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Mancilla-Martinez J, Oh MH, Luk G, Rollins A. Special Education Representation Trends Vary by Language Status: Evidence of Underrepresentation in Tennessee. JOURNAL OF LEARNING DISABILITIES 2024; 57:153-167. [PMID: 37309592 PMCID: PMC11044507 DOI: 10.1177/00222194231178285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Using U.S. state-level data, we report unadjusted and adjusted odds ratio of special education (SPED) trends in Tennessee from 2009 to 2019 for students in Grades 3 to 8 by three language groups: native English speakers (NES), English-proficient bilinguals (EPB), and Current English learners (Current EL). We report trends across all SPED disability categories and across five prevalent disability categories (specific learning disability, specific language impairment, intellectual disability, other health impairments, and autism). The cross-sectional analytic sample included 812,783 students from 28 districts that met the SPED risk ratio threshold set by the state. Results revealed that, compared with NES students, both EPB and Current EL students were generally less likely to receive SPED services, suggesting evidence of language status disparities in SPED representation. Furthermore, findings varied depending on whether adjustments were made to generate odds ratios, especially for higher-incidence disabilities (specific learning disability, specific language impairment, and intellectual disability). Finally, the most severe evidence of underrepresentation was in lower-incidence disabilities (other health impairments and autism). Our results underscore the need for further examination into low rates of SPED identification among learners whose first language is not English (EPB and Current EL). We discuss the contextualized research, practice, and policy implications of our findings.
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Affiliation(s)
| | - Min Hyun Oh
- University of Virginia, Charlottesville, USA
| | - Gigi Luk
- McGill University, Montreal, Quebec, Canada
| | - Adam Rollins
- Tennessee Department of Education, Nashville, USA
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Swann-Thomsen HE, Sitts C, Hanks J, Tivis R. Implementing a social work care coordination model for children and youth with special health care needs in a rural-urban health system. SOCIAL WORK IN HEALTH CARE 2024; 63:188-204. [PMID: 38217440 DOI: 10.1080/00981389.2024.2304010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/05/2024] [Indexed: 01/15/2024]
Abstract
This retrospective chart review examined care coordination among pediatric patients with varying levels of medical complexity who received care in a rural-urban health system. Care coordination utilization across patient acuity levels was examined for meaningful differences in frequency and duration of care coordination services. Results indicated that patients with more severe medical complexity had increased frequency and duration of care coordination services, as well as different patterns of care coordination activity utilization. This model of pediatric outpatient care coordination provides a flexible and highly targeted approach for stratification of care and services based on the needs of the individual patient.
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Affiliation(s)
| | - Claire Sitts
- St. Luke's Children's Hospital, Boise, Idaho, USA
| | - John Hanks
- St. Luke's Children's Hospital, Boise, Idaho, USA
| | - Rick Tivis
- Applied Research Division, St. Luke's Health System, Boise, Idaho, USA
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Schiavoni KH, Flom M, Blumenthal KJ, Orav EJ, Hefferon M, Maher E, Boudreau AA, Giuliano CP, Chambers B, Mandell MH, Vienneau M, Mendu ML, Vogeli C. Cost, Utilization, and Patient and Family Experience With ACO-Based Pediatric Care Management. Pediatrics 2023; 152:e2022058268. [PMID: 38013488 DOI: 10.1542/peds.2022-058268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Children and Youth with Special Health Care Needs have high healthcare utilization, fragmented care, and unmet health needs. Accountable Care Organizations (ACOs) increasingly use pediatric care management to improve quality and reduce unnecessary utilization. We evaluated effects of pediatric care management on total medical expense (TME) and utilization; perceived quality of care coordination, unmet needs, and patient and family experience; and differential impact by payor, risk score, care manager discipline, and behavioral health diagnosis. METHODS Mixed-methods analysis including claims using quasi-stepped-wedge design pre and postenrollment to estimate difference-in-differences, participant survey, and semistructured interviews. Participants included 1321 patients with medical, behavioral, or social needs, high utilization, in Medicaid or commercial ACOs, and enrolled in multidisciplinary, primary care-embedded care management. RESULTS TME significantly declined 1 to 6 months postenrollment and continued through 19 to 24 months (-$645.48 per member per month, P < .001). Emergency department and inpatient utilization significantly decreased 7 to 12 months post-enrollment and persisted through 19 to 24 months (-29% emergency department, P = .012; -82% inpatient, P < .001). Of respondents, 87.2% of survey respondents were somewhat or very satisfied with care coordination, 56.1% received education coordination when needed, and 81.5% had no unmet health needs. Emergency department or inpatient utilization decreases were consistent across payors and care manager disciplines, occurred sooner with behavioral health diagnoses, and were significant among children with above-median risk scores. Satisfaction and experience were equivalent across groups, with more unmet needs and frustration with above-median risk scores. CONCLUSIONS Pediatric care management in multipayor ACOs may effectively reduce TME and utilization and clinically provide high-quality care coordination, including education and family stress, with high participant satisfaction.
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Affiliation(s)
- Katherine H Schiavoni
- Mass General Brigham, Population Health Management, Somerville, Massachusetts
- Departments of Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Megan Flom
- Mass General Brigham, Population Health Management, Somerville, Massachusetts
| | - Karen J Blumenthal
- Mass General Brigham, Population Health Management, Somerville, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - E John Orav
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Margaret Hefferon
- Mass General Brigham, Population Health Management, Somerville, Massachusetts
| | - Erin Maher
- Mass General Brigham, Population Health Management, Somerville, Massachusetts
| | - Alexy Arauz Boudreau
- Mass General Brigham, Population Health Management, Somerville, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Christopher P Giuliano
- Mass General Brigham, Population Health Management, Somerville, Massachusetts
- Affiliated Pediatric Practices, Dedham, Massachusetts
- Mass General Brigham Community Physicians Organization, Somerville, Massachusetts
| | - Barbara Chambers
- Mass General Brigham, Population Health Management, Somerville, Massachusetts
- Mass General Brigham Community Physicians Organization, Somerville, Massachusetts
| | - Mark H Mandell
- Mass General Brigham, Population Health Management, Somerville, Massachusetts
- Pediatric Associates of Greater Salem, Salem, Massachusetts
| | - Maryann Vienneau
- Mass General Brigham, Population Health Management, Somerville, Massachusetts
| | - Mallika L Mendu
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Renal Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christine Vogeli
- Mass General Brigham, Population Health Management, Somerville, Massachusetts
- The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts
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Vasan A, Kyle MA, Venkataramani AS, Kenyon CC, Fiks AG. Inequities in Time Spent Coordinating Care for Children and Youth With Special Health Care Needs. Acad Pediatr 2023; 23:1526-1534. [PMID: 36918094 PMCID: PMC10495536 DOI: 10.1016/j.acap.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE In the United States, caregivers of children and youth with special health care needs (CYSHCN) must navigate complex, inefficient health care and insurance systems to access medical care. We assessed for sociodemographic inequities in time spent coordinating care for CYSHCN and examined the association between time spent coordinating care and forgone medical care. METHODS This cross-sectional study used data from the 2018-2020 National Survey of Children's Health, which included 102,740 children across all 50 states. We described the time spent coordinating care for children with less complex special health care needs (SHCN) (managed through medications) and more complex SHCN (resulting in functional limitations or requiring specialized therapies). We examined race-, ethnicity-, income-, and insurance-based differences in time spent coordinating care among CYSHCN and used multivariable logistic regression to examine the association between time spent coordinating care and forgone medical care. RESULTS Over 40% of caregivers of children with more complex SHCN reported spending time coordinating their children's care each week. CYSHCN whose caregivers spent ≥ 5 h/wk on care coordination were disproportionately Hispanic, low-income, and publicly insured or uninsured. Increased time spent coordinating care was associated with an increasing probability of forgone medical care: 6.7% for children whose caregivers spent no weekly time coordinating care versus 9.4% for< 1 hour; 11.4% for 1 to 4 hours; and 15.8% for ≥ 5 hours. CONCLUSIONS Reducing time spent coordinating care and providing additional support to low-income and minoritized caregivers may be beneficial for pediatric payers, policymakers, and health systems aiming to promote equitable access to health care for CYSHCN.
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Affiliation(s)
- Aditi Vasan
- Department of Pediatrics (A Vasan, CC Kenyon, and AG Fiks), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; PolicyLab and Center for Pediatric Clinical Effectiveness (A Vasan, CC Kenyon, and AG Fiks), Children's Hospital of Philadelphia, Pa; Leonard Davis Institute of Health Economics (A Vasan, AS Venkataramani, CC Kenyon, and AG Fiks), University of Pennsylvania, Philadelphia, Pa.
| | - Michael Anne Kyle
- Department of Health Care Policy (MA Kyle), Harvard Medical School and Dana Farber Cancer Institute, Boston, Mass.
| | - Atheendar S Venkataramani
- Leonard Davis Institute of Health Economics (A Vasan, AS Venkataramani, CC Kenyon, and AG Fiks), University of Pennsylvania, Philadelphia, Pa; Department of Medical Ethics and Health Policy (AS Venkataramani), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Calif.
| | - Chén C Kenyon
- Department of Pediatrics (A Vasan, CC Kenyon, and AG Fiks), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; PolicyLab and Center for Pediatric Clinical Effectiveness (A Vasan, CC Kenyon, and AG Fiks), Children's Hospital of Philadelphia, Pa; Leonard Davis Institute of Health Economics (A Vasan, AS Venkataramani, CC Kenyon, and AG Fiks), University of Pennsylvania, Philadelphia, Pa.
| | - Alexander G Fiks
- Department of Pediatrics (A Vasan, CC Kenyon, and AG Fiks), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; PolicyLab and Center for Pediatric Clinical Effectiveness (A Vasan, CC Kenyon, and AG Fiks), Children's Hospital of Philadelphia, Pa; Leonard Davis Institute of Health Economics (A Vasan, AS Venkataramani, CC Kenyon, and AG Fiks), University of Pennsylvania, Philadelphia, Pa.
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Oh J. Prevalence and factors associated with multidimensional child deprivation: Findings from the Future of Families and Child Well-Being Study. CHILDREN AND YOUTH SERVICES REVIEW 2023; 148:106890. [PMID: 37736253 PMCID: PMC10512438 DOI: 10.1016/j.childyouth.2023.106890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Despite the growing importance of the multidimensional methods of assessing child poverty, few studies in the U.S. have applied a rights-based approach to examining child deprivation. This study examines multidimensional child deprivation using eight dimensions and twelve indicators based on the Convention on the Rights of the Child (CRC). Using a sample of children at age nine from the fifth wave of the Future of Families and Child Well-being Study, this study applied the multiple overlapping deprivation analysis (MODA), a comprehensive analytic method to assess the multidimensionality of child deprivation and to provide a detailed picture of material and social forms of deprivation among the U.S. children. This study found that the overall child deprivation rate was 8.89%; environmental safety (20.36%), information (15.94%), and housing security (14.23%) dimensions contributed the highest to the overall child deprivation; the overlap between deprivation and income poverty was 12.83%. Results suggest that understanding multifaceted and interrelated contexts of child deprivation is crucial to promote child rights.
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Affiliation(s)
- Jihyun Oh
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, United States
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Pritchard AE, Northrup RA, Peterson R, Lieb R, Wexler D, Ng R, Kalb L, Ludwig N, Jacobson LA. Can We Expand the Pool of Youth Who Receive Telehealth Assessments for ADHD? Covariates of Service Utilization. J Atten Disord 2023; 27:159-168. [PMID: 36239415 PMCID: PMC10080729 DOI: 10.1177/10870547221129304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, telehealth became widely utilized for healthcare, including psychological evaluations. However, whether telehealth has reduced or exacerbated healthcare disparities for children with Attention-Deficit/Hyperactivity Disorder (ADHD) remains unclear. METHODS Data (race, ethnicity, age, insurance type, ADHD presentation, comorbidities, and distance to clinic) for youth with ADHD (Mage = 10.97, SDage = 3.42; 63.71% male; 51.62% White) were extracted from the medical record at an urban academic medical center. Three naturally occurring groups were compared: those evaluated in person prior to COVID-19 (n =780), in person during COVID-19 (n = 839), and via telehealth during COVID-19 (n = 638). RESULTS Children seen via telehealth were significantly more likely to be older, White, have fewer comorbid conditions, and live farther from the clinic than those seen in person. CONCLUSIONS The current study suggests that telehealth has not eliminated barriers to care for disadvantaged populations. Providers and institutions must take action to encourage telehealth use among these groups.
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Affiliation(s)
- Alison E. Pritchard
- Kennedy Krieger Institute, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Rachel Peterson
- Kennedy Krieger Institute, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rebecca Lieb
- Kennedy Krieger Institute, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Rowena Ng
- Kennedy Krieger Institute, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Luke Kalb
- Kennedy Krieger Institute, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Natasha Ludwig
- Kennedy Krieger Institute, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lisa A. Jacobson
- Kennedy Krieger Institute, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Howley E, Davies EG, Kreins AY. Congenital Athymia: Unmet Needs and Practical Guidance. Ther Clin Risk Manag 2023; 19:239-254. [PMID: 36935770 PMCID: PMC10022451 DOI: 10.2147/tcrm.s379673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/04/2023] [Indexed: 03/14/2023] Open
Abstract
Inborn errors of thymic stromal cell development and function which are associated with congenital athymia result in life-threatening immunodeficiency with susceptibility to infections and autoimmunity. Athymic patients can be treated by thymus transplantation using cultured donor thymus tissue. Outcomes in patients treated at Duke University Medical Center and Great Ormond Street Hospital (GOSH) over the past three decades have shown that sufficient T-cell immunity can be recovered to clear and prevent infections, but post-treatment autoimmune manifestations are relatively common. Whilst thymus transplantation offers the chance of long-term survival, significant challenges remain to optimise the outcomes for the patients. In this review, we will discuss unmet needs and offer practical guidance based on the experience of the European Thymus Transplantation programme at GOSH. Newborn screening (NBS) for severe combined immunodeficiency (SCID) and routine use of next-generation sequencing (NGS) platforms have improved early recognition of congenital athymia and increasing numbers of patients are being referred for thymus transplantation. Nevertheless, there remain delays in diagnosis, in particular when the cause is genetically undefined, and treatment accessibility needs to be improved. The majority of athymic patients have syndromic features with acute and chronic complex health issues, requiring life-long multidisciplinary and multicentre collaboration to optimise their medical and social care. Comprehensive follow up after thymus transplantation including monitoring of immunological results, management of co-morbidities and patient and family quality-of-life experience, is vital to understanding long-term outcomes for this rare cohort of patients. Alongside translational research into improving strategies for thymus replacement therapy, patient-focused clinical research will facilitate the design of strategies to improve the overall care for athymic patients.
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Affiliation(s)
- Evey Howley
- Department of Immunology and Gene Therapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - E Graham Davies
- Department of Immunology and Gene Therapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Alexandra Y Kreins
- Department of Immunology and Gene Therapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Infection, Immunity and Inflammation Research & Teaching Department, University College London, London, UK
- Correspondence: Alexandra Y Kreins, Email
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Sanford EL, Nair R, Alder A, Sessler DI, Flores G, Szmuk P. Racial/ethnic differences in receipt of surgery among children in the United States. J Pediatr Surg 2022; 57:852-859. [PMID: 35568523 DOI: 10.1016/j.jpedsurg.2022.03.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/07/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND It is unknown whether racial/ethnic disparities exist in surgical utilization for children. The aim, therefore, was to evaluate the odds of surgery among children in the US by race/ethnicity to test the hypothesis that minority children have less surgery. METHODS Cross-sectional data were analyzed on children 0-18 years old from the 1999 to 2018 National Health Interview Survey, a large, nationally representative survey. The primary outcome was odds of surgery in the prior 12 months for non Latino African-American, Asian, and Latino children, compared with non Latino White children, after adjustment for relevant covariates. The National Surgical Quality Improvement Program Pediatric Dataset was used to analyze the odds of emergent/urgent surgery by race/ethnicity. RESULTS Data for 219,098 children were analyzed, of whom 10,644 (4.9%) received surgery. After adjustment for relevant covariates, African-American (AOR, 0.54; 95% CI, 0.50-0.59), Asian (AOR, 0.39; 95% CI, 0.33-0.46), and Latino (AOR, 0.62; 95% CI, 0.57-0.67) children had lower odds of surgery than White children. Latino children were more likely to require emergent or urgent surgery (AOR, 1.71; 95% CI, 1.68-1.74). CONCLUSIONS Latino, African-American, and Asian children have significantly lower adjusted odds of having surgery than White children in America, and Latino children were more likely to have emergent or urgent surgery. These racial/ethnic differences in surgery may reflect disparities in healthcare access which should be addressed through further research, ongoing monitoring, targeted interventions, and quality-improvement efforts. LEVEL OF EVIDENCE II. TYPE OF STUDY Prognosis study.
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Affiliation(s)
- Ethan L Sanford
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, TX, USA; Department of Pediatric Critical Care, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas, USA; Outcomes Research Consortium, Cleveland, OH, USA.
| | - Rasmi Nair
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Adam Alder
- Department of Pediatric Surgery, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, TX, USA
| | - Daniel I Sessler
- Outcomes Research Consortium, Cleveland, OH, USA; Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Glenn Flores
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA; Holtz Children's Hospital, Jackson Health System, Miami, FL, USA
| | - Peter Szmuk
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, TX, USA; Outcomes Research Consortium, Cleveland, OH, USA
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Graaf G, Gigli K. Care coordination and unmet need for specialised health services among children with special healthcare needs in the USA: results from a cross-sectional analysis of the national survey of children with special healthcare needs. BMJ Open 2022; 12:e063373. [PMID: 36385031 PMCID: PMC9670924 DOI: 10.1136/bmjopen-2022-063373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To report rates of need and unmet need for specialised health services (occupational and speech therapies, durable medical equipment, home healthcare, and mobility and communication aids) from the National Survey of Children with Special Health Care Needs (CSHCN) (2009/2010) and assess the role of care coordination in having needs met. We distinguish between CSHCN with and without emotional, behavioural and developmental disorders (EBDPs) in the USA. DESIGN A cross sectional cohort study of a nationally representative sample of CSHCN from the National Survey of CSHCN for 2009/2010 used logistic regression to assess the relationship between EBDPs and need and unmet need for specialised services. It also estimates the association of care coordination with unmet need for all services, for CSHCN with and without EBDPs. SETTING A nationally representative sample of CSHCN in the USA. PARTICIPANTS Children ages 0-17 years of age. RESULTS Across all specialised health services, rates of unmet need were at or below 25%. Need and unmet need for most services was higher among CSHCN with EBDPs than those without. For CSHCN with and without EBDPs, adequate care coordination was associated with greater probability of having needs for therapy, home health and communication aids met. CONCLUSION Care coordination is essential to reducing barriers to a wide range of healthcare services for CSCHN. Policies requiring adequate insurance coverage for care coordination may play a critical role in ensuring access to specialised health services.
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Affiliation(s)
- Genevieve Graaf
- School of Social Work, University of Texas, Arlington, Texas, USA
| | - Kristin Gigli
- College of Nursing and Health Innovation, University of Texas, Arlington, Texas, USA
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Char D, Gal D, Hollander S. Sharing Decisions When Withdrawing a Technology Is Not the Same as Withholding It. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:69-72. [PMID: 36332051 DOI: 10.1080/15265161.2022.2123976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
| | - Dana Gal
- Children's Hospital of Los Angeles
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12
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Willgerodt MA, Blakeney EAR. Can relational coordination theory be used to understand and improve interprofessional care coordination in schools? A pilot study. J Interprof Care 2022; 36:761-764. [PMID: 35129028 PMCID: PMC9356112 DOI: 10.1080/13561820.2021.1997951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/02/2021] [Accepted: 10/15/2021] [Indexed: 10/19/2022]
Abstract
Attending to the health needs of students with chronic conditions requires a fluid exchange of information and coordination between parents, educators, administrators, and school healthcare professionals. Previous research often omits school nurses in this exchange, although their role is key to successful outcomes. Relational Coordination (RC) theory posits that cohesive relationships help support communication, enabling stakeholders to coordinate their work. This article preliminarily explores whether RC domains might be relevant in school health settings, utilizing existing qualitative data. Responses from focus group sessions were analyzed using a deductive and inductive analytic approach. Data were coded using the 7 RC domains as a priori codes. Frequent, timely, and accurate communication emerged as major themes in the communication domain. Shared knowledge was a major theme within the relationship domain. Problem-solving communication, shared goals, and mutual respect were minor themes. The results suggest that improving interprofessional collaboration (IPC) and health outcomes in children with chronic conditions using RC theory-informed interventions will be important to deepen the understanding of how these different domains interact and influence student health outcomes.
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Weller BE, Conrad JK, Wilburn VG, Ramamonjiarivelo Z, Gladden J. Adverse childhood experiences and mental health conditions among multiracial adolescents. ETHNICITY & HEALTH 2022; 27:1088-1102. [PMID: 33472407 DOI: 10.1080/13557858.2020.1869187] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 12/21/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The objective of this study was to verify the factor structure of the household dysfunction type of ACE using data from the National Survey of Children's Health (NSCH), and then examine whether household dysfunction (measured as a latent construct) was associated with mental health conditions among multiracial adolescents. DESIGN We used cross-sectional data collected in 2016 from caregivers who completed the NSCH and analyzed data from a subpopulation of adolescents (12-17) who reported more than one race (n = 1,231). Mplus 8.4 was used to conduct confirmatory factor analysis and probit models from a structural equation modeling framework. RESULTS Results from this study indicated that the household dysfunction type of ACE, as a latent construct, had good model fit and was significantly associated with depression [standardized coefficient [B] = .50, 95% confidence interval [CI] .36, .65], anxiety [B = .61, 95% CI .48, .73], behavior problems [B = .58, 95% CI .44, .72], and ADHD [B = .54, 95% CI .38, .69] for multiracial adolescents. CONCLUSIONS Household dysfunction may result in adolescents being separated (physically or emotionally) from their caregivers, which may hinder adolescents' ability to establish or maintain one of the most important relationships needed to promote racial/ethnic identity development and mental health. Implications for advancements in theory and NSCH are presented.
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Affiliation(s)
- Bridget E Weller
- School of Social Work, Western Michigan University, College of Health and Human Services, Kalamazoo, MI, USA
| | - Joseph K Conrad
- School of Social Work, Western Michigan University, College of Health and Human Services, Kalamazoo, MI, USA
| | - Victoria G Wilburn
- Department of Occupational Therapy, Indiana University Purdue University Indianapolis, School of Health and Human Sciences, Indianapolis, IN, USA
| | - Zo Ramamonjiarivelo
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Jessica Gladden
- School of Social Work, Western Michigan University, College of Health and Human Services, Kalamazoo, MI, USA
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Mothers’ Experiences of Care Coordination for Children with Disabilities: A Qualitative Study. CHILDREN 2022; 9:children9060835. [PMID: 35740772 PMCID: PMC9221691 DOI: 10.3390/children9060835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/27/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022]
Abstract
Few studies have investigated the care coordination for children with disabilities and their families in Japan. Care coordination enhances the quality of care for these children and their families. This study explores mothers’ experiences of coordinated care provided to their children with disabilities and their families. We used a qualitative descriptive approach, conducting semi-structured interviews with 11 Japanese mothers/primary caregivers of children with disabilities to describe their experiences. Four main themes were identified: shared decision-making with key workers, receiving an assessment of the entire family, timely access to coordinated health care services, and a reduced psychological burden and empowerment of mothers. Our findings suggest that care coordination has multiple beneficial effects on children with disabilities and their families, including improving the outcomes. Further research should examine how high-quality care coordination can be provided for such children and their families.
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Sobotka SA, Lynch E, Agrawal R. The Role of Care Coordinators for Children with Respiratory Technologies and Home Nursing. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2022; 35:49-57. [PMID: 35723661 PMCID: PMC9247673 DOI: 10.1089/ped.2021.0236] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/19/2022] [Indexed: 06/03/2023]
Abstract
Background: Children with respiratory technologies, particularly those with mechanical ventilation, represent a growing population that require complex home nursing, medical equipment, outpatient medical and habilitative supports to live and thrive in their community. Care coordination is essential to support these children and their families to navigate and integrate key community-based health and educational services, however, care is often fragmented and care coordination needs unmet. Therefore, to fully support children with respiratory technologies, it is critical to understand the role of care coordinators (CCs) and how to sustain this workforce. The aim of this article is to describe CCs' perspective on (1) their role in supporting families in a home care program for children with respiratory technologies and home nursing, and (2) the core components of recruiting into and sustaining the CC workforce. Methods: Semistructured interviews were conducted with 15 CC from the Division of Specialized Care for Children (DSCC) Home Care program for children with technology dependence and home nursing in Illinois. Two independent coders utilized a modified template approach and discussed to agreement to analyze transcripts. Results: CC averaged 6.6 years of CC experience; the majority had social work or nursing backgrounds. CCs' job satisfaction was derived from their role supporting hospital discharge, seeing children improve over time, and navigating challenges with families. CCs enjoyed working in a collaborative environment where they could draw from their colleagues' experience to solve problems. Job dissatisfaction and job turnover stemmed from difficult family interactions, high caseloads, and redundant and time-intensive administrative tasks, which interfered with family engagement. Conclusions: CCs for children with respiratory technologies require diverse skills, but interdisciplinary teams enable collaborative support of families. Seeing children thrive can sustain the workforce, however, CCs report challenges due to high caseloads and administrative tasks, which impede direct family involvement.
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Affiliation(s)
- Sarah A. Sobotka
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, The University of Chicago, Chicago, Illinois, USA
| | - Emma Lynch
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, The University of Chicago, Chicago, Illinois, USA
| | - Rishi Agrawal
- Division of Hospital-Based Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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16
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Identifying Barriers to Care in the Pediatric Acute Seizure Care Pathway. Int J Integr Care 2022; 22:28. [PMID: 35431702 PMCID: PMC8973859 DOI: 10.5334/ijic.5598] [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: 08/03/2020] [Accepted: 02/19/2022] [Indexed: 12/02/2022] Open
Abstract
Objective: We aimed to describe the acute seizure care pathway for pediatric patients and identify barriers encountered by those involved in seizure care management. We also proposed interventions to bridge these care gaps within this pathway. Methods: We constructed a process map that illustrates the acute seizure care pathway for pediatric patients at Boston Children’s Hospital (BCH). The map was designed from knowledge gathered from unstructured interviews with experts at BCH, direct observation of patient care management at BCH through a quality improvement implemented seizure diary and from findings through three studies conducted at BCH, including a prospective observational study by the pediatric Status Epilepticus Research Group, a multi-site international consortium. We also reviewed the literature highlighting gaps and strategies in seizure care management. Results: Within the process map, we identified twenty-nine care gaps encountered by caregivers, care teams, residential and educational institutions, and proposed interventions to address these challenges. The process map outlines clinical care of a patient through the following settings: 1) pre-hospitalization setting, defined as residential and educational settings before hospital admission, 2) BCH emergency department and inpatient settings, 3) post-hospitalization setting, defined as residential and educational settings following hospital discharge or clinic visit and 4) follow-up BCH outpatient settings, including neurology, epilepsy, and primary care provider clinics. The acute seizure care pathway for a pediatric patient who presents with seizures exhibits at least twenty-nine challenges in acute seizure care management. Significance: Identification of care barriers in the acute seizure care pathway provides a necessary first step for implementing interventions and strategies in acute seizure care management that could potentially impact patient outcomes.
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17
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Benito KG, Ramanathan A, Lobato D, Jandasek B, Mamaril E, McBride H, Feit LR. Symptoms, impairment and treatment needs among youth with orthostatic intolerance in a secondary care setting. CHILDRENS HEALTH CARE 2022. [DOI: 10.1080/02739615.2022.2047049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Kristen G. Benito
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Pediatric Heart Center, Hasbro Children’s Hospital, Providence, RI, USA
| | - Amrita Ramanathan
- Pediatric Heart Center, Hasbro Children’s Hospital, Providence, RI, USA
| | - Debra Lobato
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Barbara Jandasek
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Pediatric Heart Center, Hasbro Children’s Hospital, Providence, RI, USA
| | - Erin Mamaril
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Haley McBride
- Pediatric Heart Center, Hasbro Children’s Hospital, Providence, RI, USA
| | - Lloyd R. Feit
- Pediatric Heart Center, Hasbro Children’s Hospital, Providence, RI, USA
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
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18
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Pfeifauf KD, Cooper DC, Gibson E, Skolnick GB, Naidoo SD, Snyder-Warwick AK, Patel KB. Factors contributing to delay or absence of alveolar bone grafting. Am J Orthod Dentofacial Orthop 2022; 161:820-828.e1. [DOI: 10.1016/j.ajodo.2021.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/01/2021] [Accepted: 01/01/2021] [Indexed: 11/01/2022]
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19
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Palusak C, Shook B, Davies SC, Lundine JP. A scoping review to inform care coordination strategies for youth with traumatic brain injuries: Care coordination personnel. INTERNATIONAL JOURNAL OF CARE COORDINATION 2022. [DOI: 10.1177/20534345211070647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction & Importance: Effective, patient-centered care coordination has been shown to improve outcomes for children with special healthcare needs (CSHCN), who often have complex, long-term involvement with multiple service providers. Traumatic brain injury (TBI) can result in long-term physical, intellectual, social, and emotional disabilities that persist long after acute treatment. Yet, even though it is a chronic condition, TBI remains an area with scarce standardization and research surrounding the complex, long-term care coordination need in this population. The purpose of this scoping review is to summarize current research on outcomes in CSHCN after implementation of care coordinators, whether individual or teams, to inform future research for youth with TBI. Methods: OVID/Medline, CINAHL, PsycINFO, EMBASE, and ERIC databases were searched for articles relevant to care coordination and CSHCN. Results: 31 articles met inclusion criteria. Outcomes for children and families were grouped into 5 major categories: healthcare utilization, cost of care, disease status, parent and child quality of life, and healthcare satisfaction and perception of care. Discussion: Implementation of care coordinators, whether in the form of individuals, dyads, or teams, resulted in overall positive outcomes for CSHCN and their families across all 5 major outcome domains. Future research should be focused on the efficacy of care coordinators differing in profession, qualifications, and educational attainment specifically for the unique needs of children with TBI. Additionally, the application of care coordination within medical homes should be further investigated to increase proactive, preventative care of children with TBI and further reduce reactive, need-based treatment only.
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Affiliation(s)
- Cara Palusak
- Heritage College of Osteopathic Medicine, Ohio University Dublin Campus, Columbus, OH
| | - Brandy Shook
- Department of Speech & Hearing Science, The Ohio State University, Columbus, OH
| | - Susan C. Davies
- Department of Counselor Education and Human Services, University of Dayton, Dayton, OH
| | - Jennifer P. Lundine
- Department of Speech & Hearing Science, The Ohio State University, Columbus, OH
- Division of Clinical Therapies & Inpatient Rehabilitation Program, Nationwide Children's Hospital, Columbus, OH
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20
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Ward VL, Tennermann NW, Chuersanga G, Melvin P, Milstein ME, Finkelstein JA, Garvin MM, Wood LJ, Rauscher NA, Laussen PC, Leichtner AM, Emans SJ, Churchwell KB. Creating a health equity and inclusion office in an academic pediatric medical center: priorities addressed and lessons learned. Pediatr Radiol 2022; 52:1776-1785. [PMID: 35229182 PMCID: PMC8885314 DOI: 10.1007/s00247-022-05283-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 11/21/2021] [Accepted: 01/10/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Over the last two decades, medical schools and academic health centers have acknowledged the persistence of health disparities in their patients and the lack of diversity in their faculty, leaders and extended workforce. We established an Office of Health Equity and Inclusion (OHEI) at our pediatric academic medical center after a thorough evaluation of prior diversity initiatives and review of faculty development data. OBJECTIVE To describe the lessons learned at a pediatric academic medical center in prioritizing and implementing health equity, diversity and inclusion (EDI) initiatives in creating the OHEI. MATERIALS AND METHODS We reviewed internal administrative data and faculty development data, including data related to faculty who are underrepresented in medicine, to understand the role of our EDI initiatives in the strategic priorities addressed and lessons learned in the creation of the OHEI. RESULTS The intentional steps taken in our medical center's strategic approach in the creation of this office led to four important lessons to improve pediatric health equity: (1) board, senior executive and institutional prioritization of EDI initiatives; (2) multi-specialty and interprofessional collaboration; (3) academic approach to EDI programmatic development; and (4) intentionality with accountability in all EDI initiatives. CONCLUSION The key lessons learned during the creation of an Office of Health Equity and Inclusion can provide guidance to other academic health centers committed to implementing institutional priorities that focus their EDI initiatives on the improvement of pediatric health equity.
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Affiliation(s)
- Valerie L Ward
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA.
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Nicole W Tennermann
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
| | - Geeranan Chuersanga
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
| | - Patrice Melvin
- Office of Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA
- Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston, MA, USA
| | - Maxine E Milstein
- Office of Faculty Development, Boston Children's Hospital, Boston, MA, USA
| | - Jonathan A Finkelstein
- Harvard Medical School, Boston, MA, USA
- Program for Patient Safety and Quality, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Michele M Garvin
- Office of General Counsel, Boston Children's Hospital, Boston, MA, USA
| | - Laura J Wood
- Nursing and Patient Care Operations, Boston Children's Hospital, Boston, MA, USA
| | - Nina A Rauscher
- Department of Health Affairs, Boston Children's Hospital, Boston, MA, USA
| | - Peter C Laussen
- Harvard Medical School, Boston, MA, USA
- Department of Health Affairs, Boston Children's Hospital, Boston, MA, USA
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Alan M Leichtner
- Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Division of Gastroenterology, Boston Children's Hospital, Boston, MA, USA
- Department of Education, Boston Children's Hospital, Boston, MA, USA
| | - S Jean Emans
- Harvard Medical School, Boston, MA, USA
- Office of Faculty Development, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Kevin B Churchwell
- Harvard Medical School, Boston, MA, USA
- Office of the CEO and President, Boston Children's Hospital, Boston, MA, USA
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21
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Carroll AR, Hall M, Brown CM, Johnson DP, Antoon JW, Kreth H, Ngo ML, Browning W, Neeley M, Herndon A, Chokshi SB, Plemmons G, Johnson J, Hart SR, Williams DJ. Association of Race/Ethnicity and Social Determinants with Rehospitalization for Mental Health Conditions at Acute Care Children's Hospitals. J Pediatr 2022; 240:228-234.e1. [PMID: 34478747 PMCID: PMC8712354 DOI: 10.1016/j.jpeds.2021.08.078] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/02/2021] [Accepted: 08/26/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate associations of race/ethnicity and social determinants with 90-day rehospitalization for mental health conditions to acute care nonpsychiatric children's hospitals. STUDY DESIGN We conducted a retrospective cohort analysis of mental health hospitalizations for children aged 5-18 years from 2016 to 2018 at 32 freestanding US children's hospitals using the Children's Hospital Association's Pediatric Health Information System database to assess the association of race/ethnicity and social determinants (insurance payer, neighborhood median household income, and rurality of patient home location) with 90-day rehospitalization. Risk factors for rehospitalization were modeled using mixed-effects multivariable logistic regression. RESULTS Among 23 556 index hospitalizations, there were 1382 mental health rehospitalizations (5.9%) within 90 days. Non-Hispanic Black children were 26% more likely to be rehospitalized than non-Hispanic White children (aOR 1.26, 95% CI 1.08-1.48). Those with government insurance were 18% more likely to be rehospitalized than those with private insurance (aOR 1.18, 95% CI 1.04-1.34). In contrast, those living in a suburban location were 22% less likely to be rehospitalized than those living in an urban location (suburban: aOR 0.78, 95% CI 0.63-0.97). CONCLUSIONS Non-Hispanic Black children and those with public insurance were at greatest risk for 90-day rehospitalization, and risk was lower in those residing in suburban locations. Future work should focus on upstream interventions that will best attenuate social disparities to promote equity in pediatric mental healthcare.
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Affiliation(s)
- Alison R Carroll
- Monroe Carell Jr Children's Hospital at Vanderbilt, Division of Hospital Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN.
| | - Matt Hall
- Children's Hospital Association, Lenexa, KS
| | - Charlotte M Brown
- Monroe Carell Jr Children's Hospital at Vanderbilt, Division of Hospital Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - David P Johnson
- Monroe Carell Jr Children's Hospital at Vanderbilt, Division of Hospital Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - James W Antoon
- Monroe Carell Jr Children's Hospital at Vanderbilt, Division of Hospital Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Heather Kreth
- Monroe Carell Jr Children's Hospital at Vanderbilt, Division of Hospital Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - My-Linh Ngo
- Monroe Carell Jr Children's Hospital at Vanderbilt, Division of Hospital Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Whitney Browning
- Monroe Carell Jr Children's Hospital at Vanderbilt, Division of Hospital Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Maya Neeley
- Monroe Carell Jr Children's Hospital at Vanderbilt, Division of Hospital Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Alison Herndon
- Monroe Carell Jr Children's Hospital at Vanderbilt, Division of Hospital Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Swati B Chokshi
- Monroe Carell Jr Children's Hospital at Vanderbilt, Division of Hospital Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Gregory Plemmons
- Monroe Carell Jr Children's Hospital at Vanderbilt, Division of Hospital Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Jakobi Johnson
- Monroe Carell Jr Children's Hospital at Vanderbilt, Division of Hospital Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Sarah R Hart
- Monroe Carell Jr Children's Hospital at Vanderbilt, Division of Hospital Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Derek J Williams
- Monroe Carell Jr Children's Hospital at Vanderbilt, Division of Hospital Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
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22
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Anyigbo C, Fuller AE, Cheng YI, Fu LY, Belcher HM, Tarini BA, Brown NM. Associations between adverse childhood experiences and need and unmet need for care coordination. INTERNATIONAL JOURNAL OF CARE COORDINATION 2021; 24:125-132. [DOI: 10.1177/20534345211067620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Children exposed to adverse childhood experiences (ACEs) may access multiple systems of care to address medical and social complexities. Care coordination (CC) optimizes health outcomes for children with special health care needs who often use multiple systems of care. Little is known about whether ACEs are associated with the need and unmet need for CC. Methods Use of the 2016–2017 National Survey of Children’s Health to identify children who saw ≥1 health care provider in the last 12 months. The study team used weighted logistic regression analyses to examine associations between 9 ACE types, ACE score, and need and unmet need for CC. Results In the sample ( N = 39,219, representing 38,316,004 US children), material hardship (adjusted odds ratio (aOR), 1.50; 95% confidence interval (CI), 1.29–1.75), parental mental illness (aOR, 1.31; 95% CI, 1.07–1.60), and neighborhood violence (aOR, 1.33; 95% CI, 1.01–1.74) were significantly associated with an increased need for CC. Material hardship was also associated with an unmet need for CC (aOR, 2.37; 95% CI, 1.80–3.11). Children with ACE scores of 1, 2, 3, and ≥4 had higher odds of need and unmet need for CC than children with 0 ACEs. Discussion Specific ACE types and higher ACE scores were associated with the need and unmet need for CC. Evaluating the unique needs of children who endured ACEs should be considered in the design and implementation of CC processes in the pediatric health care system.
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Affiliation(s)
- Chidiogo Anyigbo
- Division of General Pediatrics and Community Health, Children’s National Hospital, Washington, DC, USA
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Anne E. Fuller
- Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Linda Y. Fu
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Harolyn M. Belcher
- Office for Health, Equity, Inclusion, and Diversity, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine; Baltimore, MD, USA
| | - Beth A. Tarini
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
- Children’s National Research Institute, Children’s National Hospital, Silver Spring, MD, USA
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23
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Anyigbo C, Tarini BA, Wang J, Lanier P. Clusters of adverse childhood experiences and unmet need for care coordination. CHILD ABUSE & NEGLECT 2021; 122:105334. [PMID: 34571356 PMCID: PMC8612971 DOI: 10.1016/j.chiabu.2021.105334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 08/04/2021] [Accepted: 09/14/2021] [Indexed: 06/01/2023]
Abstract
BACKGROUND The lack of consensus on how to measure ACEs limits our estimation of their impact on health outcomes and understanding of which ACE clusters drive unmet care coordination (CC) needs. OBJECTIVES 1) Identify latent classes of ACEs among a representative group of U.S. children; 2) Examine the association between these classes and unmet needs for CC. PARTICIPANT AND SETTING Using the 2016-2017 National Survey of Children's Health, we sampled children ages 0-17 the who had seen >1 healthcare provider within 12 months (n = 38,758). METHODS We conducted latent class analyses and weighted logistic regression analyses to examine associations between latent classes and unmet need for CC. RESULTS We identified seven distinct classes: household poverty and parental divorce, household poverty and parental death, household poverty only, household substance abuse and witnessing violence, multiple ACEs, household poverty and child discrimination, and household poverty and household mental illness. Children in the following classes had the greatest odds of unmet need for CC: household poverty only (AOR 2.0; 95% CI, 1.42-2.84), household poverty and household mental illness (AOR 1.67; 95% CI, 1.15-2.44), multiple ACEs (AOR 2.31; 95% CI, 1.53-3.50), and household poverty and child discrimination (AOR 3.55; 95% CI, 1.71-7.37). CONCLUSIONS Children who experienced specific combinations of ACEs, have an increased risk of unmet need for CC, with those experiencing both poverty and discrimination having the highest odds of unmet need for CC. Discrimination widens the gap of unmet CC need for poor children.
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Affiliation(s)
- Chidiogo Anyigbo
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Division of General Pediatrics and Community Health, Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010, United States of America.
| | - Beth A Tarini
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Children's National Research Institute, Children's National Hospital, 1 Inventa Place Silver Spring, MD 20910, United States of America.
| | - Jichuan Wang
- Center for Translational Science, Children's Research Institute, 1 Inventa Place Silver Spring, MD 20910, United States of America.
| | - Paul Lanier
- School of Social Work, The University of North Carolina at Chapel Hill, Tate-Turner-Kuralt Building 548-K, 325 Pittsboro Street, Chapel Hill, NC 27599, United States of America.
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Casseus M, Cheng J. Children with Cerebral Palsy and Unmet Need for Care Coordination. J Dev Behav Pediatr 2021; 42:605-612. [PMID: 33990510 DOI: 10.1097/dbp.0000000000000950] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/15/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the physical and functional health of children with cerebral palsy (CP) and determine the prevalence and correlates of unmet need for health care coordination among this population. METHODS We analyzed data from the 2016 to 2018 National Survey of Children's Health (n = 102,341). Bivariate and multivariable analyses were conducted to compare the prevalence of chronic health conditions, functional disabilities, and care coordination among children with and without CP. Multivariable logistic regression models were used to estimate the adjusted odds ratio of comorbid conditions, functional disabilities, and unmet need for care coordination. Associations between select sociodemographic factors and unmet need for care coordination were assessed. RESULTS Children with CP had significantly higher prevalence of all the comorbid conditions and functional disabilities examined. The most prevalent health conditions among children with CP were allergies (34.2%), anxiety (26.5%), and asthma (25.1%). Notably, children with CP had higher odds of autism spectrum disorder (adjusted odds ratio [aOR] = 2.97; 95% confidence interval [CI] 1.40-6.30) and mental health conditions (aOR = 3.65; 95% CI 2.15-6.21). More than half (53.8%) of children with CP had unmet need for care coordination. They also had higher odds of unmet need for care coordination than children without CP (aOR = 2.63; 95% CI 1.69-4.10). CONCLUSION Children with CP have high prevalence of chronic health conditions and are also more likely to have unmet need for care coordination. Given the complexity of CP, our study supports the need for robust efforts to ensure that all children with CP have effective care coordination.
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Affiliation(s)
- Myriam Casseus
- Research Department, Children's Specialized Hospital, New Brunswick, NJ
| | - JenFu Cheng
- Physiatry Section, Children's Specialized Hospital, Mountainside, NJ
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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25
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Petitgout JM, Werner J, Stewart S. Pediatric Complexity Tool Best Practice Alert: Early Identification of Care Coordination for Children with Special Health Care Needs. J Pediatr Health Care 2021; 35:485-490. [PMID: 34099347 DOI: 10.1016/j.pedhc.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
Care coordination programs continue to be developed for children with special health care needs (CSHCN). The goals for these programs are to improve access, increase communication, and decrease the overall length of stay for CSHCN. Care coordination optimizes resources to support children's health and well-being early in their hospitalization and facilitates a smooth discharge process and transition to home. Providing care coordination for CSHCN requires collaboration from many disciplines. To achieve high-quality care coordination, early identification of medically complex pediatric patients on admission is optimal. For more efficient and timelier enrollment into our care coordination program, we created a best practice alert within our electronic medical record to help overcome the challenges in timely identification of CSHCN. The best practice alert has helped us to provide care coordination benefits to our patients earlier in their hospital course. The purpose of this paper is to describe a quality improvement initiative to improve the early identification of CSHCN on hospital admission through the development of a best practice alert.
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Affiliation(s)
- Janine M Petitgout
- Care Coordination Division, University of Iowa Stead Family Children's Hospital, Iowa City, IA.
| | - John Werner
- Pediatric Social Work, University of Iowa Stead Family Children's Hospital, Iowa City, IA
| | - Stephanie Stewart
- Department of Nursing, Children's and Women's Services, University of Iowa Stead Family Children's Hospital, Iowa City, IA
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26
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Bogetz JF, Lemmon ME. Pediatric Palliative Care for Children With Severe Neurological Impairment and Their Families. J Pain Symptom Manage 2021; 62:662-667. [PMID: 33485937 PMCID: PMC8295396 DOI: 10.1016/j.jpainsymman.2021.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 01/11/2023]
Affiliation(s)
- Jori F Bogetz
- Division of Pediatric Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine; Seattle Children's Research Institute, Center for Clinical and Translational Research, Seattle, WA, United States.
| | - Monica E Lemmon
- Division of Neurology, Department of Pediatrics and Population Health Sciences, Duke University School of Medicine, Duke University Medical Center 3936, Durham, NC, United States
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27
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Chisolm DJ, Keedy HE, Dolce M, Chavez L, Abrams MA, Sanders L. Do health literacy disparities explain racial disparities in family-centered care for youths with special health care needs? PATIENT EDUCATION AND COUNSELING 2021; 104:887-895. [PMID: 32994106 PMCID: PMC7997812 DOI: 10.1016/j.pec.2020.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 09/09/2020] [Accepted: 09/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To explore the relationship among youth health literacy, parental health literacy, and family-centered care (FCC) for youth with special health care needs (YSHCN) and assess potential racial disparities. METHODS HL and FCC were assessed in 486 Medicaid-enrolled YSHCN (ages 12-18) and their healthcare-responsible parent/caregiver. Analyses assessed racial differences in HL and FCC for parents and youth using logistic regression. RESULTS Half of youth and over 80 percent of parents had adequate HL (REALM score ≥62). Adequate HL was significantly lower in African Americans (AA) for both YSHCN and parents. Only 57 % of parents and 29 % of YSHCN reported FCC. AA YSHCN reported significantly lower levels of FCC compared to White YSHCN. AA parents trended lower for FCC compared to Whites, though the disparity was not significant. AA youth and parents had significantly lower odds of reporting that doctors spent enough time with them compared to Whites. CONCLUSION Results suggest that AA and those with less than adequate health literacy experience lower FCC, however the relationship between race and health literacy does not explain the racial disparity in FCC. PRACTICAL IMPLICATIONS Provider time spent focused on HL may not reduce the racial disparity in FCC, but opportunities for improvement exist.
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Affiliation(s)
- Deena J Chisolm
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Division of Health Services Management and Policy, The Ohio State University, Columbus, OH, USA.
| | - Hannah E Keedy
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
| | - Millie Dolce
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
| | - Laura Chavez
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
| | - Mary Ann Abrams
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Lee Sanders
- Department of Pediatrics, Stanford University, Palo Alto, CA, USA.
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Ling EJ, Frean M, So J, Tietschert M, Song N, Covington C, Bahadurazada H, Khurana S, Garcia L, Singer SJ. Differences in patient perceptions of integrated care among black, hispanic, and white Medicare beneficiaries. Health Serv Res 2021; 56:507-516. [PMID: 33569775 DOI: 10.1111/1475-6773.13637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE This study sought to identify potential disparities among racial/ethnic groups in patient perceptions of integrated care (PPIC) and to explore how methodological differences may influence measured disparities. DATA SOURCE Data from Medicare beneficiaries who completed the 2015 Medicare Current Beneficiary Survey (MCBS) and were enrolled in Part A benefits for an entire year. STUDY DESIGN We used 4-point measures of eight dimensions of PPIC and assessed differences in dimensions among racial/ethnic groups. To estimate differences, we applied a "rank and replace" method using multiple regression models in three steps, balancing differences in health status among racial groups and adjusting for differences in socioeconomic status. We reran all analyses with additional SES controls and using standard multiple variable regression. DATA COLLECTION/EXTRACTION METHODS Not applicable. PRINCIPAL FINDINGS We found several significant differences in perceived integrated care between Black versus White (three of eight measures) and Hispanic versus White (one of eight) Medicare beneficiaries. On average, Black beneficiaries perceived more integrated support for self-care than did White beneficiaries (mean difference = 0.14, SE = 0.06, P =.02). Black beneficiaries perceived more integrated specialists' knowledge of past medical history than did White beneficiaries (mean difference = 0.12, SE = 0.06, P =.01). Black and Hispanic beneficiaries also each reported, on average, 0.18 more integrated medication and home health management than did White beneficiaries (P <.01 and P <.01). These findings were robust to sensitivity analyses and model specifications. CONCLUSIONS There exist some aspects of care for which Black and Hispanic beneficiaries may perceive greater integrated care than non-Hispanic White beneficiaries. Further studies should test theories explaining why racial/ethnic groups perceive differences in integrated care.
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Affiliation(s)
- Emilia J Ling
- Stanford University School of Medicine, Stanford, California, USA
| | - Molly Frean
- The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jody So
- Stanford University School of Medicine, Stanford, California, USA
| | - Maike Tietschert
- Stanford University School of Medicine, Stanford, California, USA
| | - Nancy Song
- Stanford University School of Medicine, Stanford, California, USA
| | | | | | - Sonia Khurana
- Department of Humanities, Yale University, New Haven, Connecticut, USA
| | - Luis Garcia
- Stanford University School of Medicine, Stanford, California, USA
| | - Sara J Singer
- Stanford University School of Medicine, Stanford, California, USA
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Larson IA, Rodean J, Richardson T, Bergman D, Morehous J, Colvin JD. Agreement of Provider and Parent Perceptions of Complex Care Medical Homes After a Care Management Intervention. J Pediatr Health Care 2021; 35:91-98. [PMID: 32958456 DOI: 10.1016/j.pedhc.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/29/2020] [Accepted: 08/01/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Children with medical complexity frequently lack coordinated and family-centered care and are best cared for in a medical home. METHOD We assessed concordance between provider and family perceptions of care management improvements during a prospective, 3-year study of nine complex care clinics and 42 primary care clinics. Using a pre-post design, we compared provider and parent perceptions of changes in care coordination and family-centered care responses using paired t tests, Spearman rank correlations, and linear regression. RESULTS Provider scores significantly increased in every domain (range: 14.1 points [data management], 23.0 points [chronic care management]; p < .001). Parent perceptions improved only for shared decision making improved significantly (2.2 points, p < .01). DISCUSSION These results indicate that it is possible to improve the medical home for children with medical complexity through a quality improvement initiative, but that provider perception of the improvement may be greater than parents' perceptions.
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Litt JS, Mercier CE, Edwards EM, Morrow K, Soll R. Follow-through care for high-risk infants during the COVID-19 pandemic: lessons learned from the Vermont Oxford Network. J Perinatol 2021; 41:2625-2630. [PMID: 34315972 PMCID: PMC8314022 DOI: 10.1038/s41372-021-01158-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 06/07/2021] [Accepted: 06/14/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The COVID-19 pandemic has altered the delivery of follow-up care for high-risk infants. We performed an audit to characterize programmatic responses in a quality improvement network. STUDY DESIGN We audited 43 North American-based follow-up programs of the Vermont Oxford Network Extremely Low Birth Weight Follow-up Study Group in October, 2020. Our electronic survey included yes/no, agree/disagree, and free text response items. RESULT The response rate was 67.4%. Most programs altered capacity and the timing, frequency, or content of clinical assessments. Most perceived practice changes compromised their ability to ascertain infants' medical and developmental needs. There was a rapid uptake of telemedicine services. Despite challenges with implementation, many endorsed improved connectedness with families. CONCLUSION Programs adapted rapidly to meet the needs of high-risk infants during the pandemic. Clinical operations, assessment procedures, and quality metrics will also need to evolve. Quality improvement study group collaboratives are well-positioned to coordinate such work.
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Affiliation(s)
- Jonathan S. Litt
- grid.239395.70000 0000 9011 8547Beth Israel Deaconess Medical Center, Boston, MA USA
| | - Charles E. Mercier
- grid.414924.e0000 0004 0382 585XUniversity of Vermont Medical Center, Burlington, VT USA ,grid.492967.7Vermont Oxford Network, Burlington, VT USA
| | - Erika M. Edwards
- grid.414924.e0000 0004 0382 585XUniversity of Vermont Medical Center, Burlington, VT USA ,grid.492967.7Vermont Oxford Network, Burlington, VT USA
| | - Kate Morrow
- grid.492967.7Vermont Oxford Network, Burlington, VT USA
| | - Roger Soll
- grid.414924.e0000 0004 0382 585XUniversity of Vermont Medical Center, Burlington, VT USA ,grid.492967.7Vermont Oxford Network, Burlington, VT USA
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Baek S, Choi EH, Lee J. Unmet Healthcare Needs of Children in Vulnerable Families in South Korea: Finding from the Community Child Center Child Panel Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218241. [PMID: 33171882 PMCID: PMC7664643 DOI: 10.3390/ijerph17218241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 11/30/2022]
Abstract
Presented in this paper is a study that examined the status of unmet healthcare needs of children in vulnerable families and identified factors affecting such unmet needs. The Community Child Center (CCC) Child Panel Survey data in Korea were used. A multiple stepwise logistic regression analysis was performed to examine factors influencing unmet healthcare needs of children. Influencing factors comprised predisposing, enabling, and need factors based on the Andersen Behavioral Model of Health Services Utilization. A total of 340 sixth-graders from vulnerable families participated, and 96 (28.2%) children had unmet healthcare needs. Factors included absence of an after-school caregiver (OR = 1.95, 95% CI [1.16, 3.27]), perceived physical symptoms (OR = 1.33, 95% CI [1.02, 1.73]), parental indifference (OR = 1.33, 95% CI [1.002, 1.77]), duration of daily stay at CCCs (OR = 1.32, 95% CI [1.01, 1.71]), and satisfaction with CCC teachers (OR = 0.65, 95% CI [0.49, 0.85]). The relationship with parents and CCC teachers had the strongest influence on unmet healthcare needs of children. In order to reduce the unmet healthcare needs of children in vulnerable families, existing support structures should be expanded to offer financial and administrative support for children’s parents and CCC teachers.
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Affiliation(s)
- Suyon Baek
- Department of Nursing, College of Nursing and Health, Kongju National University, Gongju-si 32588, Korea;
| | - Eun-Hi Choi
- College of Nursing, Eulji University, Daejeon 34824, Korea
- Correspondence:
| | - Jungeun Lee
- College of Nursing, University of Rhode Island, Kingston, RI 02881, USA;
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Pankewicz A, Davis RK, Kim J, Antonelli R, Rosenberg H, Berhane Z, Turchi RM. Children With Special Needs: Social Determinants of Health and Care Coordination. Clin Pediatr (Phila) 2020; 59:1161-1168. [PMID: 32672059 DOI: 10.1177/0009922820941206] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Care coordination (CC) facilitates access to resources/services for children/youth with special health care needs (CYSHCN). We conducted a cross-sectional analysis of the 2009-2010 National Survey of CSHCN to examine socioeconomic factors related to report of receiving adequate CC services for CYSHCN. Descriptive statistics were used to describe sociodemographic characteristics of respondents and examine socioeconomic factors. Receiving adequate CC varied by socioeconomic variables including income (100% to 199% federal poverty line [FPL]; aOR [adjusted odds ratio] = 0.848; 95% CI [confidence interval] = 0.722-0.997; P < .05), insurance (uninsured; aOR = 0.446; 95% CI = 0.326-0.609; P < .0001), and marital status (never married; aOR = 0.79; 95% CI = 0.64-0.97; P < .05). More families reporting adequate CC had private insurance, non-Hispanic white ethnicity, income >400% federal poverty level, and 2-parent households. Findings suggest unmet needs in terms of adequate access or knowledge leading to insufficient provision of CC for families with the greatest needs. Further analysis identifying specific deficits and implementing strategies to address these disparities is warranted.
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Affiliation(s)
| | | | - John Kim
- Drexel University, Philadelphia, PA, USA
| | - Richard Antonelli
- Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Hannah Rosenberg
- Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Renee M Turchi
- Drexel University, Philadelphia, PA, USA.,St Christopher's Hospital for Children, Philadelphia, PA, USA
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Twanow JDE, Maturu S, Khandker N. Pediatric to Adult Epilepsy Transition in Ambulatory Care: Benefits of a Multidisciplinary Epilepsy Transition Clinic. JOURNAL OF PEDIATRIC EPILEPSY 2020. [DOI: 10.1055/s-0040-1716827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractChildren with epilepsy comprise 3.2% of the estimated 500,000 youth with special medical needs who move from the pediatric to adult care model annually. These 16,000 children who require transfer each year represent a challenging subset of 470,000 youth living with epilepsy in the United States. Transition and transfer of care are complex and require gradual processes. This period for youth with epilepsy is often associated with inadequate follow-up and increased risk of nonadherence. Furthermore, youth and adults with epilepsy are known to have suboptimal social and emotional outcomes compared with peers, with high rates of under education, underemployment, poverty, and struggles with mental health. The goal of improving social determinants and continuity of care prompted the development of formal epilepsy transition clinics. Multiple clinic models exist, sharing the overarching goal of supporting youth while building self-management skills, tailored to age and developmental level. Early evidence shows that transition discussion leads to statistically significant increases in transfer readiness and self-efficacy in young adults with epilepsy. Our center boasts a 100% attendance rate at our transition and transfer clinic and 78% compliance with follow-up, further demonstrating that patients and families value quality transition programming.
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Affiliation(s)
- Jaime-Dawn E. Twanow
- Division of Neurology, Department of Pediatrics, Nationwide Children’s Hospital, Ohio State University, Columbus, Ohio, United States
| | - Sarita Maturu
- Division of Epilepsy, Department of Neurology, Nationwide Children’s Hospital, Ohio State University, Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Nabil Khandker
- Division of Epilepsy, Department of Neurology, Nationwide Children’s Hospital, Ohio State University, Ohio State University Wexner Medical Center, Columbus, Ohio, United States
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Abstract
OBJECTIVES Medical homes are an effective model of primary care. Historically, however, racial and ethnic minorities have not had equal access to medical homes. The present study estimated the national prevalence of youth's access to a medical home and its components by race and ethnicity. METHODS We conducted secondary data analysis using the 2016-2017 National Survey of Children's Health, a nationally representative, cross-sectional survey of U.S. youth age 0-17 years (N = 62,308). We obtained weighted and unweighted descriptive statistics and conducted multivariate logit regression models. RESULTS Although 49% of the total sample had access to a medical home, 57.1% of white youth had access compared to 37% of Hispanic youth and 39.7% of black youth. Among youth without a medical home, black youth had less access than white youth to a usual place for care (64.7% vs. 55.3%, adjusted odds ratio [aOR] = 0.82, 95% confidence interval [CI] 0.69-0.97) and family-centered care (78.1% vs. 66.7%, aOR = 0.64, 95% CI 0.52-0.79). Hispanic youth (68.2%) also had less access to family-centered care than white youth (aOR = 0.73, 95% CI 0.60-0.89). White youth were less likely to have access to effective care coordination, when needed, than Hispanic youth (46.2% vs. 53.5%, aOR = 1.35, 95% CI 1.09-1.66). CONCLUSIONS FOR PRACTICE Our findings suggest racial/ethnic disparities exist in youth's access to a medical home and its components. We posit the need for continued efforts to enhance access to medical homes for all youth. Future studies need to examine systemic barriers to youth's access to medical homes.
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35
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The Impact of Medicaid Expansion for Adults Under the Affordable Care Act on Preventive Care for Children. Med Care 2020; 58:945-951. [DOI: 10.1097/mlr.0000000000001385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pennington JR, Oglesby WH, Alemagno S. Impact of Social Capital on the Availability of Health Care Services. Popul Health Manag 2020; 24:369-375. [PMID: 32780625 DOI: 10.1089/pop.2020.0142] [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: 11/12/2022] Open
Abstract
Children with special health care needs (CSHCN) and their families experience many structural, financial, psychosocial, and physical obstacles to accessing and fully utilizing a continuum of health care services, including a myriad of contextual barriers that are unique to their local communities. Social capital is one contextual barrier hypothesized in the literature to reduce access to health care services. To better understand the role of social capital in accessing health care services for this vulnerable population, a study was constructed using data from a large representative sample of CSHCNs. The analysis was conducted on data collected through the National Survey of Children's Health, a cross-sectional study of child health that includes information on physical and mental health; access to health care; and neighborhood, school, and social context. Logistic regression analyses were performed on a reduced, complete data set containing only CSHCN (n = 32,496) using 5 medical home variables and an investigator-constructed social capital composite score. Social capital was not found to be a complete mediator of individual medical home characteristics; however, each increase in the social capital scale reduced the odds of experiencing a delay in care of overall health care services by 12.5% (P = .006). The effects of social capital on the accessibility of health care services is significant and focusing on strengthening social capital within communities will improve overall health outcomes for this vulnerable group of children.
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Affiliation(s)
- Jared R Pennington
- College of Education and Health Sciences, Department of Physician Assistant Studies, Baldwin Wallace University, Berea, Ohio, USA
| | - Willie H Oglesby
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sonia Alemagno
- College of Public Health, Kent State University, Kent, Ohio, USA
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37
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Matsuzawa A, Shiroki Y, Arai J, Hirasawa A. Care coordination for children with medical complexity in Japan: Caregivers' perspectives. Child Care Health Dev 2020; 46:436-444. [PMID: 32246855 DOI: 10.1111/cch.12767] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 01/10/2020] [Accepted: 01/21/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Little is known about the provision of care coordination to children with medical complexity (CMC) and their families in Japan. The aim of this study was to describe provision of care coordination and explore the factors associated with quality of care coordination for Japanese CMC and their families. METHODS We used an exploratory cross-sectional study design. Participants were recruited at a children's hospital located in one prefecture, Japan. Primary caregivers raising children aged between <1 and 20 years and receiving reimbursements for their home-based medical care at a children's hospital were eligible to participants in this study. The study examined the relationship between parents' ratings of care coordination as 'adequate,' 'inadequate' or 'not received' and characteristics of children, parents, and families. RESULTS Ninety-nine parents caring for CMC were included in the analysis. Of those, 22.2% reported their child had a care coordinator. Caregivers were divided into three groups depending on the quality of care coordination: Group 1 reported adequate care coordination; Group 2 reported inadequate care coordination; and Group 3 had no need for care coordination. We compared the socio-demographics of children, parents and families, their service use and the health-related quality of life (HR-QOL) and caregiver burden scores of parents across the three groups. The parents' free time, access to timely care for children and service satisfaction were positively associated with adequate care coordination for CMC and their families. CONCLUSIONS Providing adequate care coordination for CMC and their families is essential for access to timely services and more positive psychological health of parents. High quality care coordination for CMC and their families is urgently needed in Japan.
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Affiliation(s)
- Akemi Matsuzawa
- School of Nursing, Ibaraki Christian University, Hitachi, Japan
| | - Yuko Shiroki
- School of Nursing, Ibaraki Christian University, Hitachi, Japan
| | - Junichi Arai
- Department of Neonatology, Ibaraki Children's Hospital, Mito, Japan
| | - Akemi Hirasawa
- Department of Neonatology, Ibaraki Children's Hospital, Mito, Japan
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Abstract
OBJECTIVES To identify the diverse services required by families of children with special health care needs (CSHCN) and identify the specific care coordination (CC) efforts associated with the most common types of observed diagnoses. Requested services were categorized into specific sectors, and CC efforts were quantified by observed diagnoses and defined sectors. METHODS CC service data were extracted and analyzed from patient encounters over 4 years (2009-2013) in a department database. This included descriptive information about referrals and linkages to medical, dental, and behavioral health providers and to state, private, and community agencies. Diagnostic classifications and CC sectors were defined to enable categorization. RESULTS A total of 2682 CSHCN records were reviewed. The majority (59%) required services/resources in 1 to 2 sectors, 24% required services/resources in 3 to 5 sectors, and 17% required services/resources in 6 or more sectors. Including informational service, the most frequently required sectors across the study population were education, financial, medical/dental, social connections, and advocacy. Children diagnosed with autism spectrum disorder had the highest needs across all sectors. CONCLUSION Most CSHCN and their families use a substantial amount of CC time and effort to secure services from diverse sectors. High-quality and efficient CC requires an understanding of the specific needs of these CSHCN and their families and how to link them to a diverse array of services and resources.
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Corneal Collagen Cross-Linking Under General Anesthesia for Pediatric Patients With Keratoconus and Developmental Delay. Cornea 2019; 39:546-551. [PMID: 31725701 DOI: 10.1097/ico.0000000000002197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the clinical characteristics and outcomes of pediatric patients with keratoconus (KCN) who underwent corneal collagen cross-linking (CXL) under general anesthesia for developmental delay or inability to cooperate with topical anesthesia. METHODS In this retrospective case series, we reviewed the medical charts of pediatric patients with KCN who had CXL under general anesthesia from January 2018 to April 2019. Baseline disease characteristics of patients with and without developmental delay were compared using the Pearson χ test and the t test. Main outcomes were anesthesia or surgical complications and postoperative best corrected visual acuity (BCVA), keratometry (K) values, and caregiver report of eye-rubbing behavior. RESULTS Fourteen eyes of 9 patients were reviewed. All were habitual eye rubbers at baseline. Six (66.7%) were developmentally delayed. Compared with patients without developmental delay, developmentally delayed patients were diagnosed and treated at older ages (16.0 vs. 13.9 years), experienced longer delays from diagnosis to surgery (20.7 vs. 8.8 weeks), and had lower BCVA (20/70 vs. 20/40), higher steep K values (54.0 vs. 50.9), and a higher incidence of corneal scarring (75.0% vs. 33.3%) and monocular vision loss (50.0% vs. 0.0%) at baseline, although these differences were not statistically significant. No anesthesia or surgical complications occurred. BCVA and K values were stable at postoperative month 6, with no clinically or statistically significant change observed for either measure. Eight patients decreased or stopped eye rubbing. CONCLUSIONS We demonstrate the efficacy and safety of CXL under general anesthesia in halting the progression of KCN for pediatric patients with developmental delay or an inability to cooperate with the procedure until topical anesthesia.
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Figueroa JF, Zhou X, Jha AK. Characteristics And Spending Patterns Of Persistently High-Cost Medicare Patients. Health Aff (Millwood) 2019; 38:107-114. [PMID: 30615516 DOI: 10.1377/hlthaff.2018.05160] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
One strategy for reducing health care spending is to target the Medicare beneficiaries who remain persistently high cost over time. Using a 20 percent sample of Medicare fee-for-service beneficiaries in the period 2012-14, we sought to identify the proportion of patients who remained persistently high cost (that is, in the top 10 percent of spending each year) and determine the characteristics and spending patterns that differentiated them from other patients. We found that 28.1 percent of patients who were high cost in 2012 remained persistently high cost over the subsequent two years. On average, persistently high-cost patients were younger, more likely to be members of racial/ethnic minority groups, eligible for Medicare based on having end-stage renal disease, and dually eligible for Medicaid, compared to transiently and never high-cost patients. Persistently high-cost patients had greater relative spending on outpatient care and medications, while very little of their spending was related to preventable hospitalizations. Health care systems and policy makers can use this information to better target spending reductions and care improvements over time.
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Affiliation(s)
- José F Figueroa
- José F. Figueroa is an instructor of medicine at Harvard Medical School and an associate physician in the Department of Medicine, Brigham and Women's Hospital, both in Boston, Massachusetts
| | - Xiner Zhou
- Xiner Zhou was an analyst at the Harvard T. H. Chan School of Public Health, in Boston, when this manuscript was submitted. She is now a PhD candidate in the Department of Statistics at the University of California Davis
| | - Ashish K Jha
- Ashish K. Jha ( ) is the K. T. Li Professor of International Health at the Harvard T. H. Chan School of Public Health and director of the Harvard Global Health Institute, in Cambridge, Massachusetts
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Ning M, Daniels J, Schwartz J, Dunlap K, Washington P, Kalantarian H, Du M, Wall DP. Identification and Quantification of Gaps in Access to Autism Resources in the United States: An Infodemiological Study. J Med Internet Res 2019; 21:e13094. [PMID: 31293243 PMCID: PMC6652124 DOI: 10.2196/13094] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 01/25/2023] Open
Abstract
Background Autism affects 1 in every 59 children in the United States, according to estimates from the Centers for Disease Control and Prevention’s Autism and Developmental Disabilities Monitoring Network in 2018. Although similar rates of autism are reported in rural and urban areas, rural families report greater difficulty in accessing resources. An overwhelming number of families experience long waitlists for diagnostic and therapeutic services. Objective The objective of this study was to accurately identify gaps in access to autism care using GapMap, a mobile platform that connects families with local resources while continuously collecting up-to-date autism resource epidemiological information. Methods After being extracted from various databases, resources were deduplicated, validated, and allocated into 7 categories based on the keywords identified on the resource website. The average distance between the individuals from a simulated autism population and the nearest autism resource in our database was calculated for each US county. Resource load, an approximation of demand over supply for diagnostic resources, was calculated for each US county. Results There are approximately 28,000 US resources validated on the GapMap database, each allocated into 1 or more of the 7 categories. States with the greatest distances to autism resources included Alaska, Nevada, Wyoming, Montana, and Arizona. Of the 7 resource categories, diagnostic resources were the most underrepresented, comprising only 8.83% (2472/28,003) of all resources. Alarmingly, 83.86% (2635/3142) of all US counties lacked any diagnostic resources. States with the highest diagnostic resource load included West Virginia, Kentucky, Maine, Mississippi, and New Mexico. Conclusions Results from this study demonstrate the sparsity and uneven distribution of diagnostic resources in the United States, which may contribute to the lengthy waitlists and travel distances—barriers to be overcome to be able to receive diagnosis in specific regions. More data are needed on autism diagnosis demand to better quantify resource needs across the United States.
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Affiliation(s)
- Michael Ning
- Division of Systems Medicine, Department of Pediatrics, Stanford University, Stanford, CA, United States.,Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
| | - Jena Daniels
- Division of Systems Medicine, Department of Pediatrics, Stanford University, Stanford, CA, United States.,Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
| | - Jessey Schwartz
- Division of Systems Medicine, Department of Pediatrics, Stanford University, Stanford, CA, United States.,Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
| | - Kaitlyn Dunlap
- Division of Systems Medicine, Department of Pediatrics, Stanford University, Stanford, CA, United States.,Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
| | - Peter Washington
- Division of Systems Medicine, Department of Pediatrics, Stanford University, Stanford, CA, United States.,Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
| | - Haik Kalantarian
- Division of Systems Medicine, Department of Pediatrics, Stanford University, Stanford, CA, United States.,Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
| | - Michael Du
- Division of Systems Medicine, Department of Pediatrics, Stanford University, Stanford, CA, United States.,Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
| | - Dennis P Wall
- Division of Systems Medicine, Department of Pediatrics, Stanford University, Stanford, CA, United States.,Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
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Liu SR, Kia-Keating M, Nylund-Gibson K. Patterns of Family, School, and Community Promotive Factors and Health Disparities Among Youth: Implications for Prevention Science. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 20:1103-1113. [PMID: 31124022 DOI: 10.1007/s11121-019-01021-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Increasing knowledge of factors that promote health among youth from diverse backgrounds is an important step towards addressing health disparities. Although many promotive factors have been identified individually, there is an overabundance of research on risk factors, and a comparable dearth of knowledge regarding the influence of combinations of promotive factors. The current study examined how promotive factors across family, school, and community contexts co-occur to promote health among youth of different race/ethnicity. Utilizing a nationally representative sample of Black (10%), Latinx (12%), and White (77%) youth ages 12-17 (N = 30,668), latent class analysis was employed to identify classes of youth who endorsed homogenous patterns of promotive factors. Associations between class membership and health were explored. Each subsample was best characterized by its own 4-class model, with significant differences in patterns of promotive factors experienced by Black, Latinx, and White youth. Youth health outcomes also varied significantly by class membership (p < .05). Greater access to more promotive factors was associated with better health, and low access to community and school promotive factors was associated with worse health. Results suggest that increasing promotive factors in school, family, and community settings may help to prevent poor health outcomes; however, jointly addressing discrimination against racial/ethnic minority youth through education, policy, and practice is also needed to address health disparities.
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Affiliation(s)
- Sabrina R Liu
- Department of Counseling, Clinical, & School Psychology, University of California, Santa Barbara, CA, 93106-9490, USA.
| | - Maryam Kia-Keating
- Department of Counseling, Clinical, & School Psychology, University of California, Santa Barbara, CA, 93106-9490, USA
| | - Karen Nylund-Gibson
- Department of Education, University of California, Santa Barbara, CA, 93106-9490, USA
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43
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Sheftall AH, Chisolm DJ, Alexy ER, Chavez LJ, Mangione-Smith RM, Ferrari RM, Song PH. Satisfaction With Care Coordination for Families of Children With Disabilities. J Pediatr Health Care 2019; 33:255-262. [PMID: 30449647 DOI: 10.1016/j.pedhc.2018.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/03/2018] [Accepted: 08/19/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Children with disabilities have significant health care needs, and receipt of care coordinator services may reduce caregiver burdens. The present study assessed caregivers' experience and satisfaction with care coordination. METHOD Caregivers of Medicaid-enrolled children with disabilities (n = 2,061) completed a survey (online or by telephone) collecting information on the caregivers' experiences and satisfaction with care coordination using the Family Experiences with Coordination of Care questionnaire. RESULTS Eighty percent of caregivers with a care coordinator reported receiving help making specialist appointments, and 71% reported help obtaining community services. Caregivers who reported that the care coordinator helped with specialist appointments or was knowledgeable, supportive, and advocating for children had increased odds of satisfaction (odds ratio = 3.46, 95% confidence interval = [1.01, 11.77] and odds ratio = 1.07, 95% confidence interval = [1.03, 1.11], respectively). DISCUSSION Findings show opportunities for improving care coordination in Medicaid-enrolled children with disabilities and that some specific elements of care coordination may enhance caregiver satisfaction with care.
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44
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Chien AT, Toomey SL, Kuo DZ, Van Cleave J, Houtrow AJ, Okumura MJ, Westfall MY, Petty CR, Quinn JA, Kuhlthau KA, Schuster MA. Care Quality and Spending Among Commercially Insured Children With Disabilities. Acad Pediatr 2019; 19:291-299. [PMID: 29932986 DOI: 10.1016/j.acap.2018.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 04/16/2018] [Accepted: 06/10/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To identify opportunities to improve care value for children with disabilities (CWD), we examined CWD prevalence within a commercially insured population and compared outpatient care quality and annual health plan spending levels for CWD relative to children with complex medical conditions without disabilities; children with chronic conditions that are not complex; and children without disabling, complex, or chronic conditions. METHODS This cross-sectional study comprised 1,118,081 person-years of Blue Cross Blue Shield Massachusetts data for beneficiaries aged 1 to 19years old during 2008 to 2012. We combined the newly developed and validated Children with Disabilities Algorithm with the Pediatric Medical Complexity Algorithm to identify CWD and non-CWD subgroups. We used 14 validated or National Quality Forum-endorsed measures to assess outpatient care quality and paid claims to examine annual plan spending levels and components. RESULTS CWD constituted 4.5% of all enrollees. Care quality for CWD was between 11% and 59% for 8 of 14 quality measures and >80% for the 6 remaining measures and was generally comparable to that for non-CWD subgroups. Annual plan spending among CWD was a median and mean 23% and 53% higher than that for children with complex medical conditions without disabilities, respectively; CWD mean and median values were higher than for all other groups as well. CONCLUSIONS CWD were prevalent in our commercially insured population. CWD experienced suboptimal levels of care, but those levels were comparable to non-CWD groups. Improving the care value for CWD involves a deeper understanding of what higher spending delivers and additional aspects of care quality.
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Affiliation(s)
- Alyna T Chien
- Division of General Pediatrics, Department of Medicine; Department of Pediatrics, Harvard Medical School.
| | - Sara L Toomey
- Division of General Pediatrics, Department of Medicine; Department of Pediatrics, Harvard Medical School
| | - Dennis Z Kuo
- Division of General Pediatrics, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, NY
| | - Jeanne Van Cleave
- Department of Pediatrics, School of Medicine, University of Colorado Denver, Anschutz Medical Campus , Aurora, Colo
| | - Amy J Houtrow
- Division of Pediatric Rehabilitation Medicine, Children's Hospital of Pittsburgh; Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine , Pittsburgh, Pa
| | - Megumi J Okumura
- Division of General Pediatrics, University of California San Francisco Benioff Children's Hospital; Division of General Pediatrics, Department of Pediatrics, University of California San Francisco School of Medicine , San Francisco
| | | | - Carter R Petty
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital
| | | | - Karen A Kuhlthau
- Department of Pediatrics, Harvard Medical School; Division of General Academic Pediatrics, Massachusetts General Hospital for Children , Boston, Mass
| | - Mark A Schuster
- Division of General Pediatrics, Department of Medicine; Department of Pediatrics, Harvard Medical School; Kaiser Permanente School of Medicine , Pasadena, Calif
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Hirschi M, Walter AW, Wilson K, Jankovsky K, Dworetzky B, Comeau M, Bachman SS. Access to care among children with disabilities enrolled in the MassHealth CommonHealth Buy-In program. J Child Health Care 2019; 23:6-19. [PMID: 29772924 DOI: 10.1177/1367493518777310] [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] [Indexed: 10/16/2022]
Abstract
Children with disabilities utilize more health-care services and incur higher costs than other children do. Medicaid Buy-In programs for children with disabilities have the potential to increase access to benefits while reducing out-of-pocket costs for families whose income exceeds Medicaid eligibility. This study sought to understand how parents and caregivers of Massachusetts children with disabilities perceive access to care under CommonHealth, Massachusetts's Medicaid Buy-In program. Parents and caregivers ( n = 615) whose children were enrolled in CommonHealth participated in a survey assessing the impact of the program. Qualitative data were coded across five access domains-availability, accessibility, accommodation, affordability, and acceptability. Data suggest that CommonHealth improves access to care for children with disabilities by providing the benefits that were limited in scope or unavailable through other insurance before enrollment and by making available services more affordable. Policy and administrative changes could improve the program and further increase access to care for children with complex, costly conditions. Adopting a Medicaid Buy-In program may be an effective way for states to create a pathway to Medicaid for children with disabilities whose family income is too high for Medicaid and who have unmet needs and/or whose families incur high out-of-pocket costs for their care.
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Affiliation(s)
- Melissa Hirschi
- 1 Department of Social Work, University of Memphis, Memphis, TN, USA
| | - Angela Wangari Walter
- 2 Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, MA, USA
| | - Kasey Wilson
- 3 School of Social Work, Boston University, Boston, MA, USA
| | - Kate Jankovsky
- 4 Colorado Department of Public Health and Environment, Denver, CO, USA
| | | | - Meg Comeau
- 6 Center for Advancing Health Policy and Practice, Boston University, Boston, MA, USA
| | - Sara S Bachman
- 6 Center for Advancing Health Policy and Practice, Boston University, Boston, MA, USA
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46
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Berg KL, Shiu CS, Feinstein RT, Msall ME, Acharya K. Adverse Childhood Experiences Are Associated with Unmet Healthcare Needs among Children with Autism Spectrum Disorder. J Pediatr 2018; 202:258-264.e1. [PMID: 30220443 DOI: 10.1016/j.jpeds.2018.07.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 05/24/2018] [Accepted: 07/05/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To explore associations between level of adverse childhood experiences (ACEs) and unmet healthcare needs among children with autism spectrum disorder (ASD) using a population-based sample. STUDY DESIGN Cross-sectional data from the 2011-2012 National Survey of Child Health were analyzed to estimate prevalence of unmet healthcare needs among children with ASD, aged 2-17 years (ASD = 1624; estimated population = 1 174 871). Multivariate Poisson and logistic regression models were used to estimate the relationship between reported ACEs and unmet healthcare needs among children with ASD. RESULTS After we adjusted for all other variables, children with ASD who experienced 1-2 ACEs and 3+ ACEs were associated with 1.78 (P < .05) and 2.53 (P < .01) times the incidence rate of unmet healthcare needs in comparison with children without ACEs. Compared with children who experienced 0 ACEs, the adjusted odds of any unmet healthcare need were 2.34 (P < .01) and 2.66 (P < .01) for children with 1-2 ACEs and 3 + ACEs, respectively. CONCLUSION Although limited to cross-sectional data, our study provides compelling evidence on the link between ACEs and unmet healthcare needs among children with ASD. It advances understanding of risk factors in the child and community context that contribute to health disparities and negatively impact healthcare access and use in this population.
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Affiliation(s)
- Kristin L Berg
- Department of Social Work, University of South Dakota, Sioux Falls, SD.
| | - Cheng-Shi Shiu
- School of Nursing, University of California-Los Angeles, Los Angeles, CA
| | - Rebecca T Feinstein
- Department of Health Services Management, College of Health Sciences, Rush University, Chicago, IL
| | - Michael E Msall
- Comer Children's Hospital, and Kennedy Research Center on Intellectual and Developmental Disabilities, University of Chicago Medicine, Chicago, IL
| | - Kruti Acharya
- Department of Disability & Human Development & Pediatrics, University of Illinois-Chicago, Chicago, IL
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47
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Jolles MP, Lee PJ, Javier JR. Shared decision-making and parental experiences with health services to meet their child's special health care needs: Racial and ethnic disparities. PATIENT EDUCATION AND COUNSELING 2018; 101:1753-1760. [PMID: 29884531 DOI: 10.1016/j.pec.2018.05.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/20/2018] [Accepted: 05/26/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Test the relationship between shared decision-making (SDM) and parental report of frustration with efforts to get services for their child and to address unmet health needs; assess SDM's influence on minority parents' service experiences. METHODS Performed secondary analysis using the 2009-2010 National Survey of Children with Special Health Care Needs (n = 40,242). Used multivariate logistic regressions to test the association between SDM and parent-reported service experiences, and whether SDM influenced the association between minorities and negative service experiences. Propensity scores accounted for observed selection bias. RESULTS Families engaged in SDM had lower odds of reporting service dissatisfaction. Fewer minority parents reported SDM engagement compared with Whites (between 62% and 66% versus 74%). Blacks engaged in SDM had higher odds of reporting negative service experiences compared with SDM-engaged Whites. This disparity was no longer significant after adjusting for covariates. CONCLUSION SDM is associated with lower reports of parental service dissatisfaction. Stratified analyses showed that SDM seems to be experienced differently across minority groups. PRACTICE IMPLICATIONS SDM may be a promising engagement strategy to improve parental service experiences. The role of SDM on increasing Black parents' reports of service dissatisfaction, perhaps due to increased awareness of service challenges, should be investigated.
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Affiliation(s)
- Mónica Pérez Jolles
- Suzanne Dworak-Peck School of Social Work, Gehr Family Center for Health Systems Science, University of Southern California, Los Angeles.
| | - Pey-Jiuan Lee
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles.
| | - Joyce R Javier
- Division of General Pediatrics, Department of Pediatrics Children's Hospital Los Angeles, USC Keck School of Medicine.
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48
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Miller R, Tumin D, Hayes D, Uffman JC, Raman VT, Tobias JD. Unmet Need for Care Coordination Among Children with Special Health Care Needs. Popul Health Manag 2018; 22:255-261. [PMID: 30272532 DOI: 10.1089/pop.2018.0094] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Socioeconomic disparities in access to care coordination have been noted among children with special health care needs (CSHCN). Following recent policy developments and technological innovation, care coordination has become more widespread, possibly leading to reduced disparity in care coordination access. This study investigates whether child and household characteristics remain associated with unmet need for care coordination among CSHCN. CSHCN (aged <18 years) requiring ≥2 types of health services in the past year were identified in the 2016 National Survey of Children's Health (NSCH). Care coordination was defined as help with arranging the child's care among different doctors or services. Children were classified as not needing care coordination, receiving sufficient care coordination (met need), or needing but not receiving care coordination (unmet need). Weighted multinomial logistic regression examined the association of child characteristics with this outcome. The analysis included 5622 children with no need for care coordination, 1466 with a met need, and 980 with unmet needs. Children with mental health conditions were more likely to have unmet rather than met needs for care coordination (odds ratio = 4.1; 95% confidence interval: 2.7, 6.1; P < 0.001). After multivariable adjustment, race/ethnicity, income, family structure, insurance coverage, place of birth, and use of English in the home were not associated with having unmet rather than met needs for care coordination. Among CSHCN, the latest data from NSCH reveal no evidence of previously described socioeconomic disparities in access to care coordination. Nevertheless, unmet needs for care coordination remain prevalent, especially among children with mental health conditions.
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Affiliation(s)
- Rebecca Miller
- 1 Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Dmitry Tumin
- 1 Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.,2 Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Don Hayes
- 3 Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio.,4 Department of Pulmonary and Critical Care Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Joshua C Uffman
- 1 Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.,5 Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Vidya T Raman
- 1 Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.,5 Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Joseph D Tobias
- 1 Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.,5 Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio
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49
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Sprecher E, Conroy K, Chan J, Lakin PR, Cox J. Utilization of Patient Navigators in an Urban Academic Pediatric Primary Care Practice. Clin Pediatr (Phila) 2018; 57:1154-1160. [PMID: 29451008 DOI: 10.1177/0009922818759318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Navigating health care systems can be a challenge for families. A retrospective descriptive cohort analysis was conducted assessing referrals to patient navigators (PNs) in one urban academic pediatric primary care practice. PNs tracked referral processes and a subset of PN referrals was assessed for markers of successful referrals. The most common reasons for referral were assistance overcoming barriers to care (46%), developmental concerns (38%), and adherence/care coordination concerns (14%). Significant predictors of referral were younger age, medical complexity, public insurance, male sex, and higher rates of no-show to visits in primary or subspecialist care. The majority of referrals were resolved. The referrals for process-oriented needs were significantly more successful than those for other concerns. PNs were more effective for discrete process tasks than for those that required behavior change by patients or families. Future directions include analysis of cost effectiveness of the PN program and analysis of parent and primary care provider experience.
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Affiliation(s)
- Eli Sprecher
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Kathleen Conroy
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Jenny Chan
- 1 Boston Children's Hospital, Boston, MA, USA
| | | | - Joanne Cox
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
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50
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McKenzie RB, Sanders L, Bhattacharya J, Bundorf MK. Health Care System Factors Associated with Transition Preparation in Youth with Special Health Care Needs. Popul Health Manag 2018; 22:63-73. [PMID: 29957127 DOI: 10.1089/pop.2018.0027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of this study was to assess: (1) the proportion of youth with special health care needs (YSHCN) with adequate transition preparation, (2) whether transition preparation differs by individual, condition-related and health care system-related factors, and (3) whether specific components of the medical home are associated with adequate transition preparation. The authors conducted a cross-sectional analysis of the 2009-2010 National Survey of Children with Special Health Care Needs, which surveyed a nationally representative sample of 17,114 parents of YSHCN ages 12 to 18 years. Adequate transition preparation was based on positive responses to questions about transition to an adult provider, changing health care needs, maintaining insurance coverage, and if providers encouraged YSHCN to take responsibility for health care needs. Weighted descriptive, bivariate and multivariate analyses were conducted to determine the association between patient and health care system factors and adequate transition preparation. Overall, 32.1% of YSHCN had adequate transition preparation. Older age, female sex, income ≤400% of the poverty level, lack of medical complexity, and having shared decision making, family-centered care, and effective care coordination were associated with increased odds of transition preparation. The majority of YSHCN do not receive adequate transition preparation and younger, male adolescents with medical complexity were less likely to receive transition preparation. Different patterns of disparities were identified for each subcomponent measure of transition preparation, which may help target at-risk populations for specific services. Efforts to improve transition preparation should leverage specific components of the medical home including care coordination, shared decision making, and family-centered care.
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Affiliation(s)
| | - Lee Sanders
- 2 Division of General Pediatrics, Stanford University , Stanford, California
| | - Jay Bhattacharya
- 1 Division of Pediatric Gastroenterology, Stanford University , Stanford, California.,3 Center for Primary Care and Outcomes Research, Department of Medicine, Stanford University , Stanford, California
| | - M Kate Bundorf
- 4 Department of Health Research and Policy, Stanford University , Stanford, California
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