demographic categories. RESULTS Among 15,294 respondents to the survey (mean child age, 8.73 years; 43.68% Hispanic, 29.73% non-Hispanic White, 18.27% non-Hispanic Black, 6.79% other race/ethnicity; 53.95% male), 50.25% of respondents reported at least one SDOH, whereas 23.39% reported two or more SDOH. The most prevalent SDOH was lack of social support (3,456, 23.91%). Hispanic, non-Hispanic Black, and other race/ethnicity respondents, non-English speakers, and public insurance users had higher odds of reporting almost all SDOH in logistic regression models adjusted for age, race/ethnicity, language, gender, and insurance type. DISCUSSION Race/ethnicity, language, and insurance type disparities were identified for all SDOH.
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12
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Lendrum EC, Peterson KR, Camara S, DeBlasio D, Shah AN. A Community Initiative to Help Children Who Are Homeless. Pediatrics 2024; 153:e2023061533. [PMID: 38384204 DOI: 10.1542/peds.2023-061533] [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] [Accepted: 09/07/2023] [Indexed: 02/23/2024] Open
Abstract
Children experiencing homelessness (CEH) have several health-related needs. It is necessary to address barriers posed by homelessness to improve health outcomes. Our objectives were to (1) conduct a health-related needs assessment and (2) determine acceptability/feasibility of the community-based initiative designed to identify and address health-related needs for CEH. The initiative involved a mobile care center, a health-focused education series for CEH, and resource provision, which included establishing connections with a stable source of health care. The needs assessment included standardized screening questions assessing health-related needs. We surveyed guardians of CEH who attended Summer360 between June and July 2022. Guardians were invited to evaluate our intervention via survey. We used descriptive statistics to characterize health-related needs. A needs assessment was completed on 36 of 100 children (42% white persons, 64% male), with 94% reporting at least 1 health-related need, and 61% with ≥3 needs. The most common needs identified were dental health and food insecurity. Twenty-four (24%) campers participated in a mobile health clinic that included hearing and vision screening, fluoride application, and vaccinations. The education series included dental hygiene, nutrition, and mental health. All families who desired assistance (73%) were connected to resources, and 91% of guardians agreed that the initiative helped meet their children's health-related needs and provided helpful resources. Implementation required planning with contributors including dental partners, mobile clinic operators, and school leadership. A community-based health initiative may serve as a unique opportunity to identify and address health-related needs for CEH.
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Affiliation(s)
| | - Kristen R Peterson
- Pediatric Residency Training Program
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Dominick DeBlasio
- Pediatric Residency Training Program
- Division of General and Community Pediatrics
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Anita N Shah
- Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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13
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McHale L, Siddique R, Gienapp AJ, Bagwell T. A Descriptive Analysis: Infants Presenting to the Pediatric Emergency Department With a Brief Resolved Unexplained Event. Pediatr Emerg Care 2024; 40:169-174. [PMID: 38416650 DOI: 10.1097/pec.0000000000003140] [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] [Indexed: 03/01/2024]
Abstract
OBJECTIVES Infants presenting to pediatric emergency departments (EDs) after a choking episode, cyanotic event, or irregular breathing pattern are often diagnosed with a brief, resolved, unexplained event (BRUE). Social determinants of health may affect these patients; therefore, we aimed to define population demographics and determine significant demographic predictors between 2 cohorts-infants presenting with BRUE, and those admitted to the intensive care unit. METHODS Using data from the Pediatric Health Information System (Children's Hospital Association, Washington, DC, Lenexa, KS), this multicenter, retrospective study included children aged 0-1 year from 52 hospitals who presented with an International Classification of Diseases-10 coded primary diagnosis for BRUE/apparent life-threatening event (ALTE) between January 1, 2016, and June 30, 2021. Cohort 1 patients presented to the ED with BRUE; cohort 2 patients were admitted from the ED for BRUE. Univariate and multivariate logistic regression were performed for both cohorts to discover possible demographic predictors. RESULTS Overall, 24,027 patients were evaluated. Patient sex did not affect admission rates (odds ratio [OR] = 1.034; 95% confidence interval [CI], 0.982-1.089; P = 0.2051). Black race (OR = 1.252; 95% CI, 1.177-1.332; P < 0.0001) and Medicaid insurance (OR = 1.126; 95% CI, 1.065-1.19; P < 0.0001) were significantly associated with an increased risk of admission. "Other" race (OR = 0.837; 95% CI, 0.777-0.902; P < 0.0001) and commercial insurance were significantly associated with a greater likelihood of discharge (OR = 0.888; 95% CI, 0.84-0.939; P < 0.0001). CONCLUSIONS Black race and Medicaid insurance predicted admission in this patient population, but demographics did not play a role in intensive care unit admission overall. Social determinants of health and demographics therefore appeared to play a role in admission for patients presenting to the ED. Future research could evaluate the effect of focused interventions, such as providing additional resources to socially at-risk families through community outreach, on admission rates of patients with these specific at-risk demographics.
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Affiliation(s)
| | - Rumana Siddique
- Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN
| | - Andrew J Gienapp
- Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN
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14
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Johnson KA, Owens C, Edelson HC, Yonker M, Robinson-Mosley S, Park J, Cook M. Food insecurity in pediatric HIV: understanding a critical challenge in the United States. AIDS Care 2024:1-9. [PMID: 38387444 DOI: 10.1080/09540121.2023.2287734] [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: 03/01/2023] [Accepted: 11/20/2023] [Indexed: 02/24/2024]
Abstract
Advancing the well-being of individuals living with HIV necessitates attention to social determinants of health, including food insecurity. Through a clinical and community-based needs assessment, we aimed to gain insight into experiences of food insecurity among patients receiving care at a large pediatric HIV outpatient clinic in the Southeastern United States. We adopted a multimodal assessment approach involving a literature review, community profiling, key informant interviews, focus group discussions with staff, patients and parents and a community stakeholder advisory meeting. Our needs assessment demonstrates that food insecurity is an important aspect of the lived experience of children, adolescents and young adults living with HIV. Clinical staff agreed that food insecurity screening should be incorporated into the patient care workflow but ideally only in concert with providing resources that meet their needs. We formulated a recommendation matrix for addressing food insecurity based on priority importance and feasibility. Collaborative relationships between healthcare practitioners and leaders, community-based organizations and local and federal funding sources are vital for enhancing patients' access to sustainable, reliable solutions to this fundamental determinant of health. Our approach provides a tested model for other clinics seeking to identify and alleviate food insecurity among patients.
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Affiliation(s)
- Khaliah A Johnson
- Department of Pediatrics, Division of Pediatric Palliative Care, Emory University, Atlanta, GA, USA
- The Ponce de Leon Center, Grady Medical Center, Atlanta, GA, USA
| | - Caroline Owens
- Department of Anthropology, Emory University, Atlanta, GA, USA
- Department of Anthropology, Washington State University, Pullman, WA, USA
| | - Hannah Claire Edelson
- Department of Emergency Medicine, Oliver View- UCLA Medical Center, Los Angeles, CA, USA
| | - Magdalene Yonker
- The Ponce de Leon Center, Grady Medical Center, Atlanta, GA, USA
- Department of Psychiatry, Emory University, Atlanta, GA, USA
| | | | - Jenny Park
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Miranda Cook
- Laney Graduate School, Emory University, Atlanta, GA, USA
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15
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Fuji KT, White ND, Packard KA, Kalkowski JC, Walters RW. Effect of a Financial Education and Coaching Program for Low-Income, Single Mother Households on Child Health Outcomes. Healthcare (Basel) 2024; 12:127. [PMID: 38255016 PMCID: PMC10815544 DOI: 10.3390/healthcare12020127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/23/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
The financial difficulties of parents have a negative impact on the health of their children. This problem is more pronounced in single mother families. There is limited research on low-income, single mothers and how interventions to help them address financial difficulties may also benefit their children. The purpose of this study was to evaluate the effect of a year-long financial education and coaching program on school absenteeism and health care utilization of children in employed, low-income, single mother households. This was a post hoc analysis of the Finances First study, a randomized controlled trial conducted in 2017-2020 examining the impact of a financial coaching and education program on economic stability and health outcomes in 345 low-income, single mothers. Either generalized estimating equations (GEEs) or generalized linear mixed models (GLMMs) were used to account for relationships between participants. For the continuous outcomes of child absenteeism, physician visits, emergency room visits, and hospitalization days, a linear mixed-effects model was used. The Finances First study demonstrated improvements in various financial strain measures. Compared to the control group, children of intervention group participants experienced 1 fewer day of school absence (p = 0.049) and 1 fewer physician visit (p = 0.032) per year, but no impact was seen on emergency room visits (p = 0.55) or hospitalizations (p = 0.92). Addressing social determinants of health in parents is necessary for improving child health outcomes.
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Affiliation(s)
- Kevin T. Fuji
- Department of Pharmacy Sciences, School of Pharmacy and Health Professions, Creighton University, Omaha, NE 68178, USA
| | - Nicole D. White
- Department of Pharmacy Practice, School of Pharmacy and Health Professions, Creighton University, Omaha, NE 68178, USA
| | - Kathleen A. Packard
- Department of Pharmacy Practice, School of Pharmacy and Health Professions, Creighton University, Omaha, NE 68178, USA
| | - Julie C. Kalkowski
- Financial Hope Collaborative, Heider College of Business, Creighton University, Omaha, NE 68178, USA
| | - Ryan W. Walters
- Department of Clinical Research and Public Health, School of Medicine, Creighton University, Omaha, NE 68178, USA
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16
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Assaf RR, Dolce M, Garg A. Sustainably Implementing Social Determinants of Health Interventions in the Pediatric Emergency Department. JAMA Pediatr 2024; 178:9-10. [PMID: 37983050 DOI: 10.1001/jamapediatrics.2023.4949] [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] [Indexed: 11/21/2023]
Abstract
This Viewpoint discusses 5 principal challenges and opportunities for the sustainable implementation of social determinants of health interventions in emergency department settings.
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Affiliation(s)
- Raymen Rammy Assaf
- Emergency Medicine Specialists of Orange County, Children's Hospital of Orange County, Orange, California
- Department of Pediatrics, University of California Irvine School of Medicine, Irvine, California
| | | | - Arvin Garg
- Child Health Equity Center, Department of Pediatrics, UMass Chan Medical School, UMass Memorial Children's Medical Center, Worcester, Massachusetts
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17
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Das K, Onwuka AJ, Chisolm DJ. Social Determinants of Health Are Associated With Visits for Ambulatory Care Sensitive Conditions. Pediatr Emerg Care 2023; 39:934-939. [PMID: 37205847 DOI: 10.1097/pec.0000000000002971] [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] [Indexed: 05/21/2023]
Abstract
OBJECTIVES Population health experts have described the link between social factors and health, but few studies link specific social needs to disease processes. Nationwide Children's Hospital implemented a universal, annual screener for social determinants of health (SDH) in 2018. Early analyses have shown that patients identifying an SDH need were more likely to have an emergency department (ED) or inpatient stay. The objective of this study is to identify links between SDH and ED presentation for ambulatory care sensitive conditions (ACSCs). METHODS This was a retrospective observational study of children aged 0-21 years receiving care at Nationwide Children's Hospital from 2018 to 2021 that were screened for SDH. Acute care utilization within 6 months of screener completion, sociodemographic, and clinical data were collected via EPIC data extraction. Patients that completed screening tool for the first time in the ED were excluded to minimize selection bias. Logistic regression was used to analyze the association between ED presentation for ACSCs and SDH needs. RESULTS A total of 108,346 social determinants screeners were included with 9% of screeners identifying a need. Five percent of the population expressed food needs, 4% transportation needs, 3% utility needs, and 1% housing needs. Eighteen percent of patients had an ED visit for ACSC, with the most common complaints being upper respiratory infections and asthma. Having any SDH need was associated with ED visits for ACSCs (odds ratio, 1.12; 95% confidence interval, 1.06-1.18). Needs in all domains were significantly associated with increased visits for ACSCs; however, patients with housing needs had the highest odds of utilization (odds ratio, 1.25; confidence interval, 1.11-1.41). CONCLUSIONS The odds of ED presentation for ACSCs are higher in patients with expressed social needs. Further delineating the connections between specific SDH and health outcomes can inform timely and appropriate interventions.
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Affiliation(s)
- Kristol Das
- From the Nationwide Children's Hospital, Columbus, OH
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18
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Myers CN, Chandran A, Psoter KJ, Bergmann JP, Galiatsatos P. Indicators of Neighborhood-Level Socioeconomic Position and Pediatric Critical Illness. Chest 2023; 164:1434-1443. [PMID: 37487988 PMCID: PMC10925544 DOI: 10.1016/j.chest.2023.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/21/2023] [Accepted: 07/06/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND With recent prioritization of equity in pediatric health outcomes, a shift to examine neighborhood-level health care disparities within pediatric populations has occurred, specifically in the context of critical illness. RESEARCH QUESTION Does an association exist between individual indicators of neighborhood-level disadvantage and incidence of PICU admission? STUDY DESIGN AND METHODS Pediatric patients younger than 18 years admitted to a PICU in a large urban tertiary pediatric hospital from January 1, 2016, through December 31, 2019, with a residential address in the city of Baltimore or Baltimore County on the day of admission were included in this ecological study. Demographic and clinical characteristics of children admitted to the PICU were summarized, with the primary outcome being PICU admission. Unadjusted negative binomial regression was used to examine the association between census tract-level PICU admissions and the previously described census tract-level indicators of neighborhood socioeconomic position. Regression models included an offset term for the population younger than 18 years for each census tract; results of models are reported as incidence rate ratios (IRRs) with corresponding 95% CIs. RESULTS We identified 2,476 PICU admissions: 1,351 patients from the city of Baltimore (10.25 per 1,000 children) and 1,125 patients from Baltimore County (6.31 per 1,000 children). Most PICU admissions (n = 906 [68%]) for the city of Baltimore represented an area deprivation index (ADI) of > 60, whereas most Baltimore County PICU admissions (n = 919 [82.3%]) represented an ADI of < 60. At the neighborhood level, the percentage of families living below the poverty line was associated with greater incidence of PICU admission in the city of Baltimore (IRR, 1.09; 95% CI, 1.00-1.18) and Baltimore County (IRR, 1.19; 95% CI, 1.05-1.36). For every $10,000 increase in median household income, PICU admission rates dropped by 9% for the city of Baltimore (IRR, 0.91; 95% CI, 0.86-0.95) and Baltimore County (IRR, 0.91; 95% CI, 0.88-0.94). Neighborhoods with vacant housing units also were associated with a higher incidence of PICU admission in the city of Baltimore (IRR, 1.10; 95% CI, 1.01-1.21) and Baltimore County (IRR, 1.46; 95% CI, 1.21-1.77), as was a 10% increase in occupied homes without vehicles (city of Baltimore: IRR, 1.14; 95% CI, 1.07-1.21; Baltimore County: IRR, 1.23; 95% CI, 1.11-1.37). INTERPRETATION Health outcomes of pediatric critical illness should be examined in the context of structural determinants of health, including neighborhood-level and environmental characteristics.
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Affiliation(s)
- Carlie N Myers
- Division of Critical Care Medicine, Cincinnati Children's Hospital, Cincinnati, OH; University of Cincinnati School of Medicine, Cincinnati, OH.
| | - Aruna Chandran
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Medicine, Baltimore, MD
| | - Kevin J Psoter
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jules P Bergmann
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Medicine, Baltimore, MD
| | - Panagis Galiatsatos
- Department of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
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19
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Gresh A, Ahmed N, Boynton-Jarrett R, Sharifi M, Rosenthal MS, Fenick AM. Clinicians' Perspectives on Equitable Health Care Delivery in Group Well-Child Care. Acad Pediatr 2023; 23:1385-1393. [PMID: 37302699 DOI: 10.1016/j.acap.2023.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/14/2023] [Accepted: 06/03/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore clinicians' perspectives about the impact of group well-child care (GWCC) on equitable health care delivery. METHODS In this qualitative study, we conducted semistructured interviews with clinicians engaged in GWCC recruited via purposive and snowball sampling. We first conducted a deductive content analysis using constructs from Donabedian's framework for health care quality (structure, process, and outcomes) followed by inductive thematic analysis within these constructs. RESULTS We completed 20 interviews with clinicians who deliver or research GWCC in 11 institutions across the United States. Four major themes around equitable health care delivery in GWCC emerged from clinicians' perspectives: 1) shifts in power dynamics (process); 2) enabling relational care, social support, and a sense of community (process, outcome); 3) centering multidisciplinary care delivery around patient and family needs (structure, process, and outcomes); and 4) unaddressed social and structural barriers limit patient and family participation. CONCLUSIONS Clinicians perceived that GWCC enhances equity in health care delivery by shifting hierarchies in clinical visits and promoting relational, patient, and family-centered care. However, potential opportunities exist to further address provider implicit bias in group care delivery and structural inequities at the level of the health care institution. Clinicians underscored the need to address barriers to participation so that GWCC can more fully enhance equitable health care delivery.
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Affiliation(s)
- Ashley Gresh
- Johns Hopkins University School of Nursing (A Gresh), Baltimore, Md
| | - Noureen Ahmed
- Department of Social and Behavioral Science, Yale School of Public Health (N Ahmed and M Sharifi), New Haven, Conn
| | - Renée Boynton-Jarrett
- Department of Pediatrics, Boston University School of Medicine (R Boynton-Jarrett), Mass
| | - Mona Sharifi
- Department of Pediatrics, Yale School of Medicine (M Sharifi, MS Rosenthal, and AM Fenick), New Haven, Conn; Department of Biostatistics, Yale School of Public Health (M Sharifi), New Haven, Conn
| | - Marjorie S Rosenthal
- Department of Pediatrics, Yale School of Medicine (M Sharifi, MS Rosenthal, and AM Fenick), New Haven, Conn
| | - Ada M Fenick
- Department of Pediatrics, Yale School of Medicine (M Sharifi, MS Rosenthal, and AM Fenick), New Haven, Conn.
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Ronis S, Guyon-Harris KL, Burkhart K, Gabriel M, Cipolla K, Riggs JL, Huth-Bocks A. Profiles of Early Childhood Adversity in an Urban Pediatric Clinic: Implications for Pediatric Primary Care. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1023. [PMID: 37371255 DOI: 10.3390/children10061023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/27/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023]
Abstract
Pediatricians are well-positioned to screen for early childhood adversities, but effective responses to positive screens require an understanding of which adversities typically co-occur, and to what extent they are associated with other risk or protective factors. Among children seen at an urban academic pediatric practice, this study aimed to (1) examine the prevalence of different types of early adversity and protective experiences reported by primary caregivers, and (2) define latent classes of co-occurring adversities. Of 1434 children whose parents completed the Safe Environment for Every Kid (SEEK) at well-child visits during November 2019-January 2021, three classes of adverse experiences emerged, including those reporting low adversity (L; 73%), caregiver stress (CS; 17%), and both caregiver stress and depression (CSD; 10%). Among those who also completed the Adverse Childhood Experiences Questionnaire (ACE-Q, n = 1373) and the Protective and Compensatory Experiences Scale (PACES, n = 1377), belonging to the L class was associated with lower ACE-Q and higher PACES scores. For parent-respondents only, ACE-Q scores were significantly greater for the CSD class compared to the CS and L classes. Pediatricians should attend to the needs of caregivers reporting both stress and depression, as these families may face especially high levels of adversity and low levels of protective factors.
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Affiliation(s)
- Sarah Ronis
- UH Rainbow Center for Child Health and Policy, Department of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH 44106, USA
| | - Katherine L Guyon-Harris
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Kimberly Burkhart
- Department of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH 44106, USA
| | - Mary Gabriel
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Kristin Cipolla
- Department of Pediatrics, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Jessica L Riggs
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Alissa Huth-Bocks
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- Merrill Palmer Skillman Institute, Division of Research, Wayne State University, Detroit, MI 48202, USA
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21
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Guo T, Bardhan I, Khurshid A. Social Determinants of Health and ER Utilization: Role of Information Integration during COVID-19. ACM TRANSACTIONS ON MANAGEMENT INFORMATION SYSTEMS 2023. [DOI: 10.1145/3583077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Emergency room (ER) admissions are the front door for the utilization of a community's health resources and serve as a valuable proxy for a community health system's capacity. While recent research suggests that social determinants of health (SDOH) are important predictors of patient health outcomes, their impact on ER utilization during the COVID-19 pandemic is not well understood. Further, the role of hospital information integration in moderating the impact of SDOH on ER utilization has not received adequate attention. Utilizing longitudinal claims data from a regional health information exchange spanning six years including the COVID-19 period, we study how SDOH affects ER utilization and whether effective integration of patient health information across hospitals can moderate its impact. Our results suggest that a patient's economic well-being significantly reduces future ER utilization. The magnitude of this relationship is significant when patients are treated at hospitals with high information integration but is weaker when patients receive care at hospitals with lower levels of information integration. Instead, patients' family and social support can reduce ER utilization when they are treated at hospitals with low information integration. In other words, different dimensions of SDOH are important in low versus high information integration conditions. Furthermore, predictive modeling shows that patient visit type and prior visit history can significantly improve the predictive accuracy of ER utilization. Our research implications support efforts to develop national standards for the collection and sharing of SDOH data, and their use and interpretation for clinical decision making by healthcare providers and policy makers.
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Ostendorf AP, Axeen ET, Eschbach K, Fedak Romanowski E, Morgan LA, Gross P, Narayanan UG, Glader L, Noritz G. Epilepsy and proxy-reported health-related quality of life in children and young people with non-ambulatory cerebral palsy. Dev Med Child Neurol 2023; 65:200-206. [PMID: 35820144 PMCID: PMC10084160 DOI: 10.1111/dmcn.15336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 01/04/2023]
Abstract
AIM To assess the association between epilepsy characteristics and proxy-reported health-related quality of life (HRQoL) in children and young people with non-ambulatory cerebral palsy (CP) and seizures. METHOD This was a cross-sectional study of 164 children and young people (74 females, 90 males; mean age 10 years 6 months, range 2-21 years, SD 5 years 5 months). Caregivers completed the Child Health Index of Life with Disabilities (CPCHILD) in an outpatient setting. We utilized univariable linear regression and multivariable modeling to study relationships between variables and CPCHILD scores. RESULTS Gross Motor Function Classification System levels were 37% IV and 63% V. Sociodemographic factors included the Child Opportunity Index (median 51, interquartile range [IQR] 25-80). A median of 2 (IQR 1-3) antiseizure medications (ASMs) were used, and days with seizures ranged from 0 (30%) to 28 (20%) days in the previous 4 weeks. Total CPCHILD scores decreased 2.3 points for each ASM (95% confidence interval [CI] -4.1 to -0.42). Compared to persons with focal epilepsy, those with generalized epilepsy had lower total CPCHILD scores (-5.7; 95% CI -11 to -0.55). Number of days with seizures was not associated with total CPCHILD scores. INTERPRETATION Proxy-reported HRQoL was affected by epilepsy-specific features in children and young people with severe CP. WHAT THIS PAPER ADDS Health-related quality of life (HRQoL) was lower with increasing numbers of antiseizure medications. Overall quality of life (QoL) scores were lower by a similar amount, independent of seizure frequency. HRQoL was lower in persons with recent hospital admissions for epilepsy.
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Affiliation(s)
- Adam P Ostendorf
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Erika T Axeen
- Departments of Neurology and Pediatrics, University of Virginia, Virginia, USA
| | - Krista Eschbach
- Children's Hospital Colorado, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Erin Fedak Romanowski
- Department of Pediatrics, Division of Pediatric Neurology, CS Mott Children's Hospital and University of Michigan Health, Ann Arbor, Michigan, USA
| | - Lindsey A Morgan
- Seattle Children's Hospital and University of Washington, Washington, USA
| | - Paul Gross
- University of Utah, Salt Lake City, Utah, USA
| | - Unni G Narayanan
- University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | - Laurie Glader
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Garey Noritz
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA
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Abstract
PURPOSE OF REVIEW This article outlines updates in social determinants of health (SDOH) screening practices in pediatric healthcare and community settings. The transition to value-based care and the COVID-19 pandemic have both had significant impacts on screening practices, with implications for providers, communities, and policymakers. RECENT FINDINGS The COVID-19 pandemic has exacerbated social needs for vulnerable patients and families, resulting in increased recognition by healthcare teams through screening. Policy frameworks like value-based care that aim to deliver whole-child care in the community are reorienting the logistics of screening, including screening in acute-care settings and community settings. Recent studies on family and provider perspectives should be integrated into screening practices. SUMMARY Despite significant advances in and expansion of SDOH screening in the pediatric healthcare setting, there remain limitations and future research needs. More data is needed to evaluate social need screeners and interventions, and determine how healthcare systems, communities, and states can spread and scale such interventions based on outcomes and value measurements. Population-based social indices have the potential to augment individual patient screening, but this remains a future research need.
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Affiliation(s)
- Abby L Nerlinger
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
- Nemours Children's Hospital, Delaware, Wilmington, Delaware
| | - Gift Kopsombut
- University of Central Florida
- Nemours Children's Hospital, Florida, Orlando, Florida, USA
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Jesus LED, Rosina AG, Rabeca ACG, Pereira LMBM, Dekermacher S. [How much does a specialized medical consultation cost for families of pediatric patients in the Brazilian Unified National Health System?]. CAD SAUDE PUBLICA 2023; 39:e00137322. [PMID: 36651381 DOI: 10.1590/0102-311xpt137322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 12/12/2022] [Indexed: 01/18/2023] Open
Abstract
In this study, we investigated the costs of transportation for each outpatient consultation in patients referred to specialized surgical evaluation in a tertiary hospital in Rio de Janeiro, Brazil. Descriptive study with guardians of pediatric patients scheduled for pediatric surgery, questioning transportation cost, and opportunity costs (loss of remuneration, food, payment of caregivers for other children, expenses for other companions). About half patients were aged up to five years; about two thirds had diseases of simple and definitive surgical resolution; and 181 families (89.17%) presented monthly family income up to BRL 1,999.00. The proportion of families that benefited from free transportation ranged from 4.26% to 15.56% for patients living up to 100 km away from the hospital (45.83% for patients living more than 100 km away from the institution). A total of 176 (87.13%) guardians reported expenses buying food, 12 (5.94%) paid caregivers to the other children on the day of the consultation, and 80 (39.6%) reported loss of remuneration for the working day. Among the high complexity cases, 9.33% of the mothers have given up their regular paid employment. Transportation expenses for a pediatric surgery consultation at a reference hospital in Rio de Janeiro cost about 4.42% of the current minimum wage, spending around 217.32 minutes of displacement/consultation. Expenses with food and loss of remuneration due to absence at work also entail significant financial charges or loss of remuneration for the patient at each consultation.
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Affiliation(s)
- Lisieux Eyer de Jesus
- Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brasil
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Giambra BK, Spratling R. Examining Children With Complex Care and Technology Needs in the Context of Social Determinants of Health. J Pediatr Health Care 2022; 37:262-268. [PMID: 36462998 DOI: 10.1016/j.pedhc.2022.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 12/05/2022]
Abstract
Children with complex care and technology needs require daily, intensive care from family caregivers. These children are understudied, particularly in relation to the social determinants of health (SDOH) that affect their health, well-being, and quality of life. This paper examines the salient research on SDOH among this population, focusing on the Healthy People 2030 domains. Gaps in the research are identified and recommendations for future research, practice, policy, and education are presented. Pediatric nurses, advanced practice nurses, and other health care provider teams that care for these children and families can improve their health by examining and addressing SDOH.
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26
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Rigdon J, Montez K, Palakshappa D, Brown C, Downs SM, Albertini LW, Taxter AJ. Social Risk Factors Influence Pediatric Emergency Department Utilization and Hospitalizations. J Pediatr 2022; 249:35-42.e4. [PMID: 35697140 DOI: 10.1016/j.jpeds.2022.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To characterize the association of children's social risk factors with total number of emergency department (ED) visits or hospitalization and time to first subsequent ED or hospitalization. STUDY DESIGN This was a retrospective cohort study of patients seen at a general pediatric clinic between 2017 and 2021 with documented ≥1 social risk factors screened per visit. Negative binomial or Poisson regression modeled ED utilization and hospitalizations as functions of the total number of risk factors or each unique risk factor. Time-varying Cox models were used to evaluate differences between those who screened positive and those who screened negative, controlling for demographic and clinical covariates. RESULTS Overall, 4674 patients (mean age, 6.6 years; 49% female; 64% Hispanic; 21% Black) were evaluated across a total of 20 927 visits. Children with risk factors had higher rates of attention-deficit hyperactivity disorder, failure to gain weight, asthma, and prematurity compared with children with no risk (all P < .01). Adjusted models show a positive association between increased total number of factors and ED utilization (incidence rate ratio [IRR], 1.18; 95% CI, 1.12-1.23) and hospitalizations (IRR, 1.36; 95% CI, 1.26-1.47). There were no associations between a positive screen and time to first ED visit (hazard ratio [HR], 0.95; 95% CI, 0.85-1.06; P = .36) or hospitalization (HR, 1.15; 95% CI, 0.84-1.59; P = .40). CONCLUSIONS Social risk factors were associated with increased ED utilization and hospitalizations at the patient level but were not significantly associated with time to subsequent acute care use. Future research should evaluate the effect of focused interventions on health care utilization, such as those addressing food insecurity and transportation challenges.
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Affiliation(s)
- Joseph Rigdon
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kimberly Montez
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC; Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston-Salem, NC; Center for Biomedical Informatics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Deepak Palakshappa
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC; Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC; Center for Healthcare Innovation, Wake Forest School of Medicine, Winston-Salem, NC; Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Callie Brown
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC; Center for Healthcare Innovation, Wake Forest School of Medicine, Winston-Salem, NC
| | - Stephen M Downs
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC; Center for Biomedical Informatics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Laurie W Albertini
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Alysha J Taxter
- Department of Pediatric Rheumatology, Nationwide Children's Hospital, Columbus, OH; Department of Clinical Informatics, Nationwide Children's Hospital, Columbus, OH.
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Identifying Health-Related Social and Unintentional Injury Risks Among Patients Presenting to a Pediatric Urgent Care. Acad Pediatr 2022; 23:597-603. [PMID: 35931272 DOI: 10.1016/j.acap.2022.07.020] [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: 06/08/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Many families seek medical care at pediatric urgent care centers. The objective of this study was to determine social and unintentional injury risks reported by these families. METHODS This cross-sectional study surveyed a convenience sample of guardians of patients 1 to 5 years of age presenting to our pediatric urgent care, 9/10/21 to 2/25/22. Outcomes were the number of reported social and unintentional injury risks. Predictors and covariates included child and parent demographic characteristics and a neighborhood socioeconomic deprivation index. Chi-square, Student's t test, Pearson's correlation tests, and multinominal regression were used. RESULTS A total of 273 guardians (and children) were included; 245 of guardians (89.7%) were female; 137 (50.2%) of included children identified as Black. Approximately 60% reported ≥1 social risk; 31.5% reported ≥3. Approximately 90% reported ≥1 unintentional injury risk; 57.9% reported ≥3. There were significant associations between social risk presence and Black race, public/no insurance, and neighborhood deprivation (all P < .05). There were no significant associations between unintentional injury risks and assessed predictors. Black guardians were more likely than those of other races to report a greater number of social risks (adjusted odds ratio [AOR] 2.90, 95% confidence interval [CI] 1.50, 5.58 for ≥3 vs 0 risk). Children with public/no insurance compared to private insurance were more likely to experience a greater number of social risks (AOR 3.34, 95% CI 1.42, 7.84 for ≥3 vs 0 risks). CONCLUSIONS Many presenting to pediatric urgent cares experience social and unintentional injury risks. Risk identification may guide equitable responses.
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Anyigbo C, Jimenez ME, Sosnowski DW. Association Between Adverse Childhood Experiences at Age 5 Years and Healthcare Utilization at Age 9 Years. J Pediatr 2022; 246:227-234.e2. [PMID: 35427692 DOI: 10.1016/j.jpeds.2022.04.006] [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: 12/20/2021] [Revised: 03/01/2022] [Accepted: 04/07/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine associations between adverse childhood experiences (ACEs) at age 5 years and healthcare utilization patterns at age 9 years. STUDY DESIGN We conducted a secondary analysis using longitudinal data from the Fragile Families and Child Wellbeing Study. Caregivers (n = 2521) provided data on their child's ACEs at age 5 years and on 4 types of healthcare utilization at age 9 years: past-year well visits, dental visits, primary care sick visits for injury or illness, and emergency room (ER) visits. Logistic regression analysis was used to examine the association between ACEs at age 5 and each type of healthcare utilization, adjusting for relevant sociodemographic covariates. RESULTS Among the 2521 children (51% male, 48% Non-Hispanic Black), 77% had ≥1 ACE at age 5. Children with ≥4 ACEs had lower odds of a dental visit (aOR, 0.51; 95% CI, 0.29-0.91) and higher odds of a primary care sick visit (aOR, 1.77; 95% CI, 1.20-2.64) and an ER visit (aOR, 1.70; 95% CI, 1.11-2.59) compared with children with no reported ACEs. CONCLUSION Our findings demonstrate suboptimal healthcare utilization patterns among families with ACEs and indicate a need for targeted interventions that support appropriate healthcare utilization for children who endure adversity.
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Affiliation(s)
- Chidiogo Anyigbo
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH.
| | - Manuel E Jimenez
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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Anderst A, Hunter K, Andersen M, Walker N, Coombes J, Raman S, Moore M, Ryan L, Jersky M, Mackenzie A, Stephensen J, Williams C, Timbery L, Doyle K, Lingam R, Zwi K, Sheppard-Law S, Erskine C, Clapham K, Woolfenden S. Screening and social prescribing in healthcare and social services to address housing issues among children and families: a systematic review. BMJ Open 2022; 12:e054338. [PMID: 35487725 PMCID: PMC9058796 DOI: 10.1136/bmjopen-2021-054338] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Housing is a social determinant of health that impacts the health and well-being of children and families. Screening and referral to address social determinants of health in clinical and social service settings has been proposed to support families with housing problems. This study aims to identify housing screening questions asked of families in healthcare and social services, determine validated screening tools and extract information about recommendations for action after screening for housing issues. METHODS The electronic databases MEDLINE, PsycINFO, EMBASE, Ovid Emcare, Scopus and CINAHL were searched from 2009 to 2021. Inclusion criteria were peer-reviewed literature that included questions about housing being asked of children or young people aged 0-18 years and their families accessing any healthcare or social service. We extracted data on the housing questions asked, source of housing questions, validity and descriptions of actions to address housing issues. RESULTS Forty-nine peer-reviewed papers met the inclusion criteria. The housing questions in social screening tools vary widely. There are no standard housing-related questions that clinical and social service providers ask families. Fourteen screening tools were validated. An action was embedded as part of social screening activities in 27 of 42 studies. Actions for identified housing problems included provision of a community-based or clinic-based resource guide, and social prescribing included referral to a social worker, care coordinator or care navigation service, community health worker, social service agency, referral to a housing and child welfare demonstration project or provided intensive case management and wraparound services. CONCLUSION This review provides a catalogue of housing questions that can be asked of families in the clinical and/or social service setting, and potential subsequent actions.
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Affiliation(s)
- Ania Anderst
- Aboriginal and Torres Strait Islander Health Program, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Kate Hunter
- Aboriginal and Torres Strait Islander Health Program, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Melanie Andersen
- Aboriginal and Torres Strait Islander Health Program, The George Institute for Global Health, Newtown, New South Wales, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Natasha Walker
- Aboriginal and Torres Strait Islander Health Program, The George Institute for Global Health, Newtown, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Julieann Coombes
- Aboriginal and Torres Strait Islander Health Program, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Shanti Raman
- Community Paediatrics, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Melinda Moore
- Sydney Children's Hospitals Network (Randwick Campus), Sydney, New South Wales, Australia
| | - Lola Ryan
- Child, Youth and Family Services, Population and Community Health, South Eastern Sydney Local Health District, Kogarah, New South Wales, Australia
| | - Michelle Jersky
- Sydney Children's Hospitals Network (Randwick Campus), Sydney, New South Wales, Australia
| | - Amy Mackenzie
- Sydney Children's Hospitals Network (Randwick Campus), Sydney, New South Wales, Australia
| | - Jennifer Stephensen
- Sydney Children's Hospitals Network (Randwick Campus), Sydney, New South Wales, Australia
| | - Carina Williams
- Youth Health Services, Community Health, NSW Health, Sydney, New South Wales, Australia
| | - Lee Timbery
- Sydney Children's Hospitals Network (Randwick Campus), Sydney, New South Wales, Australia
| | - Kerrie Doyle
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Raghu Lingam
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Karen Zwi
- Sydney Children's Hospitals Network (Randwick Campus), Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Suzanne Sheppard-Law
- Faculty of Health, School of Nursing and Midwifery, University of Technology Sydney, Broadway, New South Wales, Australia
| | | | - Kathleen Clapham
- Ngarruwan Ngadju First Peoples Health and Wellbeing Research Centre, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Susan Woolfenden
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Community Paediatrics Research Group, Institute for Women, Children and Families, Sydney Local Health District, Sydney, New South Wales, Australia
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Mutic AD, Mauger DT, Grunwell JR, Opolka C, Fitzpatrick AM. Social Vulnerability Is Associated with Poorer Outcomes in Preschool Children With Recurrent Wheezing Despite Standardized and Supervised Medical Care. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:994-1002. [PMID: 35123099 PMCID: PMC9007879 DOI: 10.1016/j.jaip.2021.12.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/13/2021] [Accepted: 12/31/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Social determinants of health are associated with disparate asthma outcomes in school-age children. Social determinants have not been studied in preschool children with recurrent wheezing. OBJECTIVE We hypothesized that preschool children with recurrent wheezing at highest risk of social vulnerability would have more frequent symptoms and exacerbations when followed over 1 year, despite receiving standardized and supervised asthma care. METHODS A multicenter population of adherent preschool children receiving standardized and supervised care for wheezing was stratified by a composite measure of social vulnerability based on individual-level variables. Primary outcomes included days with upper respiratory infections and days with asthma symptom flares. Other outcomes included symptom scores during upper respiratory infections and respiratory symptom flare days, exacerbation occurrence, quality of life during the exacerbation, and hospitalization. RESULTS Preschool children at highest risk of social vulnerability did not have more frequent upper respiratory infections, respiratory symptoms, or exacerbations, but instead had more severe symptoms during upper respiratory infections and respiratory flare days, as well as more severe exacerbations with significantly poorer caregiver quality of life. Children at highest risk of social vulnerability also lived in poorer housing conditions with differing exposures and self-reported triggers. CONCLUSIONS Individual-level social determinants of health reflecting social vulnerability are associated with poorer outcomes in preschool children with recurrent wheezing despite access to supervised and standardized care. Comprehensive assessment of social determinants of health is warranted in even the youngest children with wheezing, because mitigation of these social inequities is an essential first step toward improving outcomes in pediatric patients.
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Affiliation(s)
- Abby D Mutic
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Ga
| | - David T Mauger
- Division of Biostatistics and Bioinformatics, Pennsylvania State University, Hershey, Pa
| | - Jocelyn R Grunwell
- Department of Pediatrics, Emory University, Atlanta, Ga; Division of Pediatric Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Cydney Opolka
- Division of Pediatric Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Anne M Fitzpatrick
- Department of Pediatrics, Emory University, Atlanta, Ga; Division of Pediatric Pulmonology, Children's Healthcare of Atlanta, Atlanta, Ga.
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31
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Greene HM, Maguire-Jack K, Malthaner L, Truelove A, Leonard JC. The relationship between emergency medical services use and social service needs in a pediatric emergency department population. CHILD ABUSE & NEGLECT 2022; 125:105482. [PMID: 35030391 DOI: 10.1016/j.chiabu.2022.105482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/28/2021] [Accepted: 01/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Emergency Medical Services (EMS) use for children is correlated with areas of resource deprivation as well as child maltreatment. Households using EMS may have more social needs and be willing to accept services. OBJECTIVE To compare social service needs and willingness to accept services in families arriving to a pediatric emergency department (ED) via EMS vs non-EMS, before and during COVID-19. PARTICIPANTS AND SETTING Caregivers of children 0-5 years old in a quaternary pediatric ED, with a 1:1 ratio of EMS vs non-EMS arrivals. METHODS Participants completed a survey of demographics, social service needs, and willingness to accept services, before and during COVID-19. RESULTS Of 220 participants, 84 were enrolled before COVID-19. The EMS group reported less full-time employment (34.6% vs 51.8%, p < 0.05) and more social service needs (2.47 vs 1.76 needs, p < 0.05). Mean score for willingness to accept a service provider in the home was 3.62 for EMS and 3.19 for non-EMS (p = 0.09). Mean score for accepting a phone referral was 3.84 for EMS and 3.40 for non-EMS (p = 0.07). COVID-19 impacted needs for both groups (20.9% EMS vs 30.3% non-EMS). For all subjects presenting to the ED, COVID-19 was associated with decreased food insecurity (28.6% vs 15.4%) and children with a chronic medical condition (31.0% vs 12.5%). CONCLUSIONS The EMS group had more social service needs. There was no difference in social services acceptance. COVID-19 affected both groups' needs. Future interventions may use EMS systems to mitigate social service needs which may be risk factors for child abuse.
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Affiliation(s)
- H Michelle Greene
- Division of Emergency Medicine, Department of Pediatrics, The Ohio State University College of Medicine, and Nationwide Children's Hospital, Columbus, OH, United States of America; Division of Child Abuse Pediatrics, Department of Pediatrics, The Ohio State University College of Medicine, and Nationwide Children's Hospital, Columbus, OH, United States of America
| | - Kathryn Maguire-Jack
- School of Social Work, University of Michigan, Ann Arbor, MI, United States of America
| | - Lauren Malthaner
- Division of Epidemiology, Human Genetics and Environmental Services, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Annie Truelove
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America
| | - Julie C Leonard
- Division of Emergency Medicine, Department of Pediatrics, The Ohio State University College of Medicine, and Nationwide Children's Hospital, Columbus, OH, United States of America; Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America.
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