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Paget SP, Mcintyre S, Schneuer FJ, Martin T, Sellars L, Burnett H, Price S, Nassar N. Outpatient encounters, continuity of care, and unplanned hospital care for children and young people with cerebral palsy. Dev Med Child Neurol 2024; 66:733-743. [PMID: 37946594 DOI: 10.1111/dmcn.15800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 09/19/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023]
Abstract
AIM To describe the relationships between outpatient encounters, continuity of care, and unplanned hospital care in children/young people with cerebral palsy (CP). METHOD In this population-based data-linkage cohort study we included children/young people with CP identified in the New South Wales/Australian Capital Territory CP Register (birth years 1994-2018). We measured the frequency of outpatient encounters and unplanned hospital care, defined as presentations to emergency departments and/or urgent hospital admissions (2015-2020). Continuity of outpatient care was measured using the Usual Provider of Care Index (UPCI). RESULTS Of 3267 children/young people with CP, most (n = 2738, 83.8%, 57.6% male) had one or more outpatient encounters (123 463 total encounters, median six outpatient encounters per year during childhood). High UPCI was more common in children/young people with mild CP (Gross Motor Function Classification System levels I-III, with no epilepsy or no intellectual disability), residing in metropolitan and areas of least socioeconomic disadvantage. Low UPCI was associated with four or more emergency department presentations (adjusted odds ratio [aOR] 2.34; 95% confidence interval [CI] 1.71-3.19) and one or more urgent hospital admissions (aOR 2.02; 95% CI 1.57-2.61). INTERPRETATION Children/young people with CP require frequent outpatient services. Improving continuity of care, particularly for those residing in regional/remote areas, may decrease need for unplanned hospital care. WHAT THIS PAPER ADDS Many children with cerebral palsy use multiple and frequent outpatient services. Better continuity of care is associated with living in metropolitan and less socioeconomically disadvantaged areas. Outpatient service utilization reduces at the time of transition to adult services. High outpatient utilization is associated with unplanned hospital care. Decreased continuity of care is associated with unplanned hospital care.
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Affiliation(s)
- Simon P Paget
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, The University of Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Sarah Mcintyre
- Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Francisco J Schneuer
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, The University of Sydney, New South Wales, Australia
| | - Tanya Martin
- School of Nursing and Midwifery, The University of Sydney, Sydney, New South Wales, Australia
| | - Louise Sellars
- Agency for Clinical Innovation, NSW Health, Sydney, New South Wales, Australia
| | - Heather Burnett
- HNEkidsHealth, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Sophie Price
- Agency for Clinical Innovation, NSW Health, Sydney, New South Wales, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, The University of Sydney, New South Wales, Australia
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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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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Gutierrez-Wu JC, Ritter V, McMahon EL, Heerman WJ, Rothman RL, Perrin EM, Shonna Yin H, Sanders LM, Delamater AM, Flower KB. Language Disparities in Caregiver Satisfaction with Physician Communication at Well Visits from 0-2 Years. Acad Pediatr 2024:S1876-2859(24)00071-8. [PMID: 38458488 DOI: 10.1016/j.acap.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/23/2024] [Accepted: 03/01/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE This study aimed to describe caregiver satisfaction with physician communication over the first two years of life and examine differences by preferred language and the relationship to physician continuity. METHODS Longitudinal data were collected at well visits (2 months to 2 years) from participants in a randomized controlled trial to prevent childhood obesity. Satisfaction with communication was assessed using the validated Communication Assessment Tool (CAT) questionnaire. Changes in the odds of optimal scores were estimated in mixed-effects logistic regression models to evaluate the associations between satisfaction over time and language, interpreter use, and physician continuity. RESULTS Of 865 caregivers, 35% were Spanish-speaking. Spanish-speaking caregivers without interpreters had lower odds of an optimal satisfaction score compared with English speakers during the first 2 years, beginning at 2 months [OR 0.64 (95% CI: 0.43, 0.95)]. There was no significant difference in satisfaction between English-speaking caregivers and Spanish-speaking caregivers with an interpreter. The odds of optimal satisfaction scores increased over time for both language groups. For both language groups, odds of an optimal satisfaction score decreased each time a new physician was seen for a visit [OR 0.82 (95% CI: 0.69, 0.97)]. CONCLUSION Caregiver satisfaction with physician communication improves over the first two years of well-child visits for both English- and Spanish-speakers. A loss of physician continuity over time was also associated with lower satisfaction. Future interventions to ameliorate communication disparities should ensure adequate interpreter use for primarily Spanish-speaking patients and address continuity issues to improve communication satisfaction.
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Affiliation(s)
- Jennifer C Gutierrez-Wu
- Division of General Pediatrics and Adolescent Medicine (JC Gutierrez-Wu, V Ritter, and KB Flower), Department of Pediatrics, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research (JC Gutierrez-Wu), University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Victor Ritter
- Division of General Pediatrics and Adolescent Medicine (JC Gutierrez-Wu, V Ritter, and KB Flower), Department of Pediatrics, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Division of General Pediatrics (V Ritter and LM Sanders), Stanford University School of Medicine, Palo Alto, Calif
| | - Ellen L McMahon
- Division of General Pediatrics (EL McMahon, WJ Heerman, and RL Rothman), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tenn
| | - William J Heerman
- Division of General Pediatrics (EL McMahon, WJ Heerman, and RL Rothman), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tenn
| | - Russell L Rothman
- Division of General Pediatrics (EL McMahon, WJ Heerman, and RL Rothman), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tenn
| | - Eliana M Perrin
- Division of General Pediatrics (EM Perrin), Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md; Johns Hopkins University School of Nursing (EM Perrin), Baltimore, Md; Department of Population, Family, and Reproductive Health (EM Perrin), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - H Shonna Yin
- Departments of Pediatrics and Population Health (H Shonna Yin), New York University School of Medicine, New York City, NY
| | - Lee M Sanders
- Division of General Pediatrics (V Ritter and LM Sanders), Stanford University School of Medicine, Palo Alto, Calif
| | - Alan M Delamater
- Department of Pediatrics (AM Delamater), University of Miami Miller School of Medicine, Miami, Fla
| | - Kori B Flower
- Division of General Pediatrics and Adolescent Medicine (JC Gutierrez-Wu, V Ritter, and KB Flower), Department of Pediatrics, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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Butler S, Tall J, Luscombe GM. Geographic variation in emergency department presentations among youth (10-24 years), New South Wales 2019: An epidemiological study. Emerg Med Australas 2023; 35:1013-1019. [PMID: 37468439 DOI: 10.1111/1742-6723.14285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To characterise ED presentations among youth in New South Wales (NSW) by geographic remoteness for 2019 and determine if intra-regional (inland vs coastal) variations exist. METHODS A population-based, retrospective descriptive analysis of 2019 Emergency Department Data Collection registry data for state-wide emergency presentations to NSW public hospitals among NSW residents aged 10-24 years was undertaken. Local government areas of residence were classified as major city, coastal regional, inland regional or remote. Sex and age-adjusted ED presentation rates were modelled according to geographical classification, using negative binomial regression. RESULTS In 2019, 178 public ED facilities in NSW received 479 880 presentations from NSW residents aged 10-24 years. ED presentation rates in regional and remote areas were more than twice (incidence rate ratio 2.23, 95% confidence interval 2.08-2.39) and four times (incidence rate ratio 4.32, 95% confidence interval 3.84-4.87) that, respectively, of major cities. Compared to major cities, youth presenting to regional and remote facilities spent 36% and 60% less time in ED, respectively, with presentations less likely to be deemed critical, occur after-hours or result in hospital admission. Variation between inland and coastal regional indicators was minimal. CONCLUSIONS Patterns of ED utilisation between major city, regional and remote youth were distinctly different, but not so between coastal and inland regional youth. Further research could better understand ED utilisation among youth and the drivers of higher presentation rates in regional and remote areas.
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Affiliation(s)
- Sally Butler
- School of Rural Medicine, Charles Sturt University, Orange, New South Wales, Australia
| | - Julie Tall
- Health Intelligence Unit, Western NSW Local Health District, Orange, New South Wales, Australia
| | - Georgina M Luscombe
- School of Rural Health, The University of Sydney, Orange/Dubbo, New South Wales, Australia
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Almalki ZS, Alahmari AK, Alajlan SAA, Alqahtani A, Alshehri AM, Alghamdi SA, Alanezi AA, Alawaji BK, Alanazi TA, Almutairi RA, Aldosari S, Ahmed N. Continuity of care in primary healthcare settings among patients with chronic diseases in Saudi Arabia. SAGE Open Med 2023; 11:20503121231208648. [PMID: 37915839 PMCID: PMC10617268 DOI: 10.1177/20503121231208648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/03/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction Maintaining continuity of care is one of the most critical components of providing great care in primary health care. This study aimed to explore continuity of care and its predictors in primary healthcare settings among patients with chronic diseases in Saudi Arabia. Method Face-to-face cross-sectional interviews were conducted with patients with chronic diseases who had at least four visits to primary care facilities in Riyadh, Saudi Arabia, between November 1, 2022 and March 3, 2023. We determined patients' continuity of care levels using the Bice-Boxerman continuity of care index. A Tobit regression model was used to determine the effects of several factors on the continuity of care index. Results The interviews were conducted with 193 respondents with chronic diseases of interest. The mean continuity of care index of the entire sample was 0.54. Those with asthma had the highest median continuity of care index at 0.75 (interquartile range, 0.62-0.75), whereas those diagnosed with thyroid disease had a much lower continuity of care index (0.47) (interquartile range, 0.3-0.62). Tobit regression model findings showed that employed respondents with poorer general health had a negative effect on continuity of care index levels. By contrast, a higher continuity of care index was significantly associated with elderly respondents, urban residents, and those diagnosed with dyslipidemia, diabetes, hypertension, or asthma. Conclusions According to our findings, the continuity of care level in Saudi Arabia's primary healthcare setting is low. The data demonstrate how continuity of care varies among study group characteristics and that improving continuity of care among chronic disease patients in Saudi Arabia is multifaceted and challenging, necessitating a coordinated and integrated healthcare delivery approach.
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Affiliation(s)
- Ziyad S Almalki
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Abdullah K Alahmari
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | | | - Abdulhadi Alqahtani
- Clinical Research Specialist, Clinical Research Department, Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmed M Alshehri
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Saleh A Alghamdi
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Adel A Alanezi
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Basil K Alawaji
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Tareq A Alanazi
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Rawan A Almutairi
- Collage of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Saad Aldosari
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Nehad Ahmed
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
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Holland JE, Rettew DC, Varni SE, Harder VS. Associations Between Mental and Physical Illness Comorbidity and Hospital Utilization. Hosp Pediatr 2023; 13:841-848. [PMID: 37555263 DOI: 10.1542/hpeds.2022-006984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
OBJECTIVE Characterize the prevalence of chronic physical illness types and mental illness and their comorbidity among adolescents and young adults (AYA) and assess the association of comorbidity on hospital utilization. METHODS This study features a population-level sample of 61 339 insurance-eligible AYA with an analytic sample of 49 089 AYA (aged 12-21) in Vermont's 2018 all-payer database. We used multiple logistic regressions to examine the associations between physical illness types and comorbid mental illness and emergency department (ED) use and inpatient hospitalization. RESULTS The analytic sample was 50% female, 63% Medicaid, and 43% had ≥1 chronic illness. Mental illness was common (31%) and highly comorbid with multiple physical illnesses. Among AYA with pulmonary illness, those with comorbid mental illness had 1.74-times greater odds (95% confidence interval [CI]: 1.49-2.05, P ≤.0005) of ED use and 2.9-times greater odds (95% CI: 2.05-4.00, P ≤.0005) of hospitalization than those without mental illness. Similarly, comorbid endocrine and mental illness had 1.84-times greater odds of ED use (95% CI: 1.39-2.44, P ≤.0005) and 2.1-times greater odds of hospitalization (95% CI: 1.28-3.46, P = .003), comorbid neurologic and mental illness had 1.36-times greater odds of ED use (95% CI: 1.18-1.56, P ≤.0005) and 2.4-times greater odds of hospitalization (95% CI: 1.73-3.29, P ≤.0005), and comorbid musculoskeletal and mental illness had 1.38-times greater odds of ED use (95% CI: 1.02-1.86, P = .04) and 2.1-times greater odds of hospitalization (95% CI: 1.20-3.52, P = .01). CONCLUSIONS Comorbid physical and mental illness was common. Having a comorbid mental illness was associated with greater ED and inpatient hospital utilization across multiple physical illness types.
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Affiliation(s)
| | - David C Rettew
- The Robert Larner, M.D. College of Medicine
- Department of Pediatrics
- Department of Psychiatry, The University of Vermont, Burlington, Vermont
- Lane County Behavioral Health, Eugene, Oregon
| | - Susan E Varni
- The Robert Larner, M.D. College of Medicine
- Department of Pediatrics
| | - Valerie S Harder
- The Robert Larner, M.D. College of Medicine
- Department of Pediatrics
- Department of Psychiatry, The University of Vermont, Burlington, Vermont
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Moss P, Nixon P, Baggio S, Newcomb D. Turning Strategy into Action - Using the ECHO Model to Empower the Australian Workforce to Integrate Care. Int J Integr Care 2023; 23:16. [PMID: 37215958 PMCID: PMC10198227 DOI: 10.5334/ijic.7036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 05/09/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction Children's Health Queensland (CHQ) established a telementoring hub in Queensland, using the Project ECHO® model, to pilot and scale a range of virtual communities of practice (CoP) to empower the Australian workforce to integrate care. Description The establishment of the first Project ECHO hub in Queensland facilitated the implementation of a variety of child and youth health CoP that strategically aligned to the organisation's approach to integrate care through workforce development. Subsequently, other organisations nationally have also been trained to implement and replicate the ECHO model to effect more integrated care through CoPs in other priority areas. Discussion Findings from a database audit and desktop analysis of project documentation highlighted that using the ECHO model was effective in establishing co-designed and interprofessional CoP to support a cross-sector workforce to deliver more integrated care. Conclusion CHQ's use of Project ECHO highlights an intentional approach to establishing virtual CoP to build workforce capability to integrate care. The approach explored in this paper highlights the value of workforce collaboration amongst non-traditional partners to foster more integrated care.
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Affiliation(s)
- Perrin Moss
- Bachelor of Business, Bachelor of Creative Industries, ECHO Program Manager, Children’s Health Queensland, and Doctor of Philosophy candidate, The University of Queensland, PO Box 3474 South Brisbane 4101, Queensland, Australia
| | - Phil Nixon
- Bachelor of Physiotherapy, Master of Development Practice, Graduate Certificate in Clinical Education, ECHO Network Coordinator, Children’s Health Queensland, PO Box 3474 South Brisbane 4101, Queensland, Australia
| | - Sarah Baggio
- Bachelor of Health Sciences (Physiotherapy), Honours Bachelor of Kinesiology (minor Gerontology), ECHO Network Coordinator, Children’s Health Queensland, PO Box 3474 South Brisbane 4101, Queensland, Australia
| | - Dana Newcomb
- Bachelor of Medicine, Bachelor of Surgery, Diploma of Child Health, Fellow of the Royal Australian College of General Practitioners, Medical Director Integrated Care, Children’s Health Queensland, and Senior Lecturer, Primary Care Clinical Unit, The University of Queensland, PO Box 3474 South Brisbane 4101, Queensland, Australia
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Bannett Y, Gardner RM, Huffman LC, Feldman HM, Sanders LM. Continuity of Care in Primary Care for Young Children With Chronic Conditions. Acad Pediatr 2023; 23:314-321. [PMID: 35858663 DOI: 10.1016/j.acap.2022.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/19/2022] [Accepted: 07/02/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES 1) To assess continuity of care (CoC) within primary-care practices for children with asthma and autism spectrum disorder (ASD) compared to children without chronic conditions, and 2) to determine patient and clinical-care factors associated with CoC. METHODS Retrospective cohort study of electronic health records from office visits of children <9 years, seen ≥4 times between 2015 and 2019 in 10 practices of a community-based primary health care network in California. Three cohorts were constructed: 1) Asthma: ≥2 visits with asthma visit diagnoses; 2) ASD: same method; 3) Controls: no chronic conditions. CoC, using Usual Provider of Care measure (range > 0-1), was calculated for 1) all visits (overall) and 2) well-care visits. Fractional regression models examined CoC adjusting for patient age, medical insurance, practice affiliation, and number of visits. RESULTS Of 30,678 children, 1875 (6.1%) were classified with Asthma, 294 (1.0%) with ASD, and 15,465 (50.4%) as Controls. Overall CoC was lower for Asthma (Mean = 0.58, SD 0.21) and ASD (M = 0.57, SD = 0.20) than Controls (M = 0.66, SD = 0.21); differences in well-care CoC were minimal. In regression models, lower overall CoC was found for Asthma (aOR = 0.90, 95% CI, 0.85-0.94). Lower overall and well-care CoC were associated with public insurance (aOR = 0.77, CI, 0.74-0.81; aOR = 0.64, CI, 0.59-0.69). CONCLUSION After accounting for patient and clinical-care factors, children with asthma, but not with ASD, in this primary-care network had significantly lower CoC compared to children without chronic conditions. Public insurance was the most prominent patient factor associated with low CoC, emphasizing the need to address disparities in CoC.
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Affiliation(s)
- Yair Bannett
- Division of Developmental-Behavioral Pediatrics (Y Bannett, LC Huffman and HM Feldman), Stanford University School of Medicine, Stanford, Calif.
| | | | - Lynne C Huffman
- Division of Developmental-Behavioral Pediatrics (Y Bannett, LC Huffman and HM Feldman), Stanford University School of Medicine, Stanford, Calif
| | - Heidi M Feldman
- Division of Developmental-Behavioral Pediatrics (Y Bannett, LC Huffman and HM Feldman), Stanford University School of Medicine, Stanford, Calif
| | - Lee M Sanders
- Division of General Pediatrics (LM Sanders), Stanford University School of Medicine, Stanford, Calif
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Mason-Jones AJ, Beltrán L, Keding A, Berry V, Blower SL, Whittaker K, Bywater T. Predictors of Mother and Infant Emergency Department Attendance and Admission: A Prospective Observational Study. Matern Child Health J 2023; 27:527-537. [PMID: 36701099 PMCID: PMC9879240 DOI: 10.1007/s10995-022-03581-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To explore the predictors of emergency department attendance and admission for mothers and their infants. METHODS Self-reported emergency department (ED) attendance and admission, sociodemographic, mental health, and other measures were recorded at baseline and at 12 months at 4 sites in England between May 2017 and March 2020. RESULTS Infants' gestational age (OR 0.73, 95% CI 0.61 to 0.88, p = 0.001), mothers' mental health (OR 2.40, 95% CI 1.30 to 4.41, p = 0.005) and mothers' attendance at ED (OR 2.34, 95% CI 1.13 to 4.84, p = 0.022) predicted infant ED attendance. Frequency of attendance was predicted by ED site (IRR 0.46, 95% CI 0.29 to 0.73, p = 0.001) and mothers' age (IRR 0.96, 95% CI 0.92 to 1.00, p = 0.028). Infant hospital admissions were predominantly for respiratory (40%) and other infectious diseases (21%) and were predicted by previous health problems (OR 3.25, 95% CI 1.76 to 6.01, p < 0.001). Mothers' ED attendance was predicted by mixed or multiple ethnic origin (OR 9.62, 95% CI 2.19 to 42.27, p = 0.003), having a male infant (OR 2.08, 95% CI 1.03 to 4.20, p = 0.042), and previous hospitalisation (OR 4.15, 95% CI 1.81 to 9.56, p = 0.001). Hospital admission was largely for reproductive health issues (61%) with frequency predicted by having attended the ED at least once (IRR 3.39, 95% CI 1.66 to 6.93, p = 0.001), and being anxious or depressed (IRR 3.10, 95% CI 1.14 to 8.45, p = 0.027). CONCLUSIONS FOR PRACTICE Improving the reproductive and mental health of mothers may help to avoid poor maternal and infant health outcomes and reduce emergency service utilisation and hospitalisation.
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Affiliation(s)
- Amanda J Mason-Jones
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
| | - Luis Beltrán
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Ada Keding
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Vashti Berry
- College of Medicine and Health, South Cloisters, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Sarah L Blower
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Karen Whittaker
- School of Nursing, University of Central Lancashire, Preston, PR1 2HE, UK
| | - Tracey Bywater
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
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Davis E, Fagnano M, Halterman JS, Frey SM. Utilization of the emergency department as a routine source of care among children with asthma. J Asthma 2022; 60:1377-1385. [PMID: 36399630 DOI: 10.1080/02770903.2022.2149409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objective: To describe characteristics of children with persistent asthma in the ED who receive most of their healthcare in emergency settings; and determine whether recent asthma experiences or historic patterns of care are associated with identifying the ED as a typical location for care.Methods: We conducted a sub-analysis of baseline data from Telemedicine Enhanced Asthma Management through the Emergency Department (TEAM-ED), an RCT of children (3-12 years) presenting to the ED with persistent asthma (2016-2020). Caregivers identified reasons for seeking emergency care, including if their child received most overall healthcare in the ED ('ED Care'; primary outcome) or not ('Other Care'). Independent variables included demographics, recent symptoms and quality of life (QOL), and historic preventive care and healthcare use. We compared responses between ED Care and Other Care groups using bivariate and multivariate analyses.Results: We analyzed data for 355 children (31% ED Care, 69% Other Care). Compared with Other Care, ED Care respondents were more likely to identify the ED as the closest source of healthcare; report fewer symptom nights but a poorer quality of life; and describe the ED as a usual place for sick care, despite most having a PCP.Conclusions: Many children with asthma use the ED as a typical source of healthcare, and are distinguished by need for proximity, poorer caregiver QOL, and historic patterns of care-seeking. Efforts to improve timely access to outpatient care and reinforce the role of PCP-directed asthma management, such as through telemedicine, may reduce preventable morbidity including ED visits.
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Affiliation(s)
- Erin Davis
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Maria Fagnano
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Jill S Halterman
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Sean M Frey
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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11
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Redirecting Nonurgent Patients From the Pediatric Emergency Department to Their Pediatrician Office for a Same-Day Visit-A Quality Improvement Initiative. Pediatr Emerg Care 2022; 38:692-696. [PMID: 36318627 DOI: 10.1097/pec.0000000000002879] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVES Providing high-quality care in the appropriate setting to optimize value is a worthy goal of an efficient health system. Consequences of managing nonurgent complaints in the emergency department (ED) have been described including inefficiency, loss of the primary care-patient relationship, and delayed care for other ED patients. The purpose of this initiative was to redirect nonurgent patients arriving in the ED to their primary care office for a same-day visit, and the SMART AIM was to increase redirected patients from 0% of those eligible to 30% in a 12-month period. METHODS The setting was a pediatric ED (PED) and primary care office of a tertiary care pediatric medical system. The initiative utilized the electronic health record to identify and mediate the redirection of patients to the patient's primary care office after ED triage. The primary measurement was the percentage of eligible patients redirected. Additional measures included health benefits during the primary care visit (vaccines, well-visits) and a balancing measure of patients returned to the PED. RESULTS The SMART AIM of >30% redirection was achieved and sustained with a final redirection rate of 46%. In total, 216 of 518 eligible patients were redirected, with zero untoward outcomes. The encounter time for redirected patients was similar for those who remained in the PED, and additional health benefits were appreciated for redirected patients. CONCLUSIONS This initiative redirected nonurgent patients efficiently from a PED setting to their primary care office. The process is beneficial to patients and families and supports the patient-centered medical home. The balancing measure of no harm done to patients who accepted redirect reinforced the reliability of PED triage. The benefits achieved through the project highlight the value of the primary care-patient relationship and the continued need to improve access for patients and families.
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12
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Schuettig W, Sundmacher L. The impact of ambulatory care spending, continuity and processes of care on ambulatory care sensitive hospitalizations. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:1329-1340. [PMID: 35091856 PMCID: PMC9550748 DOI: 10.1007/s10198-022-01428-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 01/06/2022] [Indexed: 06/14/2023]
Abstract
Ambulatory care sensitive hospitalizations are widely considered as important measures of access to as well as quality and performance of primary care. In our study, we investigate the impact of spending, process quality and continuity of care in the ambulatory care sector on ambulatory care sensitive hospitalizations in patients with type 2 diabetes. We used observational data from Germany's major association of insurance companies from 2012 to 2014 with 55,924 patients, as well as data from additional sources. We conducted negative binomial regression analyses with random effects at the district level. To control for potential endogeneity of spending and physician density in the ambulatory care sector, we used an instrumental variable approach. We controlled for a wide range of covariates, such as age, sex, and comorbidities. The results of our analysis suggest that spending in the ambulatory care sector has weak negative effects on ambulatory care sensitive hospitalizations. We also found that continuity of care was negatively associated with hospital admissions. Patients with type 2 diabetes are at increased risk of hospitalization resulting from ambulatory care sensitive conditions. Our study provides some evidence that increased spending and improved continuity of care while controlling for process quality in the ambulatory care sector may be effective ways to reduce the rate of potentially avoidable hospitalizations among patients with type 2 diabetes.
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Affiliation(s)
- Wiebke Schuettig
- Chair of Health Economics, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992 Munich, Germany
| | - Leonie Sundmacher
- Chair of Health Economics, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992 Munich, Germany
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13
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Neill S, Bray L, Carter B, Roland D, Carrol ED, Bayes N, Riches L, Hughes J, Pandey P, O'Donnell J, Palmer-Hill S. Navigating uncertain illness trajectories for young children with serious infectious illness: a modified grounded theory study. BMC Health Serv Res 2022; 22:1103. [PMID: 36042434 PMCID: PMC9427158 DOI: 10.1186/s12913-022-08420-5] [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: 02/22/2022] [Accepted: 07/27/2022] [Indexed: 11/23/2022] Open
Abstract
Background Infectious illness is the biggest cause of death in children due to a physical illness, particularly in children under five years. If mortality is to be reduced for this group of children, it is important to understand factors affecting their pathways to hospital. The aim of this study was to retrospectively identify organisational and environmental factors, and individual child, family, and professional factors affecting timing of admission to hospital for children under five years of age with a serious infectious illness (SII). Methods An explanatory modified grounded theory design was used in collaboration with parents. Two stages of data collection were conducted: Stage 1, interviews with 22 parents whose child had recently been hospitalised with a SII and 14 health professionals (HPs) involved in their pre-admission trajectories; Stage 2, focus groups with 18 parents and 16 HPs with past experience of SII in young children. Constant comparative analysis generated the explanatory theory. Results The core category was ‘navigating uncertain illness trajectories for young children with serious infectious illness’. Uncertainty was prevalent throughout the parents’ and HPs’ stories about their experiences of navigating social rules and overburdened health services for these children. The complexity of and lack of continuity within services, family lives, social expectations and hierarchies provided the context and conditions for children’s, often complex, illness trajectories. Parents reported powerlessness and perceived criticism leading to delayed help-seeking. Importantly, parents and professionals missed symptoms of serious illness. Risk averse services were found to refer more children to emergency departments. Conclusions Parents and professionals have difficulties recognising signs of SII in young children and can feel socially constrained from seeking help. The increased burden on services has made it more difficult for professionals to spot the seriously ill child. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08420-5.
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Affiliation(s)
- Sarah Neill
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Devon, UK.,Faculty of Science, Charles Sturt University, Bathurst, Australia
| | - Lucy Bray
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, Lancashire, UK
| | - Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, Lancashire, UK.,Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand
| | - Damian Roland
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK.,SAPPHIRE Group, Health Sciences, Leicester University, Leicester, UK
| | - Enitan D Carrol
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool Institute of Infection, Veterinary and Ecological Sciences, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Natasha Bayes
- Faculty of Health, Education and Society, University of Northampton, Northampton, Northamptonshire, UK.
| | - Lucie Riches
- Support Services, Meningitis Now, Gloucestershire, Stroud, UK
| | - Joanne Hughes
- Mother's Instinct and Harmed Patients Alliance, Cambridgeshire, UK
| | - Poornima Pandey
- Department of Paediatrics, Kettering General Hospital NHS Foundation Trust, Kettering, Northamptonshire, UK
| | - Jennifer O'Donnell
- Human Factors and Investigation, London City University, Cranfield University, London Cranfield, Bedfordshire, UK
| | - Sue Palmer-Hill
- Northamptonshire Healthcare NHS Foundation Trust, Northampton, Northamptonshire, UK
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14
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Pahlavanyali S, Hetlevik Ø, Blinkenberg J, Hunskaar S. Continuity of care for patients with chronic disease: a registry-based observational study from Norway. Fam Pract 2022; 39:570-578. [PMID: 34536072 PMCID: PMC9295609 DOI: 10.1093/fampra/cmab107] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Continuity of care (CoC) is accepted as a core value of primary care and is especially appreciated by patients with chronic conditions. Nevertheless, there are few studies investigating CoC for these patients across levels of healthcare. OBJECTIVE This study aims to investigate CoC for patients with somatic chronic diseases, both with regular general practitioners (RGPs) and across care levels. METHODS We conducted a registry-based observational study by using nationwide consultation data from Norwegian general practices, out-of-hours services, hospital outpatient care, and private specialists with public contracts. Patients with diabetes mellitus (type I or II), asthma, chronic obstructive pulmonary disease, or heart failure in 2012, who had ≥2 consultations with these diagnoses during 2014 were included. CoC was measured during 2014 by using the usual provider of care (UPC) index and Bice-Boxerman continuity of care score (COCI). Both indices have a value between 0 and 1. RESULTS Patients with diabetes mellitus comprised the largest study population (N = 79,165) and heart failure the smallest (N = 4,122). The highest mean UPC and COCI were measured for patients with heart failure, 0.75 and 0.77, respectively. UPC increased gradually with age for all diagnoses, while COCI showed this trend only for asthma. Both indices had higher values in urban areas. CONCLUSIONS Our findings suggest that CoC in Norwegian healthcare system is achieved for a majority of patients with chronic diseases. Patients with heart failure had the highest continuity with their RGP. Higher CoC was associated with older age and living in urban areas.
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Affiliation(s)
- Sahar Pahlavanyali
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Øystein Hetlevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jesper Blinkenberg
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Steinar Hunskaar
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
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15
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Nicolet A, Al-Gobari M, Perraudin C, Wagner J, Peytremann-Bridevaux I, Marti J. Association between continuity of care (COC), healthcare use and costs: what can we learn from claims data? A rapid review. BMC Health Serv Res 2022; 22:658. [PMID: 35578226 PMCID: PMC9112559 DOI: 10.1186/s12913-022-07953-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 04/08/2022] [Indexed: 01/07/2023] Open
Abstract
Objective To describe how longitudinal continuity of care (COC) is measured using claims-based data and to review its association with healthcare use and costs. Research design Rapid review of the literature. Methods We searched Medline (PubMed), EMBASE and Cochrane Central, manually checked the references of included studies, and hand-searched websites for potentially additional eligible studies. Results We included 46 studies conducted in North America, East Asia and Europe, which used 14 COC indicators. Most reported studies (39/46) showed that higher COC was associated with lower healthcare use and costs. Most studies (37/46) adjusted for possible time bias and discussed causality between the outcomes and COC, or at least acknowledged the lack of it as a limitation. Conclusions Whereas a wide range of indicators is used to measure COC in claims-based data, associations between COC and healthcare use and costs were consistent, showing lower healthcare use and costs with higher COC. Results were observed in various population groups from multiple countries and settings. Further research is needed to make stronger causal claims. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07953-z.
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Affiliation(s)
- Anna Nicolet
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Biopôle 2 SV-A, Route de la Corniche 10, CH-1010, Lausanne, Switzerland.
| | - Muaamar Al-Gobari
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Biopôle 2 SV-A, Route de la Corniche 10, CH-1010, Lausanne, Switzerland
| | - Clémence Perraudin
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Biopôle 2 SV-A, Route de la Corniche 10, CH-1010, Lausanne, Switzerland
| | - Joël Wagner
- Department of Actuarial Science, Faculty of Business and Economics (HEC), and Swiss Finance Institute, University of Lausanne, Lausanne, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Biopôle 2 SV-A, Route de la Corniche 10, CH-1010, Lausanne, Switzerland
| | - Joachim Marti
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Biopôle 2 SV-A, Route de la Corniche 10, CH-1010, Lausanne, Switzerland
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16
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Snyder DA, Schuller J, Ameen Z, Toth C, Kemper AR. Improving Patient-Provider Continuity in a Large Urban Academic Primary Care Network. Acad Pediatr 2022; 22:305-312. [PMID: 34780999 DOI: 10.1016/j.acap.2021.11.005] [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: 05/26/2021] [Revised: 10/04/2021] [Accepted: 11/06/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Although patient-provider continuity improves care delivery and satisfaction, poor continuity with primary care providers (PCP) often exists in academic centers. We aimed to increase patient empanelment from 0% to 90% and then increase the percent of well-child care (WCC) visits scheduled with the PCP from 25.6% to 50%, without decreasing timely access that might result if patients waited for PCP availability. METHODS Nationwide Children's Hospital Primary Care Network cares for >120,000 mostly Medicaid-enrolled patients across 13 offices. Before 2017, patients were empaneled to an office, not individual PCPs. We empaneled patients to PCPs, reduced provider floating, implemented continuity-promoting scheduling guidelines, scheduled future WCC visits for patients ≤15 months during check-in for their current one, and encouraged online scheduling. We tracked the percentage of all WCC visits that were scheduled with the patient's PCP and the percentage of subsequent WCC visits for patients ≤15 months that were scheduled during the current visit, and provided feedback to schedulers. We followed emergency department (ED) utilization and visit show rates. WCC visit completion rates were tracked using HEDIS metrics. RESULTS Patient empanelment increased from 0% to >90% (P < .001). Patient-provider WCC continuity increased from 25.6% to 54.7% (P < .001). A 20.5% decrease in ED utilization rate was associated with continuity project initiation. Empaneled patients demonstrated higher show rates (76.9%) versus unempaneled patients (71.4%; P < .001). WCC completion rates increased from 52.6% to 60.7%. CONCLUSIONS WCC continuity more than doubled after interventions and was associated with decreased ED utilization, higher show rates, and increased timely WCC completion.
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Affiliation(s)
- Dane A Snyder
- Division of Primary Care Pediatrics, Nationwide Children's Hospital (DA Synder, J Schuller, Z Ameen, and AR Kemper), Columbus, Ohio.
| | - Jonathon Schuller
- Division of Primary Care Pediatrics, Nationwide Children's Hospital (DA Synder, J Schuller, Z Ameen, and AR Kemper), Columbus, Ohio
| | - Zeenath Ameen
- Division of Primary Care Pediatrics, Nationwide Children's Hospital (DA Synder, J Schuller, Z Ameen, and AR Kemper), Columbus, Ohio
| | - Christina Toth
- Quality Improvement Services, Nationwide Children's Hospital (C Toth), Columbus, Ohio
| | - Alex R Kemper
- Division of Primary Care Pediatrics, Nationwide Children's Hospital (DA Synder, J Schuller, Z Ameen, and AR Kemper), Columbus, Ohio
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17
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The Impact of COVID-19 Protocols on the Continuity of Care for Patients with Hypertension. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031735. [PMID: 35162758 PMCID: PMC8835649 DOI: 10.3390/ijerph19031735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 11/18/2022]
Abstract
The aim of this study was to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the continuity of care (COC) for patients with hypertension. Additionally, the factor of whether participants were treated via telemedicine was also considered. This study used the National Health Insurance and Medical Aid claims data of the Republic of Korea between 2019 and 2020. Multivariable regression analysis was performed to identify the differences in the number of visits and the most frequent provider continuity (MFPC) of hypertensive patients before and after the appearance of COVID-19 in Korea. Additional analysis was performed with data that excluded cases of patients who received telemedicine services. A total of 5,791,812 hypertensive patients were included in this study. The MFPC decreased by 0.0031 points after the appearance of COVID-19, and it showed the same decrease even when telemedicine cases were excluded. The number of outpatient clinic visit days decreased by 0.2930 days after the appearance of COVID-19. Without the telemedicine cases, the number of outpatient clinic visit days decreased by 0.3330 days after the appearance of COVID-19. Accordingly, the COVID-19 protocols did not affect hypertension patients’ COC but impacted the frequency of their outpatient visits. In other words, with or without telemedicine, the utilization of healthcare was not disrupted, but there was a significant difference in the volume of healthcare use depending on the inclusion of telemedicine cases.
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18
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Are primary care and continuity of care associated with asthma-related acute outcomes amongst children? A retrospective population-based study. BMC PRIMARY CARE 2022; 23:5. [PMID: 35172739 PMCID: PMC8759282 DOI: 10.1186/s12875-021-01605-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/01/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Having a primary care provider and a continuous relationship may be important for asthma outcomes. In this study, we sought to determine the association between 1) having a usual provider of primary care (UPC) and asthma-related emergency department (ED) visits and hospitalization in Québec children with asthma and 2) UPC continuity of care and asthma outcomes. METHODS Population-based retrospective cohort study using Québec provincial health administrative data, including children 2-16 years old with asthma (N = 39, 341). Exposures and outcomes were measured from 2010-2011 and 2012-2013, respectively. Primary exposure was UPC stratified by the main primary care models in Quebec (team-based Family Medicine Groups, family physicians not in Family Medicine Groups, pediatricians, or no assigned UPC). For those with an assigned UPC the secondary exposure was continuity of care, measured by the UPC Index (high, medium, low). Four multivariate logistic regression models examined associations between exposures and outcomes (ED visits and hospitalizations). RESULTS Overall, 17.4% of children had no assigned UPC. Compared to no assigned UPC, having a UPC was associated with decreased asthma-related ED visits (pediatrician Odds Ratio (OR): 0.80, 95% Confidence Interval (CI) [0.73, 0.88]; Family Medicine Groups OR: 0.84, 95% CI [0.75,0.93]; non-Family Medicine Groups OR: 0.92, 95% CI [0.83, 1.02]) and hospital admissions (pediatrician OR: 0.66, 95% CI [0.58, 0.75]; Family Medicine Groups OR: 0.82, 95% CI [0.72, 0.93]; non-Family Medicine Groups OR: 0.76, 95% CI [0.67, 0.87]). Children followed by a pediatrician were more likely to have high continuity of care. Continuity of care was not significantly associated with asthma-related ED visits. Compared to low continuity, medium and high continuity of care decreased asthma-related hospital admissions, but none of these associations were significant. CONCLUSION Having a UPC was associated with reduced asthma-related ED visits and hospital admissions. However, continuity of care was not significantly associated with outcomes. The current study provides ongoing evidence for the importance of primary care in children with asthma.
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19
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Vivier PM, Rogers ML, Gjelsvik A, Linakis JG, Schlichting LE, Mello MJ. Frequent Emergency Department Use by Children. Pediatr Emerg Care 2021; 37:e995-e1000. [PMID: 31305503 DOI: 10.1097/pec.0000000000001859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Frequent use of the emergency department (ED) is often targeted as a quality improvement metric. The objective of this study was to assess ED visit frequency by the demographic and health characteristics of children who visit the ED to better understand risk factors for high ED utilization. METHODS The majority of pediatric ED services in Rhode Island are provided by a hospital network that includes the state's only children's hospital. Using 10 years of data (2005-2014) from this statewide hospital network, we examined ED use in this network for all children aged 0 to 17 years. Patients' home addresses were geocoded to assess their neighborhood characteristics. RESULTS Between 2005 and 2014, 17,844 children visited 1 or more of the network EDs at least once. In their year of maximum use, 67.8% had only 1 ED visit, 20.1% had 2 visits, 6.9% had 3 visits, and 5.2% had 4 or more visits. In the adjusted multinomial logistic regression model, age, race/ethnicity, language, insurance coverage, medical complexity, neighborhood risk, and distance to the ED were found to be significantly associated with increased visit frequency. CONCLUSIONS Risk factors for frequent ED use by children include age, race/ethnicity, language, insurance coverage, medical complexity, neighborhood risk, and distance to the hospital. To decrease frequent pediatric ED use, improved medical management of complex medical problems is needed, but it is also essential to address modifiable social determinants of health care utilization in this population.
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20
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Hurst JH, Zhao C, Fitzpatrick NS, Goldstein BA, Lang JE. Reduced pediatric urgent asthma utilization and exacerbations during the COVID-19 pandemic. Pediatr Pulmonol 2021; 56:3166-3173. [PMID: 34289526 PMCID: PMC8441648 DOI: 10.1002/ppul.25578] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/06/2021] [Accepted: 07/11/2021] [Indexed: 12/21/2022]
Abstract
The COVID-19 pandemic has had a profound impact on healthcare access and utilization, which could have important implications for children with chronic diseases, including asthma. We sought to evaluate changes in healthcare utilization and outcomes in children with asthma during the COVID-19 pandemic. We used electronic health records data to evaluate healthcare use and asthma outcomes in 3959 children and adolescents, 5-17 years of age, with a prior diagnosis of asthma who had a history of well-child visits and encounters within the healthcare system. We assessed all-cause healthcare encounters and asthma exacerbations in the 12-months preceding the start of the COVID-19 pandemic (March 1, 2019-February 29, 2020) and the first 12 months of the pandemic (March 1, 2020-February 28, 2021). All-cause healthcare encounters decreased significantly during the pandemic compared to the preceding year, including well-child visits (48.1% during the pandemic vs. 66.6% in the prior year; p < .01), emergency department visits (9.7% vs. 21.0%; p < .01), and inpatient admissions (1.6% vs. 2.5%; p < .01), though there was over a 100-fold increase in telehealth encounters. Asthma exacerbations that required treatment with systemic steroids also decreased (127 vs. 504 exacerbations; p < .01). Race/ethnicity was not associated with changes in healthcare utilization or asthma outcomes. The COVID-19 pandemic corresponded to dramatic shifts in healthcare utilization, including increased telehealth use and improved outcomes among children with asthma. Social distancing measures may have also reduced asthma trigger exposure.
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Affiliation(s)
- Jillian H Hurst
- Department of Pediatrics, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Pediatrics, Children's Health & Discovery Initiative, Duke University School of Medicine, Durham, North Carolina, USA
| | - Congwen Zhao
- Department of Pediatrics, Children's Health & Discovery Initiative, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nicholas S Fitzpatrick
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Benjamin A Goldstein
- Department of Pediatrics, Children's Health & Discovery Initiative, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Jason E Lang
- Department of Pediatrics, Children's Health & Discovery Initiative, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
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21
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Kirby S, Wooten W, Spanier AJ. Pediatric Primary Care Relationships and Non-Urgent Emergency Department Use in Children. Acad Pediatr 2021; 21:900-906. [PMID: 33813066 PMCID: PMC8263464 DOI: 10.1016/j.acap.2021.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 03/10/2021] [Accepted: 03/13/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Non-urgent emergency department (ED) use contributes to healthcare costs and disrupts continuity of care. Factors influencing patient/guardian decision-making in non-urgent situations are poorly understood. We sought to determine the association of patient/guardian - primary care provider (PCP) relationship with non-urgent ED usage and explore related factors. METHODS In an urban practice, we recruited 218 parent-child pairs and administered a survey with the PCP relationship (PDRQ-9), caregiver knowledge of office resources, and care-seeking behavior. We performed a 12-month retrospective chart review to document non-urgent ED visits. We evaluated the association of PDRQ9 and non-urgent ED usage by regression analysis. RESULTS Mean child age was 7.0 ± 5 years, and 32.6% of children had at least one non-urgent ED visit. Mean PDRQ9 score was 39.8 ± 7.3 and was not associated with non-urgent ED use (P = .46). Lower child age (P < .001) and shorter time coming to the PCP practice (P < .001) were both associated with increased non-urgent ED use. Only 36.4% reported usually going to their PCP when they are sick. Knowledge of office resources was limited, and when prompted with acute, non-urgent medical scenarios, in 4 of 5 scenarios, 50% or more of participants chose to go to the ED over communicating with or going to their PCP. CONCLUSIONS We did not find an association between patient-doctor relationship strength and non-urgent ED usage. Many patients/guardians were unaware of the practice's resources and selected the ED as first choice for acute, non-urgent medical scenarios. Additional work is needed to determine interventions to reduce non-urgent ED use.
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Affiliation(s)
- Shannon Kirby
- Medical Student, University of Maryland, School of Medicine, Baltimore, MD, 655 West Baltimore St, Suite M-019, Baltimore, MD 21201
| | - William Wooten
- Department of Biostatistics, University of Maryland, School of Medicine, Baltimore, MD, 660 W. Redwood St, Howard Hall Suite 200, Baltimore, MD 21201
| | - Adam J. Spanier
- Department of Pediatrics, University of Maryland, School of Medicine, Baltimore, MD, 22 S. Greene Street, Rm N5E17, Baltimore, MD 21201
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22
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Graif C, Meurer J, Fontana M. An Ecological Model to Frame the Delivery of Pediatric Preventive Care. Pediatrics 2021; 148:s13-s20. [PMID: 34210842 PMCID: PMC8312252 DOI: 10.1542/peds.2021-050693d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/24/2022] Open
Abstract
Screening and surveillance are integral aspects of child health promotion and disease prevention. The American Academy of Pediatrics recommends that primary care clinicians screen children and adolescents for a broad array of conditions, conduct surveillance of growth and development, identify social determinants of health, and identify protective and risk factors that might impact health over time. However, access to and outcomes of preventive services vary based on features of children’s social ecology, including family and community contexts. The proposed five-stage socio-ecological model considers multiple contextual dimensions of pediatric screening: (1) individual, (2) interpersonal, (3) organizational, (4) community/population, and (5) public policy. Incorporating this model into routine care might improve outcomes at the individual and population level. Future endeavors should focus on integration of this model with validated risk screening tools as part of a supportive electronic health record, culture, and incentive structure. Further research assessing the contributors and outcomes of differences in beliefs, resources, practices, and opportunities among individuals, families, providers, primary care organizations, communities, health systems, and policy partners will be essential in advancing knowledge and policies to improve preventive services delivery.
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Affiliation(s)
- Corina Graif
- Department of Sociology and Criminology, College of the Liberal Arts and Population Research Institute, Pennsylvania State University, University Park, Pennsylvania
| | - John Meurer
- Institute for Health & Equity, Division of Community Health, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Margherita Fontana
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan
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23
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Pu C, Tseng YC, Tang GJ, Lin YH, Lin CH, Wang IJ. Perception and Willingness to Maintain Continuity of Care by Parents of Children with Asthma in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073600. [PMID: 33808479 PMCID: PMC8037309 DOI: 10.3390/ijerph18073600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 11/16/2022]
Abstract
To investigate caregivers’ attitudes toward continuity of care (COC) and their willingness to maintain continuity for their children with asthma under a national health insurance (NHI) system without strict referral management. We sampled 825 individuals from six pediatric outpatient departments in different parts of Taiwan from 2017 to 2018. We used a contingent valuation with a payment card method. Post-stratification weighting adjustment and coarsened exact matching were utilized. Multiple logistic regression was used to compare the willingness to pay and spend extra time maintaining continuity by parents. More than 80% of caregivers in the asthma group believed having a primary pediatrician was important for children’s health. Only 27.5% and 15.8% of caregivers in the asthma and control groups, respectively, believed changing pediatricians would negatively affect therapeutic outcomes. Regression analysis showed that the predicted willingness to pay for the asthma and non-asthma groups were NT$508 (SD = 196) and NT$402 (SD = 172), respectively, and there was a significant positive dose–response relationship between household income and willingness to pay for maintaining health care provider continuity. Caregivers’ free choices among health care providers may reduce willingness to spend extra effort to maintain high COC. Caregivers should be educated on the importance of COC.
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Affiliation(s)
- Christy Pu
- Institute of Public Health, National Yang Ming Yang Ming Chiao Tung University, Taipei 112304, Taiwan;
| | - Yu-Chen Tseng
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan; (Y.-C.T.); (G.-J.T.)
| | - Gau-Jun Tang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan; (Y.-C.T.); (G.-J.T.)
| | - Yen-Hsiung Lin
- Hengchun Tourism Hospital, Ministry of Health and Welfare, Hengchun 946, Taiwan;
| | - Chien-Heng Lin
- Division of Pediatric Pulmonology, Children’s Hospital, China Medical University, Taichung 404, Taiwan;
| | - I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, Taipei 242033, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- College of Public Health, China Medical University, Taichung 40402, Taiwan
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli 350401, Taiwan
- National Taiwan University, Taipei 10617, Taiwan
- Correspondence: ; Tel.: +886-2-2276-5566 (ext. 2532)
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24
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Kim ES, Kim CY. The association between continuity of care and surgery in lumbar disc herniation patients. Sci Rep 2021; 11:5550. [PMID: 33692399 PMCID: PMC7946938 DOI: 10.1038/s41598-021-85064-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 02/22/2021] [Indexed: 11/29/2022] Open
Abstract
Continuity of care is a core dimension of high-quality care in the management of disease. The purpose of this study was to investigate the association between continuity of care and lumbar surgery in patients with moderate disc herniation. The Korean National Sample Cohort was used. The target population consisted of patients who have had disc herniation more than 6 months and didn’t get surgery and red flag signs within 6 months from onset. The population was enrolled from 2004 to 2013. The Bice-Boxerman Continuity of Care was used in measuring continuity of care. The marginal structural model with time dependent survival analysis was used. In total, 29,061 patients were enrolled in the cohort. High level of continuity of care was associated with a lower risk of lumbar surgery (HR, 0.27; 95% CI, 0.20–0.27). When the index was calculated only with outpatient visits to primary care with related specialty, the HR was 0.49 (95% CI: 0.43–0.57). In exploratory analysis, patients with lumbar stenosis and spondylolisthesis had higher risk of having a low level of continuity of care. These results indicate that continuity of care is associated with lower rates of lumbar surgery in patients with moderate disc herniation.
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Affiliation(s)
- Eun-San Kim
- Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Chang-Yup Kim
- Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.
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25
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Piwnica-Worms K, Staiger B, Ross JS, Rosenthal MS, Ndumele CD. Effects of forced disruption in Medicaid managed care on children with asthma. Health Serv Res 2021; 56:668-676. [PMID: 33624290 DOI: 10.1111/1475-6773.13643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate the effect of a forced disruption to Medicaid managed care plans and provider networks on health utilization and outcomes for children with persistent asthma. DATA SOURCES Medicaid managed care administrative claims data from 2013 to 2016, obtained from a southeastern state. STUDY DESIGN A difference-in-difference analysis compared patients' outpatient, inpatient, and emergency department (ED) utilization and receipt of recommended services before and after implementation of a statewide redistribution of patients among nine managed care plans. DATA COLLECTION/EXTRACTION METHODS Enrollment data for children with asthma were linked to the administrative claims. Children were included if they had a diagnosis of persistent asthma in 2013 and if they were enrolled continuously throughout 2014-2016. PRINCIPAL FINDINGS Among the 28 537 children with asthma, 26% were forced to switch their managed care plan after the redistribution. Of these, 67% also switched their primary care provider (PCP). Relative to those who remained in their plan, disruption was associated with an additional 2.1 percentage-point decrease in the number of children who had an outpatient visit per quarter [95%CI -2.8, -1.3], from 71% to 66% (compared to plan stayers: 74% to 71%). Among children experiencing a change to their plan, there was overall a decrease in the proportion of children receiving an asthma-specific visit per quarter, but there was less of a decrease in children that also changed their PCP [1.6 percentage points, 95%CI 0.7, 2.5], from 9.7% to 8.3% (compared to those who did not switch their PCP: 12% to 8.6%). Indicators of asthma care quality and emergent care utilization were not significantly different between the two periods. CONCLUSIONS While there was a decrease in the number of outpatient visits associated with forced disruption of Medicaid managed care plans for children with persistent asthma, there were no consistent associations with worse asthma quality performance or higher emergent health care utilization.
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Affiliation(s)
- Katherine Piwnica-Worms
- Department of Pediatrics, NYU Langone School of Medicine, New York, New York, USA.,Office of Ambulatory Care, NYC Health+Hospital, New York, New York, USA
| | - Becky Staiger
- Center for Health Policy/Primary Care and Outcomes Research, Stanford University, Stanford, California, USA
| | - Joseph S Ross
- National Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut, USA.,Section of General Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Center for Outcomes Research and Evaluation, Yale New Haven Health System, New Haven, Connecticut, USA.,Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Marjorie S Rosenthal
- National Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Chima D Ndumele
- Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut, USA
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26
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The effect of continuity of care on medical costs in patients with chronic shoulder pain. Sci Rep 2021; 11:4077. [PMID: 33603083 PMCID: PMC7893020 DOI: 10.1038/s41598-021-83596-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 02/03/2021] [Indexed: 11/08/2022] Open
Abstract
Unnecessary surgery could be prevented through continuity of care (COC). The present study aimed to investigate the relationships between COC, surgery and cost associated with chronic shoulder pain. We used the Health Insurance Review and Assessment Service national patient sample (HIRA-NPS) in 2017. A total of 1717 patients were included. Bice-Boxerman Continuity of Care Index was used as the indicator for measuring the COC. Occurrence of surgery, associated costs, and direct medical costs were analysed. Logistic regression, a two-part model with recycled predictions and generalized linear model with gamma distribution were used. The majority of patients were 40-65 years old (high COC: 68.4%; low COC: 64.4%). The odds ratio (OR) for surgery was 0.41 in the high-COC group compared to the low COC group (95% CI, 0.20 to 0.84). Direct medical cost was 14.09% (95% CI, 8.12% to 19.66%) and 58.00% lower in surgery cost (95% CI, 57.95 to 58.05) in the high-COC group. Interaction with COC and shoulder impingement syndrome was significant lower in direct medical cost (15.05% [95% CI, 1.81% to 26.51%]). High COC was associated with low medical cost in patients diagnosed with chronic shoulder pain.
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27
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Hand BN, Coury DL, White S, Darragh AR, Moffatt-Bruce S, Harris L, Longo A, Garvin JH. Specialized primary care medical home: A positive impact on continuity of care among autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:258-265. [PMID: 32907353 PMCID: PMC7854931 DOI: 10.1177/1362361320953967] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
LAY ABSTRACT There is a nationally recognized need for innovative healthcare delivery models to improve care continuity for autistic adults as they age out of pediatric and into adult healthcare systems. One possible model of care delivery is called the "medical home". The medical home is not a residential home, but a system where a patient's healthcare is coordinated through a primary care physician to ensure necessary care is received when and where the patient needs it. We compared the continuity of care among autistic adult patients at a specialized primary care medical home designed to remove barriers to care for autistic adults, called the CAST, to matched national samples of autistic adults with private insurance or Medicare. Continuity of primary care among CAST patients was significantly better than that of matched national samples of autistic adult Medicare beneficiaries and similar to that of privately insured autistic adults. Our findings suggest that medical homes, like CAST, are a promising solution to improve healthcare delivery for the growing population of autistic adults.
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Affiliation(s)
| | | | - Susan White
- The Ohio State University Wexner Medical Center
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28
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Targeting continuity of care and polypharmacy to reduce drug-drug interaction. Sci Rep 2020; 10:21279. [PMID: 33277524 PMCID: PMC7718252 DOI: 10.1038/s41598-020-78236-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/19/2020] [Indexed: 11/27/2022] Open
Abstract
Drug–drug interaction (DDI) is common among the elderly, and it can have detrimental effects on patients. However, how DDI can be targeted has been under-researched. This study investigates whether DDI can be reduced by targeting continuity of care (COC) through reducing polypharmacy. Population claims data of Taiwan National Health Insurance were used to conduct a 7-year-long longitudinal study on patients aged ≥ 65 years (n = 2,318,766). Mediation analysis with counterfactual method and a 4-way decomposition of the effect of COC on DDI was conducted. Mediation effect through excessive polypharmacy differed from that through lower-level polypharmacy. Compared with the low COC group, the high COC group demonstrated reduced excess relative risk of DDI by 26% (excess relative risk = − 0.263; 95% Confidence Interval (CI) = − 0.263 to − 0.259) to 30% (excess relative risk = − 0.297; 95% CI = − 0.300 to − 0.295) with excessive polypharmacy as the mediator. The risk only reduced by 8% (excess relative risk = − 0.079; 95% CI, − 0.08 to − 0.078) to 10% (excess relative risk = − 0.096; 95% CI, − 0.097 to − 0.095) when the mediator was changed to lower-level polypharmacy. The effect of COC on DDI was mediated by polypharmacy, and the mediation effect was higher with excessive polypharmacy. Therefore, to reduce DDI in the elderly population, different policy interventions should be designed by considering polypharmacy levels to maximize the positive effect of COC on DDI.
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29
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Lang JE, Tang M, Zhao C, Hurst J, Wu A, Goldstein BA. Well-Child Care Attendance and Risk of Asthma Exacerbations. Pediatrics 2020; 146:peds.2020-1023. [PMID: 33229468 PMCID: PMC7706112 DOI: 10.1542/peds.2020-1023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Asthma remains a leading cause of hospitalization in US children. Well-child care (WCC) visits are routinely recommended, but how WCC adherence relates to asthma outcomes is poorly described. METHODS We conducted a retrospective longitudinal cohort study using electronic health records among 5 to 17 year old children residing in Durham County with confirmed asthma and receiving primary care within a single health system, to compare the association between asthma exacerbations and previous WCC exposure. Exacerbations included any International Classification of Diseases, Ninth Revision, or International Classification of Diseases, 10th Revision, coded asthma exacerbation encounter with an accompanying systemic glucocorticoid prescription. Exacerbations were grouped by severity: ambulatory encounter only, urgent care, emergency department, hospital encounters <24 hours, and hospital admissions ≥24 hours. In the primary analysis, we assessed time to asthma exacerbation based on the presence or absence of a WCC visit in the preceding year using a time-varying covariate Cox model. RESULTS A total of 5656 children met eligibility criteria and were included in the primary analysis. Patients with the highest WCC visit attendance tended to be younger, had a higher prevalence of private insurance, had greater asthma medication usage, and were less likely to be obese. The presence of a WCC visit in the previous 12 months was associated with a reduced risk of all-cause exacerbations (hazard ratio: 0.90; 95% confidence interval: 0.83-0.98) and severe exacerbations requiring hospital admission (hazard ratio: 0.53; 95% confidence interval: 0.39-0.71). CONCLUSIONS WCC visits were associated with a lower risk of subsequent severe exacerbations, including asthma-related emergency department visits and hospitalizations. Poor WCC visit adherence predicts pediatric asthma morbidity, especially exacerbations requiring hospitalization.
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Affiliation(s)
- Jason E. Lang
- Children’s Health & Discovery Initiative, Departments of Pediatrics and,Duke Clinical Research Institute, Duke University, Durham, North Carolina; and
| | - Monica Tang
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Congwen Zhao
- Children’s Health & Discovery Initiative, Departments of Pediatrics and,Biostatistics and Bioinformatics, School of Medicine and
| | - Jillian Hurst
- Children’s Health & Discovery Initiative, Departments of Pediatrics and
| | - Angie Wu
- Duke Clinical Research Institute, Duke University, Durham, North Carolina; and
| | - Benjamin A. Goldstein
- Children’s Health & Discovery Initiative, Departments of Pediatrics and,Biostatistics and Bioinformatics, School of Medicine and,Duke Clinical Research Institute, Duke University, Durham, North Carolina; and
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30
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Blair M. Caring for infants after hospital discharge - Are we doing enough? Early Hum Dev 2020; 150:105192. [PMID: 33012568 DOI: 10.1016/j.earlhumdev.2020.105192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Mitch Blair
- Dept of Primary Care and Public Health, Imperial College, London, United Kingdom of Great Britain and Northern Ireland.
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31
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Coller RJ, Kelly MM, Sklansky DJ, Shadman KA, Ehlenbach ML, Barreda CB, Chung PJ, Zhao Q, Edmonson MB. Ambulatory quality, special health care needs, and emergency department or hospital use for US children. Health Serv Res 2020; 55:671-680. [PMID: 32594526 PMCID: PMC7518884 DOI: 10.1111/1475-6773.13308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE This study examined family-reported ambulatory care quality and its association with emergency department and hospital utilization, and how these relationships differed across levels of medical complexity. DATA SOURCES The 2006-2013 Medical Expenditure Panel Survey (MEPS). STUDY DESIGN Secondary analysis of MEPS data. Variables fitting the National Quality Measures Clearinghouse clinical quality measures domain framework were selected. Exploratory factor analysis grouped ambulatory quality into 12 access, experience, or process measures. Weighted negative binomial regression stratified by health status identified associations between ambulatory quality and ED visits or hospitalizations. DATA COLLECTION 41,497 children ≤18 years were included. The 5-item special health care needs (SHCN) screener categorized health status as complex, less complex, or no SHCN. PRINCIPAL FINDINGS Weighted SHCN proportions were 1.6 Percent complex, 18.2 Percent less complex, and 80.0 Percent no SHCN. Mean ED visits were 130 and 335 visits/1000 children/year for no/ complex SHCN, respectively. Mean hospitalizations were 20 and 175 hospitalizations/1000 children/year for no/complex SHCN, respectively. ED visits were associated with 8 of 12 quality measures for no/less complex SHCN. For example, usually/always receiving needed care right away was associated with 22 Percent lower ED visit rate (95% CI 0.64-0.96). Hospitalizations were associated with 4 of 12 quality measures for less complex SHCN. In complex SHCN, associations between ambulatory quality and ED/hospital use were weak and inconsistent. CONCLUSIONS Ambulatory quality may best predict ED and hospital use for children with no or less complex SHCN. Whether and how ambulatory care predicts emergency and hospital care in complex SHCN remains an important question.
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Affiliation(s)
- Ryan J. Coller
- Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Michelle M. Kelly
- Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Daniel J. Sklansky
- Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Kristin A. Shadman
- Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Mary L Ehlenbach
- Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Christina B. Barreda
- Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Paul J. Chung
- Departments of Pediatrics and Health Policy & Management, Health Systems ScienceKaiser Permanente School of MedicinePasadenaCaliforniaUSA
| | - Qianqian Zhao
- Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Marshall Bruce Edmonson
- Department of PediatricsUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
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32
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Lei L, Intrator O, Conwell Y, Fortinsky RH, Cai S. Continuity of care and health care cost among community-dwelling older adult veterans living with dementia. Health Serv Res 2020; 56:378-388. [PMID: 32812658 DOI: 10.1111/1475-6773.13541] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To estimate the causal impact of continuity of care (COC) on total, institutional, and noninstitutional cost among community-dwelling older veterans with dementia. DATA SOURCES Combined Veterans Health Administration (VHA) and Medicare data in Fiscal Years (FYs) 2014-2015. STUDY DESIGN FY 2014 COC was measured by the Bice-Boxerman Continuity of Care (BBC) index on a 0-1 scale. FY 2015 total combined VHA and Medicare cost, institutional cost of acute inpatient, emergency department [ED], long-/short-stay nursing home, and noninstitutional long-term care (LTC) cost for medical (like skilled-) and social (like unskilled-) services were assessed controlling for covariates. An instrumental variable for COC (change of residence by more than 10 miles) was used to account for unobserved health confounders. DATA COLLECTION Community-dwelling veterans with dementia aged 66 and older, enrolled in Traditional Medicare (N = 102 073). PRINCIPAL FINDINGS Mean BBC in FY 2014 was 0.32; mean total cost in FY 2015 was $35 425. A 0.1 higher BBC resulted in (a) $4045 lower total cost; (b) $1597 lower acute inpatient cost, $119 lower ED cost, $4368 lower long-stay nursing home cost; (c) $402 higher noninstitutional medical LTC and $764 higher noninstitutional social LTC cost. BBC had no impact on short-stay nursing home cost. CONCLUSIONS COC is an effective approach to reducing total health care cost by supporting noninstitutional care and reducing institutional care.
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Affiliation(s)
- Lianlian Lei
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Geriatrics & Extended Care Data Analysis Center (GECDAC), Canandaigua VA Medical Center, Canandaigua, New York
| | - Orna Intrator
- Geriatrics & Extended Care Data Analysis Center (GECDAC), Canandaigua VA Medical Center, Canandaigua, New York.,Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Richard H Fortinsky
- Center on Aging, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Shubing Cai
- Geriatrics & Extended Care Data Analysis Center (GECDAC), Canandaigua VA Medical Center, Canandaigua, New York.,Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
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33
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Patterns of Primary, Specialty, Urgent Care, and Emergency Department Care in Children With Inflammatory Bowel Diseases. J Pediatr Gastroenterol Nutr 2020; 71:e28-e34. [PMID: 32142000 PMCID: PMC8083894 DOI: 10.1097/mpg.0000000000002703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Pediatric patients with inflammatory bowel diseases (IBD) require treatment, monitoring, and health maintenance services. We described patterns of primary, specialty, emergency department (ED) and urgent care delivery, and explored patient- and system-related variables that impact ED/urgent care utilization. METHODS We conducted a cross sectional survey of parents of children with IBD at a large tertiary children's hospital. RESULTS One hundred sixty-one parents completed the survey (75% response). Mean patient age 13.9 years (51% boys); 80% Crohn disease, 16% ulcerative colitis, 4% IBD-unspecified. Mean disease duration 4 years (standard deviation [SD] 2.7). Thirty percent had at least 1 other chronic disease, 31% had a history of IBD-related surgery. Parents were predominantly Caucasian (94%), well-educated (61% bachelor's degree/higher), part of a 2-parent household (79%) living in a suburban setting (57%). Seventy-seven percent of patients had private insurance. In the past year, most children had 1 to 2 IBD-related office visits (54%) with their gastroenterology (GI) doctor and no IBD-related hospitalizations (79%). Eighty-eight percent (N = 141) had a primary care provider (PCP), and most (70%) saw their PCP 1 to 2 times. Even so, 86% (N = 139) received medical care from places other than their PCP or GI doctor; 27% in the ED and 45% at urgent care. Children of parents with less than a bachelor's degree, families that lived further from their GI doctor, and children who saw their PCP more often were more likely to utilize ED/urgent care. CONCLUSIONS ED/urgent care utilization in pediatric patients with IBD was greater than expected, potentially contributing to fragmented, costly care and worse outcomes.
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Szefler SJ, Fitzgerald DA, Adachi Y, Doull IJ, Fischer GB, Fletcher M, Hong J, García-Marcos L, Pedersen S, Østrem A, Sly PD, Williams S, Winders T, Zar HJ, Bush A, Lenney W. A worldwide charter for all children with asthma. Pediatr Pulmonol 2020; 55:1282-1292. [PMID: 32142219 PMCID: PMC7187318 DOI: 10.1002/ppul.24713] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 02/14/2020] [Indexed: 12/21/2022]
Abstract
Childhood asthma is a huge global health burden. The spectrum of disease, diagnosis, and management vary depending on where children live in the world and how their community can care for them. Global improvement in diagnosis and management has been unsatisfactory, despite ever more evidence-based guidelines. Guidelines alone are insufficient and need supplementing by government support, changes in policy, access to diagnosis and effective therapy for all children, with research to improve implementation. We propose a worldwide charter for all children with asthma, a roadmap to better education and training which can be adapted for local use. It includes access to effective basic asthma medications. It is not about new expensive medications and biologics as much can be achieved without these. If implemented carefully, the overall cost of care is likely to fall and the global future health and life chance of children with asthma will greatly improve. The key to success will be community involvement together with the local and national development of asthma champions. We call on governments, institutions, and healthcare services to support its implementation.
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Affiliation(s)
- Stanley J Szefler
- Department of Pediatrics, Section of Pediatric Pulmonary and Sleep Medicine, Pediatric Asthma Research Program, Anschutz Medical Campus, Breathing Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Dominic A Fitzgerald
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Yuichi Adachi
- Department of Pediatrics, University of Toyama, Toyama, Japan
| | - Iolo J Doull
- Department of Paediatric Respiratory Medicine, Children's Hospital for Wales, Cardiff, UK
| | - Gilberto B Fischer
- Department of Paediatrics, Universidade Federal de Ciencias da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Monica Fletcher
- Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, UK
| | - Jianguo Hong
- Department of Paediatrics, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Luis García-Marcos
- Department of Paediatrics, "Virgen de la Arrixaca" University Children's Hospital, University of Murcia, Murcia, Spain
| | - Søren Pedersen
- Paediatric Research Unit, Kolding Hospital, University of Southern Denmark, Kolding, Denmark
| | | | - Peter D Sly
- Children's Health and Environment Program and World Health Organisation Collaborating Centre for Children's Health and Environment, Child Health Research Centre, University of Queensland, Brisbane, Australia
| | - Siân Williams
- International Primary Care Respiratory Group, London, UK
| | - Tonya Winders
- Allergy & Asthma Network, Vienna, Virginia.,Global Allergy & Asthma Patient Platform, Vienna, Virginia
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Andy Bush
- Department of Paediatrics, National Heart and Lung Institute and Royal Brompton & Harefield NHS Foundation Trust, Imperial College, London, UK
| | - Warren Lenney
- Department of Child Health, Institute of Applied Clinical Science, Keele University, Keele, UK
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35
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Desai AD, Zhou C, Haaland W, Johnson J, Lion KC, Lopez MA, Williams DJ, Kenyon CC, Mangione-Smith R, Johnson DP. Social Disadvantage, Access to Care, and Disparities in Physical Functioning Among Children Hospitalized with Respiratory Illness. J Hosp Med 2020; 15:211-218. [PMID: 32118564 PMCID: PMC7153490 DOI: 10.12788/jhm.3359] [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: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Understanding disparities in child health-related quality of life (HRQoL) may reveal opportunities for targeted improvement. This study examined associations between social disadvantage, access to care, and child physical functioning before and after hospitalization for acute respiratory illness. METHODS From July 1, 2014, to June 30, 2016, children ages 8-16 years and/or caregivers of children 2 weeks to 16 years admitted to five tertiary care children's hospitals for three common respiratory illnesses completed a survey on admission and within 2 to 8 weeks after discharge. Survey items assessed social disadvantage (minority race/ ethnicity, limited English proficiency, low education, and low income), difficulty/delays accessing care, and baseline and follow-up HRQoL physical functioning using the Pediatric Quality of Life Inventory (PedsQL, range 0-100). We examined associations between these three variables at baseline and follow-up using multivariable, mixed-effects linear regression models with multiple imputation sensitivity analyses for missing data. RESULTS A total of 1,325 patients and/or their caregivers completed both PedsQL assessments. Adjusted mean baseline PedsQL scores were significantly lower for patients with social disadvantage markers, compared with those of patients with none (78.7 for >3 markers versus 85.5 for no markers, difference -6.1 points (95% CI: -8.7, -3.5). The number of social disadvantage markers was not associated with mean follow-up PedsQL scores. Difficulty/delays accessing care were associated with lower PedsQL scores at both time points, but it was not a significant effect modifier between social disadvantage and PedsQL scores. CONCLUSIONS Having social disadvantage markers or difficulty/delays accessing care was associated with lower baseline physical functioning; however, differences were reduced after hospital discharge.
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Affiliation(s)
- Arti D Desai
- Department of Pediatrics, University of Washington, Seattle, Washington
- Seattle Children’s Research Institute, Seattle, Washington
- Corresponding Author: Arti D. Desai, MD, MSPH; E-mail: ; Telephone: (206) 884-1497
| | - Chuan Zhou
- Department of Pediatrics, University of Washington, Seattle, Washington
- Seattle Children’s Research Institute, Seattle, Washington
| | - Wren Haaland
- Seattle Children’s Research Institute, Seattle, Washington
| | - Jakobi Johnson
- Division of Hospital Medicine, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - K Casey Lion
- Department of Pediatrics, University of Washington, Seattle, Washington
- Seattle Children’s Research Institute, Seattle, Washington
| | - Michelle A Lopez
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Derek J Williams
- Division of Hospital Medicine, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Chén C Kenyon
- Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia and the Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Rita Mangione-Smith
- Department of Pediatrics, University of Washington, Seattle, Washington
- Seattle Children’s Research Institute, Seattle, Washington
| | - David P Johnson
- Division of Hospital Medicine, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
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Abstract
BACKGROUND Recent reports of increased national estimates of pediatric psychiatric emergency department (ED) visits and psychiatric hospitalizations emphasize the need to research these utilization patterns. OBJECTIVES To assess the patient-provider continuity of care (CoC) and compare the risk of psychiatric ED visits or hospitalization according to the CoC level. RESEARCH DESIGN A cohort design was applied to Medicaid administrative claims data (2007-2014) for 3-16-year olds with a first psychiatric diagnosis between 2009 and 2013 (n=38,825). SUBJECTS Continuously enrolled youths with (1) ≥1 outpatient psychiatric visits and (2) ≥4 pediatric outpatient visits in the prior 24 months. MEASURES The authors assessed CoC in the 24 months before the first psychiatric outpatient visit and quantified CoC using the Alpha Index. The authors assessed patient-provider CoC before first psychiatric diagnosis and the odds of psychiatric ED visits or psychiatric hospitalizations in the year after diagnosis. RESULTS Of the 38,825 youths, 88.9% received a first psychiatric diagnosis by age 14. The odds of ED visits were significantly higher among youths with low CoC [6.63%, adjusted odds ratio (AOR), 1.27; 95% confidence interval (CI), 1.13-1.41] or moderate CoC (5.76%; AOR, 1.14; 95% CI, 1.02-1.27) compared with those with high CoC (4.96%). Greater odds of psychiatric hospitalization related to low (7.53%; AOR, 1.17; 95% CI, 1.06-1.29) or moderate CoC (7.01%; AOR, 1.15; 95% CI, 1.03-1.27) compared with high CoC (6.06%). CONCLUSIONS The odds of potentially disruptive clinical management and costly psychiatric ED visits or hospitalizations were lower for youths with high CoC. The findings support the need to research the impact of CoC on long-term pediatric mental health service use.
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Shi Q, Castillo F, Viswanathan K, Kupferman F, MacDermid JC. Low Income and Nonadherence to Health Supervision Visits Predispose Children to More Emergency Room Utilization. Glob Pediatr Health 2020; 7:2333794X20938938. [PMID: 35187205 PMCID: PMC8851101 DOI: 10.1177/2333794x20938938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 05/28/2020] [Accepted: 06/10/2020] [Indexed: 11/17/2022] Open
Abstract
Social inequity can have broad health impacts. The purpose of this study was to examine the effects of low income and nonadherence to health supervision visits on emergency room (ER) utilization in Eastern Brooklyn, New York. This study surveyed parents/guardians of children who received routine medical care at Brookdale ambulatory clinics from June 2017 to February 2018. Participants were asked to fill out a questionnaire on social demographics, food insecurity, and relocation. Electronic medical records (EMRs) were reviewed to retrieve numbers of missing health supervision and ER visit in past 12 months. Comorbidity was identified through EMR by International Classification of Diseases. Logistic regression analyses were used to examine the effects of nonadherence to health supervision visits on ER utilization when controlling for demographics, food insecurity, recent moving, and comorbidity. Among 268 participants, 56.0% reported their household income was less than $20,000 annually, 39.6% missed at least 1 health supervision visit, and 31.7% had at least 1 ER visit within the past 12 months. Younger age (adjusted odds ratio [aOR] = 0.92, 95% confidence interval [CI] = 0.86-0.97, P < .01), household income less than $20,000 (aOR = 1.86, 95% CI = 1.02-3.39), preexisting comorbidity (aOR = 2.36, 95% CI = 1.26-4.42), and nonadherence to health supervision visits (aOR = 5.83, 95% CI = 3.21-10.56) were associated with increased ER utilization. Nonadherence to health supervision visits is an independent risk factor and potentially modifiable. Evaluation and remediation should be pursued as a means of improving health outcomes of children in vulnerable circumstances.
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Affiliation(s)
- Qiyun Shi
- McMaster University, Hamilton, Ontario, Canada
- Brookdale University Hospital and Medical Center, New York, NY, USA
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38
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Frey SM, Milne Wenderlich A, Halterman JS. New Opportunities With School-Based Telehealth: Convenient Connections to Care. JAMA Pediatr 2019; 173:1017-1018. [PMID: 31498381 DOI: 10.1001/jamapediatrics.2019.3083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sean M Frey
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Andrea Milne Wenderlich
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Jill S Halterman
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
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39
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Hung YC, Williams JE, Bababekov YJ, Rickert CG, Chang DC, Yeh H. Surgeon crossover between pediatric and adult centers is associated with decreased rate of loss to follow-up among adolescent renal transplantation recipients. Pediatr Transplant 2019; 23:e13547. [PMID: 31328860 DOI: 10.1111/petr.13547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 06/17/2019] [Indexed: 11/27/2022]
Abstract
The risk of adverse outcomes for pediatric renal transplant patients is highest during the transition from pediatric to adult care. While there have been many studies focus on graft failure and death, loss to follow-up likely plays a large role in patient outcomes. We hypothesize patients are lost to follow-up during this transition period and that patients transplanted at pediatric centers with a closely affiliated adult center (AFFs) are less likely to suffer from fragmentation of care and become lost to follow-up. AFFs were defined as those pediatric centers whose transplant surgeons were also on staff at an adult center and were identified using center websites. We included patients undergoing renal transplantation at <=18 years of age and had data for the entire transition period on the Scientific Registry of Transplant Recipients (n = 6,762, 92.3% in 95 AFFs). 32% of patients were lost to follow-up. On regression, patients transplanted at AFF were 33% less likely to be lost to follow-up compared with those from non-AFF (OR 0.67 CI 0.54-0.82, P < 0.01). The proportion of patients lost to follow-up during the transition period is remarkably high, but lower among recipients transplanted at AFFs. Poor follow-up may be mitigated by improving integration of care.
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Affiliation(s)
- Ya-Ching Hung
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Jonathan E Williams
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts.,Tufts University School of Medicine, Boston, Massachusetts
| | - Yanik J Bababekov
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Chalres G Rickert
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - David C Chang
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Heidi Yeh
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
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40
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Phillips CD, Truong C, Kum HC, Nwaiwu O, Ohsfeldt R. The Effects of Chronic Disease on Ambulatory Care-Sensitive Hospitalizations for Children or Youth. Health Serv Insights 2019; 12:1178632919879422. [PMID: 31662605 PMCID: PMC6796197 DOI: 10.1177/1178632919879422] [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: 08/15/2019] [Accepted: 08/27/2019] [Indexed: 11/23/2022] Open
Abstract
Considerable research has focused on hospitalizations for ambulatory
care–sensitive conditions (ACSHs), but little of that research has focused on
the role played by chronic disease in ACSHs involving children or youth (C/Y).
This research investigates, for C/Y, the effects of chronic disease on the
likelihood of an ACSH. The database included 699 473 hospital discharges for
individuals under 18 in Texas between 2011 and 2015. Effects of chronic disease,
individual, and contextual factors on the likelihood of a discharge involving an
ACSH were estimated using logistic regression. Contrary to the results for
adults, the presence of chronic diseases or a complex chronic disease among
children or youth was protective, reducing the likelihood of an ACSH for a
nonchronic condition. Results indicate that heightened ambulatory care received
by C/Y with chronic diseases is largely protective. Two of more chronic
conditions or at least one complex chronic condition significantly reduced the
likelihood of an ACSH.
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Affiliation(s)
- Charles D Phillips
- Department of Health Policy and Management, School of Public Health, Texas A&M Health Science Center, College Station, TX, USA
| | - Chau Truong
- Department of Management, Policy, and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Hye-Chung Kum
- Department of Health Policy and Management, School of Public Health, Texas A&M Health Science Center, College Station, TX, USA
| | - Obioma Nwaiwu
- Department of Family Medicine, School of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Robert Ohsfeldt
- Department of Health Policy and Management, School of Public Health, Texas A&M Health Science Center, College Station, TX, USA
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41
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Lee J, Israel E, Weinstein H, Kinane TB, Pasternack M, Linov P, Kaafarani HMA, Greenspan P, Rao SK. Using Physician-Level Emergency Department Utilization Reports to Address Avoidable Visits by Patients Managed by Pediatric Specialists. Hosp Pediatr 2019; 7:686-691. [PMID: 29055023 DOI: 10.1542/hpeds.2017-0054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Emergency department (ED) utilization is a major driver of cost. Specialist physicians have an important role in addressing ED utilization, especially at tertiary medical centers that treat highly specialized patients. We analyzed if reporting of ED utilization to pediatric specialist physicians can decrease ED visits. METHODS Physicians within pediatric neurology, hematology and oncology, infectious diseases, and pulmonary divisions received their ED use reports. By using control charts, we examined if this intervention decreased the rate of ED utilization. RESULTS Overall, for the 4 divisions, specialty-related ED utilization decreased significantly during all hours, weekdays, and office hours. This was in the setting of ED utilization increasing for all diagnoses ED visits. Pediatric ED volume did not change during the study period. CONCLUSIONS Physician-level reporting of ED utilization was associated with a reduction in ED use by patients managed by our pediatric specialists.
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Affiliation(s)
- Jarone Lee
- Departments of Emergency Medicine, .,Massachusetts General Physician Organization, Boston, Massachusetts.,Surgery
| | - Esther Israel
- Massachusetts General Physician Organization, Boston, Massachusetts.,Pediatrics, and
| | - Howard Weinstein
- Massachusetts General Physician Organization, Boston, Massachusetts.,Pediatrics, and
| | - T Bernard Kinane
- Massachusetts General Physician Organization, Boston, Massachusetts.,Pediatrics, and
| | - Mark Pasternack
- Massachusetts General Physician Organization, Boston, Massachusetts.,Pediatrics, and
| | - Pamela Linov
- Massachusetts General Physician Organization, Boston, Massachusetts
| | | | | | - Sandhya K Rao
- Pediatrics, and.,Medicine, Massachusetts General Hospital, Boston, Massachusetts; and
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42
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Levi M, Marconi E, Simonetti M, Cricelli C, Lapi F. Epidemiology of non-deferrable medical conditions in primary care in Italy. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e663-e671. [PMID: 31157507 DOI: 10.1111/hsc.12778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 04/18/2019] [Accepted: 05/02/2019] [Indexed: 06/09/2023]
Abstract
Non-deferrable medical conditions (NDMC) are clinical entities other than exacerbations of chronic diseases which are too frequently managed by emergency departments. The primary care setting would be indeed the ideal environment to proficiently treat them. Few studies have investigated the epidemiology of NDMC in primary care, especially in Italy. With the aim to better identify NDMC sufferers, we assessed the accuracy of the NDMC definition by means of four algorithms, featured by different specificities and sensitivities. Four algorithms, based on the hierarchical definition of NDMC, were developed to calculate the incidence rate of NDMC in 2014. Each was tested using a Cox univariate model adjusted for gender, comparing patients aged <45 years old with older patients. Algorithms 1 and 3 gave similar results (408.1 vs. 405.5 per 1,000 person-years); Algorithms 2 and 4 reported sensibly lower rates (84.7 and 84.0 per 1,000 person-years). Incidence rate of NDMC for female patients was higher than in males and for older age group (i.e. 75-84 age group) than younger patients, for both gender groups. Regarding the regression model, a higher risk of NDMC was estimated in patients aged 45 years or more and in females. This study allowed us to assess the incidence rate of NDMC in Italy which was unexpectedly higher among older patients. Given the crucial role of general practitioners (GPs) in the diagnosis and management of these conditions, as well as the healthcare system reforms imposed by the ongoing financial crisis, our findings may contribute to informing the capacity and strategic workload planning in group of GPs to improve service quality and profitably to reduce the excessive use of emergency departments.
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Affiliation(s)
- Miriam Levi
- CeRIMP-Regional Centre for Occupational Diseases and Injuries, Tuscany Region, Florence, Italy
| | - Ettore Marconi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Monica Simonetti
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Claudio Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
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Lynch S, Pines J, Mutter R, Teich JL, Hendry P. Characterizing behavioral health-related emergency department utilization among children with Medicaid: Comparing high and low frequency utilizers. SOCIAL WORK IN HEALTH CARE 2019; 58:807-824. [PMID: 31422764 DOI: 10.1080/00981389.2019.1653418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 07/23/2019] [Accepted: 08/03/2019] [Indexed: 06/10/2023]
Abstract
While the frequency of children's behavioral health (BH)-related visits to the emergency department (ED) is rising nationwide, few studies have examined predictors of high rates of ED use. This study examines Florida Medicaid claims (2011-2012) for children age 0-18 who were seen in an emergency department (ED) for behavioral health (BH) conditions. A logistic regression model was used to explore factors associated with frequent ED use and patterns of psychotropic medication utilization. The majority (95%) of patients with at least one BH-related ED visit had three or fewer of these visits, but 5% had four or more. Seventy-four percent of ED visits were not associated with psychotropic medication, including over half (54%) of visits for attention deficit hyperactivity disorder (ADHD). Frequent ED use was higher among older children and those with substance use disorders. The implementation of interventions that reduce non-emergent ED visits through the provision of care coordination, social work services, and/or the use of community health workers as care navigators may address these findings.
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Affiliation(s)
- Sean Lynch
- U.S. Department of Health & Human Services, Substance Abuse & Mental Health Services Administration, Center for Behavioral Health Statistics & Quality , Rockville , MD , USA
| | - Jesse Pines
- Department of Emergency Medicine, George Washington University , Washington , DC , USA
| | - Ryan Mutter
- U.S. Department of Health & Human Services, Substance Abuse & Mental Health Services Administration, Center for Behavioral Health Statistics & Quality , Rockville , MD , USA
| | - Judith L Teich
- U.S. Department of Health & Human Services, Substance Abuse & Mental Health Services Administration, Center for Behavioral Health Statistics & Quality , Rockville , MD , USA
| | - Phyllis Hendry
- Department of Emergency Medicine, University of Florida-Jacksonville , Jacksonville , FL , USA
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Nakhla M, Rahme E, Simard M, Larocque I, Legault L, Li P. Risk of ketoacidosis in children at the time of diabetes mellitus diagnosis by primary caregiver status: a population-based retrospective cohort study. CMAJ 2019; 190:E416-E421. [PMID: 29632036 DOI: 10.1503/cmaj.170676] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diabetic ketoacidosis is the leading cause of death among children with type 1 diabetes mellitus, and is an avoidable complication at first-time diagnosis of diabetes. Because having a usual provider of primary care is important in improving health outcomes for children, we tested the association between having a usual provider of care and risk of diabetic ketoacidosis at onset of diabetes. METHODS Using linked health administrative data for the province of Quebec, we conducted a population-based retrospective cohort study of children aged 1-17 years in whom diabetes was diagnosed from 2006 to 2015. We estimated adjusted risk ratios (RRs) for an episode of diabetic ketoacidosis at the time of diabetes diagnosis in relation to usual provider of care (family physician, pediatrician or none) using Poisson regression models with robust error variance. RESULTS We identified 3704 new cases of diabetes in Quebec children from 2006 to 2015. Of these, 996 (26.9%) presented with diabetic ketoacidosis. A decreased risk of this complication was associated with having a usual provider of care; the association was stronger with increasing age, reaching statistical significance among those aged 12-17 years. Within this age group, those who had a family physician or a pediatrician were 31% less likely (adjusted RR 0.69, 95% confidence interval [CI] 0.56-0.85) or 38% less likely (adjusted RR 0.62, 95% CI 0.45-0.86), respectively, to present with diabetic ketoacidosis, relative to those without a usual provider of care. INTERPRETATION For children with newly diagnosed diabetes, having a usual provider of care appears to be important in decreasing the risk of diabetic ketoacidosis at the time of diabetes diagnosis. Our results provide further evidence concerning the need for initiatives that promote access to primary care for children.
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Affiliation(s)
- Meranda Nakhla
- Department of Pediatrics (Nakhla, Legault, Li), The Montreal Children's Hospital, McGill University; Research Institute of the McGill University Health Centre (Nakhla, Rahme, Legault, Li), Montréal, Que.; Institut national de santé publique du Québec (Simard, Larocque), Québec, Que.
| | - Elham Rahme
- Department of Pediatrics (Nakhla, Legault, Li), The Montreal Children's Hospital, McGill University; Research Institute of the McGill University Health Centre (Nakhla, Rahme, Legault, Li), Montréal, Que.; Institut national de santé publique du Québec (Simard, Larocque), Québec, Que
| | - Marc Simard
- Department of Pediatrics (Nakhla, Legault, Li), The Montreal Children's Hospital, McGill University; Research Institute of the McGill University Health Centre (Nakhla, Rahme, Legault, Li), Montréal, Que.; Institut national de santé publique du Québec (Simard, Larocque), Québec, Que
| | - Isabelle Larocque
- Department of Pediatrics (Nakhla, Legault, Li), The Montreal Children's Hospital, McGill University; Research Institute of the McGill University Health Centre (Nakhla, Rahme, Legault, Li), Montréal, Que.; Institut national de santé publique du Québec (Simard, Larocque), Québec, Que
| | - Laurent Legault
- Department of Pediatrics (Nakhla, Legault, Li), The Montreal Children's Hospital, McGill University; Research Institute of the McGill University Health Centre (Nakhla, Rahme, Legault, Li), Montréal, Que.; Institut national de santé publique du Québec (Simard, Larocque), Québec, Que
| | - Patricia Li
- Department of Pediatrics (Nakhla, Legault, Li), The Montreal Children's Hospital, McGill University; Research Institute of the McGill University Health Centre (Nakhla, Rahme, Legault, Li), Montréal, Que.; Institut national de santé publique du Québec (Simard, Larocque), Québec, Que
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Nicholson E, McDonnell T, Hamza M, Barrett M, Brunsdon C, Bury G, Charlton M, Collins C, Deasy C, De Brun A, Fitzsimons J, Galligan M, Hensey C, Kiernan F, McAuliffe E. Factors that influence family and parental preferences and decision making for unscheduled paediatric healthcare: a systematic review protocol. HRB Open Res 2019; 2:11. [PMID: 32104777 PMCID: PMC7016877 DOI: 10.12688/hrbopenres.12897.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2019] [Indexed: 11/20/2022] Open
Abstract
There is a plethora of factors that dictate where parents and families choose to seek unscheduled healthcare for their child; and the complexity of these decisions can present a challenge for policy makers and healthcare planners as these behaviours can have a significant impact on resources in the health system. The systematic review will seek to identify the factors that influence parents’ and families’ preferences and decision making when seeking unscheduled paediatric healthcare. Five databases will be searched for published studies (CINAHL, PubMed, SCOPUS, PsycInfo, EconLit) and grey literature will also be searched. Inclusion and exclusion criteria will be applied and articles assessed for quality. A narrative approach will be used to synthesise the evidence that emerges from the review. By collating the factors that influence decision-making and attendance at these services, the review can inform future health policies and strategies seeking to expand primary care to support the provision of accessible and responsive care. The systematic review will also inform the design of a discrete choice experiment (DCE) which will seek to determine parental and family preferences for unscheduled paediatric healthcare. Policies that seek to expand primary care and reduce hospital admissions from emergency departments need to be cognisant of the nuanced and complex factors that govern patients’ behaviour.
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Affiliation(s)
- Emma Nicholson
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Therese McDonnell
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Moayed Hamza
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Michael Barrett
- Chilren's Health Ireland at Crumlin, Dublin 12, Ireland.,UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland.,National Children's Research Centre, Crumlin, Dublin 12, Ireland
| | - Christopher Brunsdon
- National Centre for Geocomputation, National University of Ireland, Maynooth, Maynooth, Co Kildare, Ireland
| | - Gerard Bury
- UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Martin Charlton
- National Centre for Geocomputation, National University of Ireland, Maynooth, Maynooth, Co Kildare, Ireland
| | - Claire Collins
- Irish College of General Practitioners, Dublin 2, Ireland
| | | | - Aoife De Brun
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - John Fitzsimons
- Children's Health Ireland at Temple Street, Dublin 1, Ireland
| | - Marie Galligan
- UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Conor Hensey
- Children's Health Ireland at Temple Street, Dublin 1, Ireland
| | - Fiona Kiernan
- UCD Geary Institute, University College Dublin, Belfield, Dublin 4, Ireland
| | - Eilish McAuliffe
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
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46
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Nicholson E, McDonnell T, Hamza M, Barrett M, Brunsdon C, Bury G, Charlton M, Collins C, Deasy C, De Brun A, Fitzsimons J, Galligan M, Hensey C, Kiernan F, McAuliffe E. Factors that influence family and parental preferences and decision making for unscheduled paediatric healthcare: a systematic review protocol. HRB Open Res 2019. [DOI: 10.12688/hrbopenres.12897.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
There is a plethora of factors that dictate where parents and families choose to seek unscheduled healthcare for their child; and the complexity of these decisions can present a challenge for policy makers and healthcare planners as these behaviours can have a significant impact on resources in the health system. The systematic review will seek to identify the factors that influence parents’ and families’ preferences and decision making when seeking unscheduled paediatric healthcare. Five databases will be searched for published studies (CINAHL, PubMed, SCOPUS, PsycInfo, EconLit) and grey literature will also be searched. Inclusion and exclusion criteria will be applied and articles assessed for quality. A narrative approach will be used to synthesise the evidence that emerges from the review. By collating the factors that influence decision-making and attendance at these services, the review can inform future health policies and strategies seeking to expand primary care to support the provision of accessible and responsive care. The systematic review will also inform the design of a discrete choice experiment (DCE) which will seek to determine parental and family preferences for unscheduled paediatric healthcare. Policies such as Sláintecare that seek to expand primary care and reduce hospital admissions from emergency departments need to be cognisant of the nuanced and complex factors that govern patients’ behaviour.
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Moorin RE, Youens D, Preen DB, Harris M, Wright CM. Association between continuity of provider-adjusted regularity of general practitioner contact and unplanned diabetes-related hospitalisation: a data linkage study in New South Wales, Australia, using the 45 and Up Study cohort. BMJ Open 2019; 9:e027158. [PMID: 31171551 PMCID: PMC6561442 DOI: 10.1136/bmjopen-2018-027158] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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
OBJECTIVE To assess the association between continuity of provider-adjusted regularity of general practitioner (GP) contact and unplanned diabetes-related hospitalisation or emergency department (ED) presentation. DESIGN Cross-sectional study. SETTING Individual-level linked self-report and administrative health service data from New South Wales, Australia. PARTICIPANTS 27 409 survey respondents aged ≥45 years with a prior history of diabetes and at least three GP contacts between 1 July 2009 and 30 June 2015. MAIN OUTCOME MEASURES Unplanned diabetes-related hospitalisations or ED presentations, associated costs and bed days. RESULTS Twenty-one per cent of respondents had an unplanned diabetes-related hospitalisation or ED presentation. Increasing regularity of GP contact was associated with a lower probability of hospitalisation or ED presentation (19.9% for highest quintile, 23.5% for the lowest quintile). Conditional on having an event, there was a small decrease in the number of hospitalisations or ED presentations for the low (-6%) and moderate regularity quintiles (-8%), a reduction in bed days (ranging from -30 to -44%) and a reduction in average cost of between -23% and -41%, all relative to the lowest quintile. When probability of diabetes-related hospitalisation or ED presentation was included, only the inverse association with cost remained significant (mean of $A3798 to $A6350 less per individual, compared with the lowest regularity quintile). Importantly, continuity of provider did not significantly modify the effect of GP regularity for any outcome. CONCLUSIONS Higher regularity of GP contact-that is more evenly dispersed, not necessarily more frequent care-has the potential to reduce secondary healthcare costs and, conditional on having an event, the time spent in hospital, irrespective of continuity of provider. These findings argue for the advocacy of regular care, as distinct from solely continuity of provider, when designing policy and financial incentives for GP-led primary care.
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Affiliation(s)
- Rachael E Moorin
- Health Systems and Health Economics, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- School of Population and Global Health, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - David Youens
- Health Systems and Health Economics, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Mark Harris
- School of Economics, Finance and Property, Curtin Business School, Curtin University, Perth, Western Australia, Australia
| | - Cameron M Wright
- Health Systems and Health Economics, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- School of Medicine, College of Health & Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Singh J, Dahrouge S, Green ME. The impact of the adoption of a patient rostering model on primary care access and continuity of care in urban family practices in Ontario, Canada. BMC FAMILY PRACTICE 2019; 20:52. [PMID: 30999868 PMCID: PMC6474046 DOI: 10.1186/s12875-019-0942-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 04/02/2019] [Indexed: 01/07/2024]
Abstract
BACKGROUND Greater continuity and access to primary care results in improved patient health, satisfaction, and reduced healthcare costs. Although patient rostering is considered to be a cornerstone of a high performing primary care system and is believed to improve continuity and access, few studies have examined these relationships. This study examined the impact of the adoption of a patient rostering enhanced fee-for-service model (eFFS) on continuity, coordination of specialized care, and access. METHOD A population-based longitudinal study was conducted using health administrative data from urban family practices in Ontario, Canada. Family physicians that transitioned from traditional FFS (tFFS) to eFFS between 2004 and 2013 were followed overtime. Physicians providing comprehensive primary care that had at least 4 years of pre-transition and 2 years of post-transition data were eligible. Patients were attributed to physicians on an annual basis by determining the provider that billed the largest dollar amount over a 2 year period. Outcomes of interest were the usual provider of care index (UPC), a referral index (RI) (% of total primary care referrals for a physician's roster made by the main provider), and emergency department (ED) visits for family practice sensitive conditions (FPSCs). Mixed-effects segmented linear and logistic regressions were used to examine changes in outcomes while controlling for patient and provider contextual factors. RESULTS Prior to transitioning, UPC was decreasing at a rate of 0.27%/year (95% CI: -0.34 to - 0.21, p < 0.0001). Following the transition, UPC began decreasing by an additional 0.59%/year (95% CI: -0.69 to - 0.49, p < 0.0001) relative to the pre-transition rate. RI decreased by an additional 0.34%/year (95% CI: -0.43 to - 0.24, p < 0.0001) relative to the pre-transition period, where it had been stable. The transition had minimal impact on FPSC ED visits. CONCLUSION Continuity and coordination of specialized care slightly decreased upon transition from tFFS to eFFS. This is likely due to physicians working in groups and sharing patients following the transition to the eFFS model. Adoption of an enrolment model with after-hours care did not decrease non-urgent ED use, which may reflect the small impact that primary care access has on these types of ED visits.
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Affiliation(s)
- Jatinderpreet Singh
- Department of Public Health Sciences, Queen's University, 62 Fifth Field Company Lane, Kingston, ON, K7L 3N6, Canada. .,Department of Family Medicine, Queen's University, 220 Bagot St, Kingston, ON, K7L 3G2, Canada.
| | - Simone Dahrouge
- Department of Family Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.,Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Michael E Green
- Department of Public Health Sciences, Queen's University, 62 Fifth Field Company Lane, Kingston, ON, K7L 3N6, Canada.,Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Department of Family Medicine, Queen's University, 220 Bagot St, Kingston, ON, K7L 3G2, Canada
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Tseng YC, Wang IJ, Pu C. Parents' perception and willingness to maintain provider care continuity for their children under universal health coverage. AIMS Public Health 2019; 6:121-134. [PMID: 31297398 PMCID: PMC6606528 DOI: 10.3934/publichealth.2019.2.121] [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: 01/07/2019] [Accepted: 03/29/2019] [Indexed: 11/18/2022] Open
Abstract
Background Provider continuity of care (COC) is closely related to patient outcome in pediatrics. However, no study has investigated how parents perceive the importance of COC and whether their perceptions affect their willingness to make effort to maintain good provider COC for their children under universal health coverage. Methods A cross-sectional survey was conducted between August 2017 and February 2018 across 6 different practices: 2 medical centers, 2 regional hospitals, 1 district hospital, and 1 clinic (n = 825). Parents' and caregivers' perceptions and perceived value of COC were evaluated using 7 items. The contingent valuation method was used to estimate willingness to pay and spend time. Results Of all respondents, only 47% (n = 394) were willing to spend >30 minutes to have their children see the regular physician if the regular physician relocated. Approximately 38% (n = 302) respondents were willing to pay more than New Taiwan Dollar (NT$) 300 per month to maintain provider COC. The perception that high COC is important was associated with willingness to spend more time for maintaining high provider COC. Conclusion Parents' perception of COC does not affect their willingness to pay for maintaining high provider COC for their children but affects their willingness to spend more time to maintain COC.
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Affiliation(s)
- Yu Chen Tseng
- Department of Public Health, National Yang-Ming University, Taipei 112, Taiwan
| | - I Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, Taiwan.,School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.,College of Public Health, China Medical University, Taichung 40402, Taiwan.,College of Public Health, National Taiwan University, Taipei 10055, Taiwan
| | - Christy Pu
- Department of Public Health, National Yang-Ming University, Taipei 112, Taiwan
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Horng L, Kakoly NS, Abedin J, Luby SP. Effect of household relocation on child vaccination and health service utilisation in Dhaka, Bangladesh: a cross-sectional community survey. BMJ Open 2019; 9:e026176. [PMID: 30878989 PMCID: PMC6429946 DOI: 10.1136/bmjopen-2018-026176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To explore the relationship between household relocation and use of vaccination and health services for severe acute respiratory illness (ARI) among children in Dhaka, Bangladesh. DESIGN Analysis of cross-sectional community survey data from a prior study examining the impact of Haemophilus influenzae type b vaccine introduction in 2009 on meningitis incidence in Bangladesh. SETTING Communities surrounding two large paediatric hospitals in Dhaka, Bangladesh. PARTICIPANTS Households with children under 5 years old who either recently relocated <12 months or who were residentially stable living >24 months in their current residence (total n=10 020) were selected for this study. PRIMARY OUTCOME MEASURES Full vaccination coverage among children aged 9-59 months and visits to a qualified medical provider for severe ARI among children under 5 years old. RESULTS Using vaccination cards with maternal recall, full vaccination was 80% among recently relocated children (n=3795) and 85% among residentially stable children (n=4713; χ2=37.2, p<0.001). Among children with ARI in the prior year, 69% of recently relocated children (n=695) had visited a qualified medical provider compared with 82% of residentially stable children (n=763; χ2=31.9, p<0.001). After adjusting for demographic and socioeconomic characteristics, recently relocated children were less likely to be fully vaccinated (prevalence ratio [PR] 0.97; 95% CI 0.95 to 0.99; p=0.016) and to have visited a qualified medical provider for ARI (PR 0.88; 95% CI 0.84 to 0.93; p<0.001). CONCLUSIONS Children in recently relocated households in Dhaka, Bangladesh, have decreased use of vaccination and qualified health services for severe ARI.
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Affiliation(s)
- Lily Horng
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Nadira Sultana Kakoly
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jaynal Abedin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Stephen P Luby
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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