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Alvis CE, Mosha M, Amankwah EK, Hernandez RG, Morrison JM. Comparison of Caregiver and Provider Food Insecurity Screening Preferences Within a Health System. Clin Pediatr (Phila) 2024; 63:650-658. [PMID: 37559340 DOI: 10.1177/00099228231191926] [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] [Indexed: 08/11/2023]
Abstract
Food insecurity is a public health concern associated with poor health. Evidence guiding how to best implement screening for food insecurity across a pediatric health care system is lacking. We performed a single-center, multi-department, cross-sectional study of caregivers and health care providers in outpatient and inpatient settings to describe the beliefs, barriers, preferences, and preferred food insecurity screening location. Most providers and caregivers underestimated the pervasiveness of food insecurity while acknowledging the benefit of screening. Caregivers are overall receptive to food insecurity screening and disagree with feelings of discomfort or shame when disclosing food insecurity status. Providers acknowledged perceived caregiver discomfort, lack of community food resources, and lack of a validated screening tool as barriers to screening. Both caregivers and providers identified the primary care setting as the preferred screening setting.
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Affiliation(s)
- Courtney E Alvis
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
| | - Maua Mosha
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
| | - Ernest K Amankwah
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raquel G Hernandez
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John M Morrison
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Omoladun-Tijani TA, Vish NL. Family and Neighborhood Resilience Are Associated with Children's Healthcare Utilization. J Pediatr 2023; 261:113543. [PMID: 37290587 DOI: 10.1016/j.jpeds.2023.113543] [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: 02/06/2023] [Revised: 05/28/2023] [Accepted: 06/02/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the association of external factors of resilience, neighborhood, and family resilience with healthcare use. STUDY DESIGN A cross-sectional, observational study was conducted using data from the 2016-2017 National Survey of Children's Health. Children aged 4-17 years were included. Multiple logistic regression was used to determine aOR and 95% CIs for association between levels of family resilience, neighborhood resilience and outcome measures: presence of medical home, and ≥2 emergency department (ED) visits per year while adjusting for adverse childhood experiences (ACEs), chronic conditions, and sociodemographic factors. RESULTS We included 58 336 children aged 4-17 years, representing a population of 57 688 434. Overall, 8.0%, 13.1%, and 78.9% lived in families with low, moderate, and high resilience, respectively; 56.1% identified their neighborhood as resilient. Of these children, 47.5% had a medical home and 4.2% reported ≥2 ED visits in the past year. A child with high family resilience had 60% increased odds of having a medical home (OR, 1.60; 95% CI, 1.37-1.87), and a child with moderate family resilience or resilient neighborhood had a 30% increase (OR, 1.32 [95% CI, 1.10-1.59] and OR, 1.31 [95% CI, 1.20-1.43], respectively). There was no association between resilience factors and ED use, although children with increased ACEs had increased ED use. CONCLUSIONS Children from resilient families and neighborhoods have an increased odds of receiving care in a medical home after adjusting for the effects of ACEs, chronic conditions, and sociodemographic factors, but no association was seen with ED use.
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Affiliation(s)
| | - Nora L Vish
- Wright State University, Boonshoft School of Medicine, Fairborn; Dayton Children's Hospital, Dayton, OH.
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Ardekani A, Fereidooni R, Heydari ST, Ghahramani S, Shahabi S, Bagheri Lankarani K. The association of patient-reported social determinants of health and hospitalization rate: A scoping review. Health Sci Rep 2023; 6:e1124. [PMID: 36846535 PMCID: PMC9944244 DOI: 10.1002/hsr2.1124] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/24/2023] Open
Abstract
Introduction The interplay between social determinants of health (SDOH) and hospitalization is significant as targeted interventions can improve the social status of the individuals. This interrelation has been historically overlooked in health care. In the present study, we reviewed studies in which the association between patient-reported social risks and hospitalization rate was assessed. Method We performed a scoping literature review of articles published until September 1, 2022 without time limit. We searched PubMed, Embase, Web of Science, Scopus, and Google Scholar to find relevant studies using terms representing "social determinants of health" and "hospitalization." Forward and backward reference checking was done for the included studies. All studies that used patient-reported data as a proxy of social risks to determine the association between social risks and hospitalization rates were included. The screening and data extraction processes were done independently by two authors. In case of disagreement, senior authors were consulted. Results Our search process retrieved a total of 14,852 records. After the duplicate removal and screening process, eight studies met the eligibility criteria, all of which were published from 2020 to 2022. The sample size of the studies ranged from 226 to 56,155 participants. All eight studies investigated the impact of food security on hospitalization, and six investigated economic status. In three studies, latent class analysis was applied to divide participants based on their social risks. Seven studies found a statistically significant association between social risks and hospitalization rates. Conclusion Individuals with social risk factors are more susceptible to hospitalization. There is a need for a paradigm shift to meet these needs and reduce the number of preventable hospitalizations.
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Affiliation(s)
- Ali Ardekani
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
| | - Reza Fereidooni
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
| | - Seyed Taghi Heydari
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
| | - Sulmaz Ghahramani
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
| | - Saeed Shahabi
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
| | - Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
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Lowery B, D'Acunto S, Crowe RP, Fishe JN. Using Natural Language Processing to Examine Social Determinants of Health in Prehospital Pediatric Encounters and Associations with EMS Transport Decisions. PREHOSP EMERG CARE 2023; 27:246-251. [PMID: 35500212 DOI: 10.1080/10903127.2022.2072984] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Social determinants of health (SDOH) influence access to health care and are associated with inequities in patient outcomes, yet few studies have explored SDOH among pediatric EMS patients. The objective of this study was to examine the presence of SDOH in EMS clinician free text notes and quantify the association of SDOH with EMS pediatric transport decisions. METHODS This was a retrospective analysis of primary 9-1-1 responses for patients ages 0-17 years from the 2019 ESO Data Collaborative research dataset. We excluded cardiac arrests and patients in law enforcement custody. Using natural language processing (NLP) we extracted the following SDOH categories: income insecurity, food insecurity, housing insecurity, insurance insecurity, poor social support, and child protective services. Univariate and multivariable associations between the presence of SDOH in EMS records and EMS transport decisions were assessed using logistic regression. RESULTS We analyzed 325,847 pediatric EMS encounters, of which 35% resulted in non-transport. The median age was 10 years and 52% were male. Slightly over half (53%) were White, 31% were Black, and 11% were Hispanic. Child protective services (n = 2,620) and housing insecurity (n = 1,136) were the most common SDOH categories found in the EMS free text narratives. In the multivariable model, child protective services involvement (odds ratio (OR)=2.04 [95% confidence interval (CI) 1.84-2.05]), housing insecurity (OR = 1.46 [95% CI 1.26-1.70]), insurance security (OR = 2.44 [95% CI 1.93-3.09]), and poor social support (OR = 10.48 [95% CI 1.42-77.29]) were associated with greater odds of EMS transport. CONCLUSIONS SDOH documentation in the EMS narrative was rare among pediatric encounters; however, children with documented SDOH were more likely to be transported. Additional exploration of the root causes and outcomes associated with SDOH among children encountered by EMS are warranted.
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Affiliation(s)
- Briauna Lowery
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Florida
| | - Salvatore D'Acunto
- Center for Data Solutions, University of Florida College of Medicine, Jacksonville, Florida
| | | | - Jennifer N Fishe
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Florida.,Center for Data Solutions, University of Florida College of Medicine, Jacksonville, Florida
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Tyris J, Rodean J, Kulesa J, Dixon G, Bhansali P, Gayle T, Akani D, Magyar M, Tamaskar N, Parikh K. Social Risks and Health Care Utilization Among a National Sample of Children With Asthma. Acad Pediatr 2023; 23:130-139. [PMID: 35940571 DOI: 10.1016/j.acap.2022.07.025] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Prior studies using single-center populations have established associations between social risks and health care utilization among children with asthma. We aimed to evaluate associations between social risks and health care utilization among a nationally representative sample of children with asthma. STUDY DESIGN In this cross-sectional study, we utilized the 2018-2019 National Survey of Children's Health to identify children 2 to 17 years old with asthma. Using the Healthy People (HP) 2030 social determinants of health (SDOH) framework, we identified 31 survey items assessing 18 caregiver-identified social risks as exposure variables and classified them into the 5 HP SDOH domains (Economy, Education, Health care, Community, and Environment). Primary outcome was caregiver-reported health care utilization. Associations between individual social risks and total number of SDOH domains experienced with health care utilization were assessed. RESULTS The weighted study population included 8.05 million children, 96% of whom reported ≥1 social risk. Fourteen social risks, spanning all 5 SDOH domains, were significantly associated with increased health care utilization. The 3 risks with the highest adjusted odds ratios (aOR) of health care utilization included: experiencing discrimination (aOR 3.26 [95% confidence interval (CI): 1.75, 6.08]); receiving free/reduced lunch (aOR 2.16, [95% CI 1.57, 2.98]); and being a victim of violence (aOR 2.11, [95% CI 1.11, 4]). Children with risks across more SDOH domains reported significantly higher health care utilization. CONCLUSIONS Among our national population of children with asthma, social risks are prevalent and associated with increased health care utilization, highlighting their potential contribution to pediatric asthma morbidity.
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Affiliation(s)
- Jordan Tyris
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC.
| | | | - John Kulesa
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Gabrina Dixon
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Priti Bhansali
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Tamara Gayle
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Damilola Akani
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Matthew Magyar
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Nisha Tamaskar
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Kavita Parikh
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
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Chen LP, Gerber DM, Coller RJ. Admitting what is needed: How the health system and society can reduce hospitalizations for children with medical complexity. J Hosp Med 2023; 18:90-94. [PMID: 35996947 PMCID: PMC9817383 DOI: 10.1002/jhm.12948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Laura P. Chen
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health
| | - Danielle M. Gerber
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health
| | - Ryan J. Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health
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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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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] [Grants] [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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Smiley Y, Silberholz E, Bekele E, Brodie N. Caregiver stress and social determinants of health in key populations: immigrant parents, parents of children with medical complexity, and adolescent parents. Curr Opin Pediatr 2022; 34:521-530. [PMID: 35993274 DOI: 10.1097/mop.0000000000001163] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To examine the five domains of social determinants of health - economic stability, education access, healthcare access and quality, neighborhood and built environment, and social and community context - and how these relate to caregiver stress in under-resourced populations. RECENT FINDINGS Socioeconomic and family factors are increasingly understood as drivers of child health. Caregiver stress can impact family stability and child wellbeing. Immigrant parents, caregivers of children with medical complexity, and adolescent parents experience stressors due to the unique needs of their families. These groups of parents and caregivers also face various challenges identified as social determinants of health. Interventions to mitigate these challenges can promote resilience, care coordination, and community-based supports. SUMMARY Current research describes caregiver stress in key populations, how caregiver stress affects children, and approaches to minimize and mitigate these effects. Pediatric providers can implement best practices to support families who are navigating stress due to caregiving and social determinants of health.
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Affiliation(s)
- Yael Smiley
- Division of General and Community Pediatrics, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Elizabeth Silberholz
- Division of General Pediatrics, Boston Children's Hospital; Harvard Medical School, Boston, Massachusetts, USA
| | - ElShadey Bekele
- Division of General and Community Pediatrics, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Nicola Brodie
- Division of General and Community Pediatrics, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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Hamilton H, West AN, Ammar N, Chinthala L, Gunturkun F, Jones T, Shaban-Nejad A, Shah SH. Analyzing Relationships Between Economic and Neighborhood-Related Social Determinants of Health and Intensive Care Unit Length of Stay for Critically Ill Children With Medical Complexity Presenting With Severe Sepsis. Front Public Health 2022; 10:789999. [PMID: 35570956 PMCID: PMC9099028 DOI: 10.3389/fpubh.2022.789999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/09/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives Of the Social Determinants of Health (SDoH), we evaluated socioeconomic and neighborhood-related factors which may affect children with medical complexity (CMC) admitted to a Pediatric Intensive Care Unit (PICU) in Shelby County, Tennessee with severe sepsis and their association with PICU length of stay (LOS). We hypothesized that census tract-level socioeconomic and neighborhood factors were associated with prolonged PICU LOS in CMC admitted with severe sepsis in the underserved community. Methods This single-center retrospective observational study included CMC living in Shelby County, Tennessee admitted to the ICU with severe sepsis over an 18-month period. Severe sepsis CMC patients were identified using an existing algorithm incorporated into the electronic medical record at a freestanding children's hospital. SDoH information was collected and analyzed using patient records and publicly available census-tract level data, with ICU length of stay as the primary outcome. Results 83 encounters representing 73 patients were included in the analysis. The median PICU LOS was 9.04 days (IQR 3.99–20.35). The population was 53% male with a median age of 4.1 years (IQR 1.96–12.02). There were 57 Black/African American patients (68.7%) and 85.5% had public insurance. Based on census tract-level data, about half (49.4%) of the CMC severe sepsis population lived in census tracts classified as suffering from high social vulnerability. There were no statistically significant relationships between any socioeconomic and neighborhood level factors and PICU LOS. Conclusion Pediatric CMC severe sepsis patients admitted to the PICU do not have prolonged lengths of ICU stay related to socioeconomic and neighborhood-level SDoH at our center. A larger sample with the use of individual-level screening would need to be evaluated for associations between social determinants of health and PICU outcomes of these patients.
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Affiliation(s)
- Hunter Hamilton
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States
| | - Alina N West
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States
| | - Nariman Ammar
- University of Tennessee Health Science Center - Oak-Ridge National Laboratory Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, Memphis, TN, United States
| | - Lokesh Chinthala
- Clinical Trials Network of Tennessee, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Fatma Gunturkun
- University of Tennessee Health Science Center - Oak-Ridge National Laboratory Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, Memphis, TN, United States
| | - Tamekia Jones
- Departments of Pediatrics and Preventive Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States.,Children's Foundation Research Institute Biostatistics Core, Memphis, TN, United States
| | - Arash Shaban-Nejad
- University of Tennessee Health Science Center - Oak-Ridge National Laboratory Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, Memphis, TN, United States
| | - Samir H Shah
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States
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Fritz CQ, Hall M, Bettenhausen JL, Beck AF, Krager MK, Freundlich KL, Ibrahim D, Thomson JE, Gay JC, Carroll AR, Neeley M, Frost PA, Herndon AC, Kehring AL, Williams DJ. Child Opportunity Index 2.0 and acute care utilization among children with medical complexity. J Hosp Med 2022; 17:243-251. [PMID: 35535923 PMCID: PMC9254633 DOI: 10.1002/jhm.12810] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 01/30/2023]
Abstract
BACKGROUND Disproportionately high acute care utilization among children with medical complexity (CMC) is influenced by patient-level social complexity. OBJECTIVE The objective of this study was to determine associations between ZIP code-level opportunity and acute care utilization among CMC. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional, multicenter study used the Pediatric Health Information Systems database, identifying encounters between 2016-2019. CMC aged 28 days to <16 years with an initial emergency department (ED) encounter or inpatient/observation admission in 2016 were included in primary analyses. MAIN OUTCOME AND MEASURES We assessed associations between the nationally-normed, multi-dimensional, ZIP code-level Child Opportunity Index 2.0 (COI) (high COI = greater opportunity), and total utilization days (hospital bed-days + ED discharge encounters). Analyses were conducted using negative binomial generalized estimating equations, adjusting for age and distance from hospital and clustered by hospital. Secondary outcomes included intensive care unit (ICU) days and cost of care. RESULTS A total of 23,197 CMC were included in primary analyses. In unadjusted analyses, utilization days decreased in a stepwise fashion from 47.1 (95% confidence interval: 45.5, 48.7) days in the lowest COI quintile to 38.6 (36.9, 40.4) days in the highest quintile (p < .001). The same trend was present across all outcome measures, though was not significant for ICU days. In adjusted analyses, patients from the lowest COI quintile utilized care at 1.22-times the rate of those from the highest COI quintile (1.17, 1.27). CONCLUSIONS CMC from low opportunity ZIP codes utilize more acute care. They may benefit from hospital and community-based interventions aimed at equitably improving child health outcomes.
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Affiliation(s)
- Cristin Q. Fritz
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matt Hall
- Children’s Hospital Association, Lenexa, KS
| | - Jessica L Bettenhausen
- Department of Pediatrics, Children’s Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Andrew F Beck
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Molly K Krager
- Department of Pediatrics, Children’s Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Katherine L Freundlich
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dena Ibrahim
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joanna E Thomson
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - James C Gay
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alison R Carroll
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee
| | - Maya Neeley
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee
| | - Patricia A Frost
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alison C Herndon
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee
| | - Allysa L Kehring
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee
| | - Derek J Williams
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee
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12
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Assaf RR, Barber Doucet H, Assaf R, Graff D. Social care practices and perspectives among U.S. pediatric emergency medicine fellowship programs. AEM EDUCATION AND TRAINING 2022; 6:e10737. [PMID: 35493290 PMCID: PMC9045575 DOI: 10.1002/aet2.10737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The emergence of social emergency medicine-the incorporation of social context into the structure and practice of emergency care-has brought forth greater embracement of the social determinants of health by medical professionals, yet workforce practices and training have remained elusive. Academic literature particularly in the field of pediatric emergency medicine (PEM) fellowship training is lacking relative to general pediatrics and adult emergency medicine. METHODS The primary objective of this study was to assess the social care knowledge, perspectives, and training of PEM program directors (PDs) and fellows across a national cross-sectional sample. A secondary aim was to uncover key actionable areas for the development of social care curricula in PEM training programs. A social care practices assessment tool was developed via snowball sampling interviews among clinician researcher experts and disseminated to PEM PDs and fellows nationally in accredited academic PEM training institutions. RESULTS A total of 153 participants-44 PDs (49% response rate) and 109 fellows (28%)-completed the assessment tool. Responses among PDs and fellows were highly concordant. Only 12% reported regular use of a standardized social needs screening tool. The majority felt unprepared to assist families with social needs and less than half felt comfortable talking to families about social need. At the same time, social care was highly valued by 73% of participants. All participants felt that providing social care training during PEM fellowship would be beneficial. PDs and fellows identified five priority areas for PEM curricular development. CONCLUSIONS PEM PDs and fellows have an overall favorable perception of social care yet report significant deficits in current practice organization and training. This study is part of a larger national collaborative advocacy project to organize and advance social care delivery across academic PEM training institutions through evidence-based approaches, best practices, and expert consensus.
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Affiliation(s)
- Raymen Rammy Assaf
- Harbor University of California Los Angeles (UCLA) Medical CenterTorranceCaliforniaUSA
| | - Hannah Barber Doucet
- Hasbro Children’s HospitalAlpert Medical School at Brown UniversityProvidenceRhode IslandUSA
| | | | - Danielle Graff
- School of MedicineNorton Children’s HospitalUniversity of LouisvilleLouisvilleKentuckyUSA
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13
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Fuller AE, Brown NM, Oyeku SO, Gross RS. Material Hardships, Health Care Utilization, and Children With Special Health Care Needs. Acad Pediatr 2022; 22:19-20. [PMID: 34571254 DOI: 10.1016/j.acap.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/19/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Anne E Fuller
- Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, University of Toronto (AE Fuller), Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University (AE Fuller), Hamilton, Ontario, Canada.
| | - Nicole M Brown
- Strong Children Wellness Medical Group (NM Brown), Jamaica, NY
| | - Suzette O Oyeku
- Division of Academic General Pediatrics, Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore (SO Oyeku), Bronx, NY
| | - Rachel S Gross
- Division of General Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine (RS Gross), New York, NY
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14
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Chang L, Stewart AM, Monuteaux MC, Fleegler EW. Neighborhood Conditions and Recurrent Emergency Department Utilization by Children in the United States. J Pediatr 2021; 234:115-122.e1. [PMID: 33395566 DOI: 10.1016/j.jpeds.2020.12.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/18/2020] [Accepted: 12/29/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To determine the associations of social and physical neighborhood conditions with recurrent emergency department (ED) utilization by children in the US. STUDY DESIGN This cross-sectional study was conducted with the National Survey of Children's Health from 2016 to 2018 to determine the associations of neighborhood characteristics of cohesion, safety, amenities, and detractors with the proportions of children aged 1-17 years with recurrent ED utilization, defined as 2 or more ED visits during the past 12 months. A multivariable regression model was used to determine the independent association of each neighborhood characteristic with recurrent ED utilization controlling for individual-level characteristics. RESULTS In this study of 98 711 children weighted to a population of 70 million nationally, children had significantly greater rates of recurrent ED utilization if they lived in neighborhoods that were not cohesive, were not safe, or had detractors present (all P < .001). With adjustment for individual-level covariates and the other neighborhood characteristics, only neighborhood detractors were independently associated with recurrent ED utilization (1 detractor: aOR 1.32, 95% CI 1.03-1.68; 2 or 3 detractors: aOR 1.37, 95% CI 1.04-1.81). CONCLUSIONS Among neighborhood characteristics, the presence of physical detractors such as rundown housing and vandalism was most strongly associated with recurrent ED utilization by children. Negative attributes of the built environment may be a potential target for neighborhood-level, place-based interventions to alleviate disparities in child healthcare utilization.
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Affiliation(s)
- Lawrence Chang
- Department of Pediatrics, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Pediatrics, Boston Medical Center, Boston, MA.
| | - Amanda M Stewart
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Michael C Monuteaux
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Eric W Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
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15
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Wolfson JA. Poverty and Survival in Childhood Cancer: A Framework to Move Toward Systemic Change. J Natl Cancer Inst 2021; 113:227-230. [PMID: 33227815 DOI: 10.1093/jnci/djaa108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/24/2020] [Indexed: 12/30/2022] Open
Affiliation(s)
- Julie Anna Wolfson
- Division of Pediatric Hematology-Oncology, Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
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Affiliation(s)
- Jordan Tyris
- Children's National Hospital, Washington, District of Columbia; and .,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of ColumbiaDrs Tyris and Parikh conceptualized, drafted, and approved the final manuscript as submitted
| | - Kavita Parikh
- Children's National Hospital, Washington, District of Columbia; and.,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of ColumbiaDrs Tyris and Parikh conceptualized, drafted, and approved the final manuscript as submitted
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