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Vasan A, Negro D, Yazdani M, Benitez L, Virudachalam S, Kenyon CC, Fiks AG. Caregiver Preferences for Primary Care Clinic-Based Food Assistance: A Discrete Choice Experiment. Acad Pediatr 2024; 24:619-626. [PMID: 38403156 DOI: 10.1016/j.acap.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE The American Academy of Pediatrics recommends that pediatric providers screen families for food insecurity and connect them to appropriate resources. However, it is unclear how clinics can best provide families with resources consistent with their needs and preferences. In this study, we elicited caregiver preferences for clinic-based food assistance. METHODS We conducted a cross-sectional discrete choice experiment in which caregivers at 2 pediatric primary care clinics were asked to choose between hypothetical food programs. Programs varied across 4 categories: 1) resources provided (eg, food delivery, food in clinic, assistance enrolling in benefits); 2) support staff providing resources (eg, social worker, community health worker, physician, or nurse); 3) outreach modality (eg, phone, email, text); and 4) outreach frequency. Multinomial logistic regression was used to assess caregiver preferences within each category and the relative importance of each category to caregiver decisions. RESULTS We surveyed 142 caregivers who were predominantly Black (87%) and Medicaid-insured (90%). Caregiver preferences for food programs were most strongly influenced by the food resources provided. Caregivers preferred food delivery over other forms of food supports, such as food provided in clinic. They preferred assistance from a benefits enrollment specialist, community health worker, or social worker to assistance from a physician or nurse. CONCLUSIONS Pediatric clinics serving families at risk of food insecurity should use caregiver preferences to inform the design of family-centered interventions. Clinics should consider connecting caregivers with food delivery programs, and pediatric payors should adopt reimbursement models that support multidisciplinary team-based care to address food insecurity.
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Affiliation(s)
- Aditi Vasan
- Department of Pediatrics (A Vasan, DR Negro, S Virudachalam, CC Kenyon, and AG Fiks), Perelman School of Medicine, University of Pennsylvania, Philadelphia; PolicyLab and Clinical Futures, Department of Pediatrics, (A Vasan, DR Negro, M Yazdani, L Benitez, S Virudachalam, CC Kenyon, and AG Fiks), Children's Hospital of Philadelphia, Pa.
| | - DanaRose Negro
- Department of Pediatrics (A Vasan, DR Negro, S Virudachalam, CC Kenyon, and AG Fiks), Perelman School of Medicine, University of Pennsylvania, Philadelphia; PolicyLab and Clinical Futures, Department of Pediatrics, (A Vasan, DR Negro, M Yazdani, L Benitez, S Virudachalam, CC Kenyon, and AG Fiks), Children's Hospital of Philadelphia, Pa.
| | - Mishaal Yazdani
- PolicyLab and Clinical Futures, Department of Pediatrics, (A Vasan, DR Negro, M Yazdani, L Benitez, S Virudachalam, CC Kenyon, and AG Fiks), Children's Hospital of Philadelphia, Pa.
| | - Lindsay Benitez
- PolicyLab and Clinical Futures, Department of Pediatrics, (A Vasan, DR Negro, M Yazdani, L Benitez, S Virudachalam, CC Kenyon, and AG Fiks), Children's Hospital of Philadelphia, Pa; Sidney Kimmel Medical College at Jefferson University (L Benitez), Philadelphia, Pa.
| | - Senbagam Virudachalam
- Department of Pediatrics (A Vasan, DR Negro, S Virudachalam, CC Kenyon, and AG Fiks), Perelman School of Medicine, University of Pennsylvania, Philadelphia; PolicyLab and Clinical Futures, Department of Pediatrics, (A Vasan, DR Negro, M Yazdani, L Benitez, S Virudachalam, CC Kenyon, and AG Fiks), Children's Hospital of Philadelphia, Pa.
| | - Chén C Kenyon
- Department of Pediatrics (A Vasan, DR Negro, S Virudachalam, CC Kenyon, and AG Fiks), Perelman School of Medicine, University of Pennsylvania, Philadelphia; PolicyLab and Clinical Futures, Department of Pediatrics, (A Vasan, DR Negro, M Yazdani, L Benitez, S Virudachalam, CC Kenyon, and AG Fiks), Children's Hospital of Philadelphia, Pa.
| | - Alexander G Fiks
- Department of Pediatrics (A Vasan, DR Negro, S Virudachalam, CC Kenyon, and AG Fiks), Perelman School of Medicine, University of Pennsylvania, Philadelphia; PolicyLab and Clinical Futures, Department of Pediatrics, (A Vasan, DR Negro, M Yazdani, L Benitez, S Virudachalam, CC Kenyon, and AG Fiks), Children's Hospital of Philadelphia, Pa.
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2
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Bonafide CP, Maletsky KD, Kenyon C, Doupnik SK, Vasan A, Rasooly IR, Goldstein L, Galligan M, Hart J, Ruppel H, Feudtner C, Tenney-Soeiro R. Development and evaluation of a writing retreat program to build community and promote productivity in academic hospital medicine. J Hosp Med 2024. [PMID: 38598748 DOI: 10.1002/jhm.13352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/21/2024] [Accepted: 03/23/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Scientific writing is a core component of academic hospital medicine, and yet finding time to engage in deeply focused writing is difficult in part due to the highly clinical, 24/7 nature of the specialty that can limit opportunities for writing-focused collaboration and mentorship. OBJECTIVE Our objective was to develop and evaluate an academic writing retreat program. METHODS We drafted a set of key retreat features to guide implementation of a 3-day, 2-night retreat program held within a 2 h radius of our hospital. Agendas included writing blocks ranging from 45 to 90 min interspersed with breaks and opportunities for feedback, exercise, and preparing meals together. After each retreat, we distributed an evaluation with multiple choice and free text response options to characterize retreat helpfulness and later gathered data on the status of each paper and grant worked on. RESULTS We held 4 retreats between September 2022 and October 2023, engaging 18 faculty and fellows at a cost of $296 per attendee per retreat. In evaluations, nearly 80% reported that the retreat was extremely helpful, and comments praised the highly mentored environment, enriching community of colleagues, and release from commitments that get in the way of writing. Of the 24 papers attendees worked on, 12 have been accepted and 6 are under review. Of the 4 grant proposals, 2 are under review. CONCLUSIONS We implemented a low-cost, productive writing retreat program that attendees reported was helpful in supporting deep work and represented a meaningful step toward building a community centered around academic writing.
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Affiliation(s)
- Christopher P Bonafide
- Section of Pediatric Hospital Medicine, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Clinical Futures, A Center of Emphasis within the CHOP Research Institute, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Penn Implementation Science Center (PISCE), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristin D Maletsky
- Section of Pediatric Hospital Medicine, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Chén Kenyon
- Section of Pediatric Hospital Medicine, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Clinical Futures, A Center of Emphasis within the CHOP Research Institute, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephanie K Doupnik
- Section of Pediatric Hospital Medicine, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Clinical Futures, A Center of Emphasis within the CHOP Research Institute, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aditi Vasan
- Section of Pediatric Hospital Medicine, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Clinical Futures, A Center of Emphasis within the CHOP Research Institute, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Irit R Rasooly
- Section of Pediatric Hospital Medicine, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Clinical Futures, A Center of Emphasis within the CHOP Research Institute, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laura Goldstein
- Section of Pediatric Hospital Medicine, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Meghan Galligan
- Section of Pediatric Hospital Medicine, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Clinical Futures, A Center of Emphasis within the CHOP Research Institute, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jessica Hart
- Section of Pediatric Hospital Medicine, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Halley Ruppel
- Clinical Futures, A Center of Emphasis within the CHOP Research Institute, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Chris Feudtner
- Section of Pediatric Hospital Medicine, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Clinical Futures, A Center of Emphasis within the CHOP Research Institute, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rebecca Tenney-Soeiro
- Section of Pediatric Hospital Medicine, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Bouchelle Z, G. Menko S, Yazdani M, Vasan A, Scribano P, Shea JA, Kenyon CC. Parent Perspectives on Documentation and Sharing of Health-Related Social Needs Data. Hosp Pediatr 2024; 14:308-316. [PMID: 38477053 PMCID: PMC10965757 DOI: 10.1542/hpeds.2023-007478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 03/14/2024]
Abstract
OBJECTIVE Parents of pediatric patients are key stakeholders in the design and implementation of health-related social needs (HRSN) screening programs. Yet, there is little research exploring their perspectives on the documentation and sharing of HRSN data. We aimed to examine parents' preferences regarding how HRSN data are documented and shared. METHODS We conducted semi-structured interviews with parents of hospitalized children participating in an HRSN screening program at a quaternary care children's hospital. Interviews were coded using an inductive and deductive approach to identify emergent themes. RESULTS The 20 interviewed parents were uniformly female with 55% identifying as Black or African American and 20% identifying as Hispanic or Latino. Parents expressed comfort with electronic health record documentation of HRSN data and the use of International Classification of Diseases, 10th Revision Z codes as long as this information was used to provide families with meaningful support. Most parents viewed social workers and medical teams as the most appropriate recipients of HRSN data. Few parents felt comfortable with HRSN data being shared with payors. Parents desired transparency around HRSN data sharing. Many expressed concerns that documentation and sharing of HRSN data could lead to unwanted or unsafe disclosures or result in child welfare referrals. CONCLUSIONS Parents expressed comfort with HRSN documentation and sharing with health care providers, but requested that providers be transparent and respect parental preferences regarding data sharing to mitigate potential harms. When implementing HRSN support programs, health systems and payors should prioritize transparency around documentation and data sharing with families.
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Affiliation(s)
- Zoe Bouchelle
- National Clinician Scholars Program
- Department of Pediatrics
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- PolicyLab
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Mishaal Yazdani
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Aditi Vasan
- Department of Pediatrics
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- PolicyLab
- Clinical Futures
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Philip Scribano
- Department of Pediatrics
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Judy A. Shea
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Chén C. Kenyon
- Department of Pediatrics
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- PolicyLab
- Clinical Futures
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Agyapong E, Vasan A, Anyigbo C. Reducing WIC Administrative Burdens to Promote Health Equity. JAMA Pediatr 2024; 178:329-330. [PMID: 38345798 DOI: 10.1001/jamapediatrics.2023.6504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
This Viewpoint discusses barriers to Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation for low-income and racial and ethnic minoritized families and outlines strategies that health care professionals and health systems can use to help families overcome these barriers.
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Affiliation(s)
- Eunice Agyapong
- Obstetrics and Gynecology Residency Program, Texas A&M Health Science Center College of Medicine, Baylor Scott & White Health, Temple
| | - Aditi Vasan
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Chidiogo Anyigbo
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Khazanchi R, South EC, Cabrera KI, Winkelman TNA, Vasan A. Health Care Access and Use Among U.S. Children Exposed to Neighborhood Violence. Am J Prev Med 2024:S0749-3797(24)00023-0. [PMID: 38416088 DOI: 10.1016/j.amepre.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/29/2024]
Abstract
INTRODUCTION Neighborhood violence is an adverse childhood experience which impacts millions of U.S. children and is associated with poor health outcomes across the life course. These effects may be mitigated by access to care. Yet, the ways in which exposure to neighborhood violence shapes children's health care access have been understudied. METHODS This is a cross-sectional analysis of 16,083 children (weighted N=67,214,201) ages 1 to <18 years from the 2019 and 2021 National Health Interview Survey. Guardians were asked about preventive care access, unmet health needs, and health care utilization in the last year. Changes associated with exposure to neighborhood violence were estimated using marginal effects from multivariable logistic regression models adjusted for year, age, sex, race/ethnicity, parental education, family structure, rurality, income, insurance type, insurance discontinuity, and overall reported health. RESULTS Of 16,083 sample children, 863 (weighted 5.3% [95% CI 4.8-5.7]) reported exposure to neighborhood violence, representing a weighted population of ∼3.5 million. In adjusted analyses, exposure to violence was associated with forgone prescriptions (adjusted difference 1.2 percentage-points (pp) [95%CI 0.1-2.3]; weighted national population impact 42,833 children), trouble paying medical bills (7.7pp [4.4-11.0]; 271,735), delayed medical (1.5pp [0.2-2.9]; 54,063) and mental health care (2.8pp [1.1-4.6]; 98,627), and increased urgent care (4.5pp [0.9-8.1]; 158,246) and emergency department utilization (6.4pp [3.1-9.8]; 227,373). CONCLUSIONS In this nationally representative study, neighborhood violence exposure among children was associated with unmet health needs and increased acute care utilization. Evidence-based interventions to improve access to care and reduce economic precarity in communities impacted by violence are needed to mitigate downstream physical and mental health consequences.
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Affiliation(s)
- Rohan Khazanchi
- Harvard Internal Medicine-Pediatrics Residency Program at Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center, Boston, Massachusetts; FXB Center for Health and Human Rights, Harvard University, Boston, Massachusetts; Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota.
| | - Eugenia C South
- Urban Health Lab, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Keven I Cabrera
- Urban Health Lab, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Tyler N A Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota; Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Aditi Vasan
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Bouchelle Z, Vasan A, Cholera R. Mandates and Incentives to Support Social Needs Screening-Challenges and Opportunities. JAMA Pediatr 2024; 178:105-106. [PMID: 38048084 DOI: 10.1001/jamapediatrics.2023.5232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
This Viewpoint describes 3 potential challenges associated with implementing regulatory mandates and insurer incentives for health-related social needs screening and suggests opportunities for innovation and improvement.
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Affiliation(s)
- Zoe Bouchelle
- Department of Pediatrics, Denver Health, Denver, Colorado
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Aditi Vasan
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Rushina Cholera
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
- Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
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Vasan A, Dalembert G, Garg A. An Antiracist Approach to Social Care Integration. Pediatrics 2024; 153:e2023062109. [PMID: 38058202 DOI: 10.1542/peds.2023-062109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 12/08/2023] Open
Affiliation(s)
- Aditi Vasan
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- PolicyLab and Clinical Futures, Children's Hospital of Philadelphia, Pennsylvania
| | - George Dalembert
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- PolicyLab and Clinical Futures, Children's Hospital of Philadelphia, Pennsylvania
| | - Arvin Garg
- Child Health Equity Center, Department of Pediatrics, University of Massachusetts Chan School of Medicine, UMass Memorial Children's Center, Worcester, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Luke MJ, Vasan A. From Incentives to Outcomes: A Framework for Implementing and Evaluating Social Needs Interventions. Hosp Pediatr 2023; 13:e295-e298. [PMID: 37718960 DOI: 10.1542/hpeds.2023-007375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Affiliation(s)
- Michael J Luke
- PolicyLab and Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aditi Vasan
- PolicyLab and Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Vasan A, Kenyon CC, Fiks AG, Venkataramani AS. Continuous Eligibility And Coverage Policies Expanded Children's Medicaid Enrollment. Health Aff (Millwood) 2023; 42:753-758. [PMID: 37276479 DOI: 10.1377/hlthaff.2022.01465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We examined children's Medicaid participation during 2019-21 and found that as of March 2021, states newly adopting continuous Medicaid coverage for children during the COVID-19 pandemic experienced a 4.62 percent relative increase in children's Medicaid participation compared to states with previous continuous eligibility policies.
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Affiliation(s)
- Aditi Vasan
- Aditi Vasan , University of Pennsylvania, Philadelphia, Pennsylvania
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Affiliation(s)
- Erin F Flynn
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Chén C Kenyon
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Aditi Vasan
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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12
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Knowles M, Crowley AP, Vasan A, Kangovi S. Community Health Worker Integration with and Effectiveness in Health Care and Public Health in the United States. Annu Rev Public Health 2023; 44:363-381. [PMID: 37010928 DOI: 10.1146/annurev-publhealth-071521-031648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Community health workers (CHWs) have worked in a variety of settings in the United States for more than 70 years and are increasingly recognized as an essential health workforce. CHWs share life experience with the people they serve and have firsthand knowledge of the causes and impacts of health inequity. They provide a critical link between marginalized communities and health care and public health services. Several studies have demonstrated that CHWs can improve the management of chronic conditions, increase access to preventive care, improve patients' experience of care, and reduce health care costs. CHWs can also advance health equity by addressing social needs and advocating for systems and policy change. This review provides a history of CHW integration with health care in the United States; describes evidence of the impact of CHW programs on population health, experience, costs of care, and health equity; and identifies considerations for CHW program expansion.
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Affiliation(s)
- Molly Knowles
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
- Penn Center for Community Health Workers, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aidan P Crowley
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
| | - Aditi Vasan
- Department of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Shreya Kangovi
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
- Penn Center for Community Health Workers, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Luke MJ, Vasan A. Understanding and Addressing Racial and Ethnic Inequities in Pediatric Length of Stay. Hosp Pediatr 2023; 13:e92-e94. [PMID: 36911918 PMCID: PMC10087104 DOI: 10.1542/hpeds.2023-007146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Affiliation(s)
- Michael J Luke
- PolicyLab and Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aditi Vasan
- PolicyLab and Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Bouchelle Z, Bowers M, Vasan A. Ethically Managing Social Needs Data in an Era of Enhanced Electronic Health Information Sharing. Pediatrics 2023; 151:e2022059046. [PMID: 36519251 PMCID: PMC9906565 DOI: 10.1542/peds.2022-059046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Zoe Bouchelle
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- PolicyLab
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Megan Bowers
- Department of Social Work, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Aditi Vasan
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- PolicyLab
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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15
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Bouchelle Z, Vasan A, Candon M, Kenyon CC. Food Insufficiency Following Discontinuation of Monthly Child Tax Credit Payments Among Lower-Income US Households. JAMA Health Forum 2022; 3:e224039. [PMID: 36367738 PMCID: PMC9652756 DOI: 10.1001/jamahealthforum.2022.4039] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Importance The 2021 expanded Child Tax Credit provided advance monthly payments to many US families with children from July through December 2021 and was associated with a reduction in food insufficiency. Less is known about the effect of the discontinuation of monthly payments. Objective To assess whether the discontinuation of monthly Child Tax Credit payments was associated with subsequent changes in food insufficiency among lower-income US households with children. Design, Setting, and Participants This population-based cross-sectional study used data from the Household Pulse Survey, a recurring online survey of US households conducted by the US Census Bureau, from January 2021 to March 2022. This study estimated difference-in-differences regression models for households making less than $50 000, less than $35 000, and less than $25 000 annually, adjusting for demographic characteristics and state of residence. The estimation sample of households making less than $50 000/y included 114 705 responses, representing a weighted population size of 27 342 296 households. Exposures Receipt of monthly Child Tax Credit payments, as measured by living in a household with children during the period of monthly payments from July through December 2021. Main Outcomes and Measures Household food insufficiency, as measured by a respondent indicating that there was sometimes or often not enough food to eat in the household in the previous 7 days. Results Among 114 705 households making less than $50 000/y, respondents were predominantly female (57%); White (71%); not of Hispanic, Latino, or Spanish origin (79%); had high school or equivalent education (38%); and were unmarried (70%). Following the discontinuation of monthly Child Tax Credit payments, food insufficiency in US households with children increased by 3.5 percentage points (95% CI, 1.4-5.7 percentage points) among households making less than $50 000/y, 4.9 percentage points (95% CI, 2.6-7.3 percentage points) among households making less than $35 000/y, and 6.2 percentage points (95% CI, 3.3-9.3 percentage points) among households making less than $25 000/y. These estimates represent a relative increase in food insufficiency of approximately 16.7% among households making less than $50 000/y, 20.8% among households making less than $35 000/y, and 23.2% among households making less than $25 000/y. Conclusions and Relevance In this population-based cross-sectional study, discontinuation of monthly Child Tax Credit payments in December 2021 was associated with a statistically significant increase in household food insufficiency among lower-income households, with the greatest increase occurring in the lowest-income households.
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Affiliation(s)
- Zoe Bouchelle
- National Clinician Scholars Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia,PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Aditi Vasan
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia,PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Molly Candon
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia,Department of Health Care Management, Wharton School, University of Pennsylvania, Philadelphia
| | - Chén C. Kenyon
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia,PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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16
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Bouchelle Z, Vasan A. Promoting Health Equity Through Family-Centered Social Needs Screening and Intervention in the Inpatient Setting. Hosp Pediatr 2022; 12:e275-e277. [PMID: 35843956 PMCID: PMC9390831 DOI: 10.1542/hpeds.2022-006725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Zoe Bouchelle
- National Clinician Scholars Program, Perelman School of Medicine.,Department of Pediatrics, Perelman School of Medicine.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,PolicyLab and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Aditi Vasan
- Department of Pediatrics, Perelman School of Medicine.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,PolicyLab and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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17
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Vasan A, Darko O, Fortin K, Scribano PV, Kenyon CC. Community Resource Connection for Pediatric Caregivers With Unmet Social Needs: A Qualitative Study. Acad Pediatr 2022; 22:461-469. [PMID: 34571255 PMCID: PMC8942862 DOI: 10.1016/j.acap.2021.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Pediatric health systems are increasingly screening caregivers for unmet social needs. However, it remains unclear how best to connect families with unmet needs to available and appropriate community resources. We aimed to explore caregivers' perceived barriers to and facilitators of community resource connection. METHODS We conducted semistructured interviews with caregivers of pediatric patients admitted to one inpatient unit of an academic quaternary care children's hospital. All caregivers who screened positive for one or more unmet social needs on a tablet-based screener were invited to participate in an interview. Interviews were recorded, transcribed, and coded by 2 independent coders using content analysis, resolving discrepancies by consensus. Interviews continued until thematic saturation was achieved. RESULTS We interviewed 28 of 31 eligible caregivers. Four primary themes emerged. First, caregivers of children with complex chronic conditions felt that competing priorities related to their children's medical care often made it more challenging to establish connection with resources. Second, caregivers cited burdensome application and enrollment processes as a barrier to resource connection. Third, caregivers expressed a preference for geographically tailored, web-based resources, rather than paper resources. Last, caregivers expressed a desire for ongoing longitudinal support in establishing and maintaining connections with community resources after their child's hospital discharge. CONCLUSION Pediatric caregivers with unmet social needs reported competing priorities and burdensome application processes as barriers to resource connection. Electronic resources can help caregivers identify locally available services, but longitudinal supports may also be needed to ensure caregivers can establish and maintain linkages with these services.
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Affiliation(s)
- Aditi Vasan
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia (A Vasan and CC Kenyon), Philadelphia, Pa; Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania (A Vasan and CC Kenyon), Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania (A Vasan, O Darko, K Fortin, PV Scribano, and CC Kenyon), Philadelphia, Pa.
| | - Olivia Darko
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Kristine Fortin
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Philip V. Scribano
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Chén C. Kenyon
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA,Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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18
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Affiliation(s)
- Aditi Vasan
- University of Pennsylvania, Philadelphia, PA
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19
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Vasan A, Mitchell HK, Fein JA, Buckler DG, Wiebe DJ, South EC. Association of Neighborhood Gun Violence With Mental Health-Related Pediatric Emergency Department Utilization. JAMA Pediatr 2021; 175:1244-1251. [PMID: 34542562 PMCID: PMC8453357 DOI: 10.1001/jamapediatrics.2021.3512] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE Many children and adolescents in the United States are exposed to neighborhood gun violence. Associations between violence exposure and children's short-term mental health are not well understood. OBJECTIVE To examine the association between neighborhood gun violence and subsequent mental health-related pediatric emergency department (ED) utilization. DESIGN, SETTING, AND PARTICIPANTS This location-based cross-sectional study included 128 683 ED encounters for children aged 0 to 19 years living in 12 zip codes in Philadelphia, Pennsylvania, who presented to an urban academic pediatric ED from January 1, 2014, to December 31, 2018. Children were included if they (1) had 1 or more ED visits in the 60 days before or after a neighborhood shooting and (2) lived within a quarter-mile radius of the location where this shooting occurred. Analysis began August 2020 and ended May 2021. EXPOSURE Neighborhood violence exposure, as measured by whether a patient resided near 1 or more episodes of police-reported gun violence. MAIN OUTCOMES AND MEASURES ED encounters for a mental health-related chief complaint or primary diagnosis. RESULTS A total of 2629 people were shot in the study area between 2014 and 2018, and 54 341 children living nearby had 1 or more ED visits within 60 days of a shooting. The majority of these children were Black (45 946 [84.5%]) and were insured by Medicaid (42 480 [78.1%]). After adjusting for age, sex, race and ethnicity, median household income by zip code, and insurance, children residing within one-eighth of a mile (2-3 blocks) of a shooting had greater odds of mental health-related ED presentations in the subsequent 14 days (adjusted odds ratio, 1.86 [95% CI, 1.20-2.88]), 30 days (adjusted odds ratio, 1.49 [95% CI, 1.11-2.03]), and 60 days (adjusted odds ratio, 1.35 [95% CI, 1.06-1.72]). CONCLUSIONS AND RELEVANCE Exposure to neighborhood gun violence is associated with an increase in children's acute mental health symptoms. City health departments and pediatric health care systems should work together to provide community-based support for children and families exposed to violence and trauma-informed care for the subset of these children who subsequently present to the ED. Policies aimed at reducing children's exposure to neighborhood gun violence and mitigating the mental symptoms associated with gun violence exposure must be a public health priority.
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Affiliation(s)
- Aditi Vasan
- National Clinician Scholars Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia,Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Hannah K. Mitchell
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joel A. Fein
- Division of Emergency Medicine, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Center for Violence Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David G. Buckler
- The Urban Health Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia,Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Douglas J. Wiebe
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia,Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Eugenia C. South
- The Urban Health Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia,Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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20
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Abstract
This study assesses whether participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) differed before and during the COVID-19 pandemic in states with offline vs online electronic benefits transfer debit cards.
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Affiliation(s)
- Aditi Vasan
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Chén C. Kenyon
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christina A. Roberto
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Alexander G. Fiks
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Atheendar S. Venkataramani
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
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21
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Fortin K, Vasan A, Wilson-Hall CL, Brooks E, Rubin D, Scribano PV. Using Quality Improvement and Technology to Improve Social Supports for Hospitalized Children. Hosp Pediatr 2021; 11:1120-1129. [PMID: 34475224 DOI: 10.1542/hpeds.2020-005800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To develop and test the feasibility of a caregiver self-administered social needs screener, a Web-based searchable community resource map, and a process map for implementation of these tools as part of social needs screening and referral on a pediatric inpatient unit. METHODS A multidisciplinary team used quality improvement methodology to develop an electronic social needs screener, resource map Web site, and electronic health record enhancements. A process map for implementation of these tools was refined through plan-do-study-act cycles before full implementation. Weekly measures included the number of eligible caregivers screened, prevalence of reported social needs, and use of social work resources. RESULTS During the 22-week study period, 147 caregivers were screened and 2 declined to participate. Thirty-four percent of caregivers endorsed ≥1 social need. The most common needs identified were depressive symptoms (23%), food insecurity (19%), and need for assistance with utilities (10%). All participants received information about the resource map, and 99% of caregivers with an identified need met with a social worker during their admission. CONCLUSIONS Using quality improvement methodology and technology, the team implemented a new standardized process for addressing social needs on an inpatient unit. This led to identification of social needs in more than one-third of caregivers screened and provision of resource map information to all caregivers. These findings reinforce the importance of standardized assessment of social needs in the pediatric inpatient setting. The role of technology, including resource maps and electronic health record enhancements, was highlighted.
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Affiliation(s)
- Kristine Fortin
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania .,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aditi Vasan
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,PolicyLab
| | | | | | - David Rubin
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,PolicyLab
| | - Philip V Scribano
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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22
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Vasan A, Kenyon CC, Feudtner C, Fiks AG, Venkataramani AS. Association of WIC Participation and Electronic Benefits Transfer Implementation. JAMA Pediatr 2021; 175:609-616. [PMID: 33779712 PMCID: PMC8008428 DOI: 10.1001/jamapediatrics.2020.6973] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/20/2020] [Indexed: 11/14/2022]
Abstract
Importance The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is an important source of nutritional support and education for women and children living in poverty; although WIC participation confers clear health benefits, only 50% of eligible women and children currently receive WIC. In 2010, Congress mandated that states transition WIC benefits by 2020 from paper vouchers to electronic benefits transfer (EBT) cards, which are more convenient to use, are potentially less stigmatizing, and may improve WIC participation. Objective To estimate the state-level association between transition from paper vouchers to EBT and subsequent WIC participation. Design, Setting, and Participants This economic evaluation of state-level WIC monthly benefit summary administrative data regarding participation between October 1, 2014, and November 30, 2019, compared states that did and did not implement WIC EBT during this time period. Difference-in-differences regression modeling allowed associations to vary by time since policy implementation and included stratified analyses for key subgroups (pregnant and postpartum women, infants younger than 1 year, and children aged 1-4 years). All models included dummy variables denoting state, year, and month as covariates. Data analyses were performed between March 1 and June 15, 2020. Exposures Statewide transition from WIC paper vouchers to WIC EBT cards, specified by month and year. Main Outcomes and Measures Monthly number of state residents enrolled in WIC. Results A total of 36 states implemented WIC EBT before or during the study period. EBT and non-EBT states had similar baseline rates of poverty and food insecurity. Three years after statewide WIC EBT implementation, WIC participation increased by 7.78% (95% CI, 3.58%-12.15%) in exposed states compared with unexposed states. In stratified analyses, WIC participation increased by 7.22% among pregnant and postpartum women (95% CI, 2.54%-12.12%), 4.96% among infants younger than 1 year (95% CI, 0.95%-9.12%), and 9.12% among children aged 1 to 4 years (95% CI, 3.19%-15.39%; P for interaction = .20). Results were robust to adjustment for state unemployment and poverty rates, population, and Medicaid expansion status. Conclusions and Relevance In this study, the transition from paper vouchers to WIC EBT was associated with a significant and sustained increase in enrollment. Interventions that simplify the process of redeeming benefits may be critical for addressing low rates of enrollment in WIC and other government benefit programs.
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Affiliation(s)
- Aditi Vasan
- National Clinician Scholars Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Chén C. Kenyon
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Chris Feudtner
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Alexander G. Fiks
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Atheendar S. Venkataramani
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Krass P, Vasan A, Kenyon CC. Building Political Capital: Engaging Families in Child Health Policy. Pediatrics 2021; 147:peds.2020-0766. [PMID: 32994180 PMCID: PMC8628354 DOI: 10.1542/peds.2020-0766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Polina Krass
- PolicyLab and Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and .,National Clinician Scholars Program and.,Contributed equally as co-first authors
| | - Aditi Vasan
- PolicyLab and Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;,National Clinician Scholars Program
| | - Chén C. Kenyon
- PolicyLab and Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Vasan A, Krass P, Seifu L, Hitt TA, Ijaz N, Villegas L, Pallegedara K, Pandurangi S, Congdon M, Rezet B, Kenyon CC. Pediatric provider perspectives and practices regarding health policy discussions with families: a mixed methods study. BMC Pediatr 2020; 20:343. [PMID: 32660527 PMCID: PMC7359268 DOI: 10.1186/s12887-020-02238-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/02/2020] [Indexed: 01/22/2023] Open
Abstract
Background Advocacy regarding child health policy is a core tenet of pediatrics. Previous research has demonstrated that most pediatric providers believe collective advocacy and political involvement are essential aspects of their profession, but less is known about how pediatric providers engage with families about policy issues that impact child health. The objectives of this study were to examine providers’ perceptions and practices with regards to discussing health policy issues with families and to identify provider characteristics associated with having these discussions. Methods In this cross-sectional mixed methods study, pediatric resident physicians, attending physcians, and nurse practitioners at primary care clinics within a large academic health system were surveyed to assess (1) perceived importance of, (2) frequency of, and (3) barriers to and facilitators of health policy discussions with families. Multivariable ordinal regression was used to determine provider characteristics (including demographics, practice location, and extent of civic engagement) associated with frequency of these discussions. A subset of providers participated in subsequent focus groups designed to help interpret quantitative findings. Results The overall survey response rate was 155/394 (39%). The majority of respondents (76%) felt pediatricians should talk to families about health policy issues affecting children, but most providers (69%) reported never or rarely having these discussions. Factors associated with discussing policy issues included being an attending physician/nurse practitioner (OR 8.22, 95% CI 2.04–33.1) and urban practice setting (OR 3.85, 95% CI 1.03–14.3). Barriers included feeling uninformed about relevant issues and time constraints. In provider focus groups, four key themes emerged: (1) providers felt discussing policy issues would help inform and empower families; (2) providers frequently discussed social service programs, but rarely discussed policies governing these programs; (3) time constraints and concerns about partisan bias were a barrier to conversations; and (4) use of support staff and handouts with information about policy changes could help facilitate more frequent conversations. Conclusions Pediatric providers felt it was important to talk to families about child health policy issues, but few providers reported having such conversations in practice. Primary care practices should consider incorporating workflow changes that promote family engagement in relevant health policy discussions.
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Affiliation(s)
- Aditi Vasan
- Department of Pediatrics, Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, USA. .,National Clinician Scholars Program, Perelman School of Medicine, University of Pennsylvania, Blockley Hall, 13th Floor, 423 Guardian Drive, Philadelphia, PA, 19104, USA. .,PolicyLab, Children's Hospital of Philadelphia, 2716 South St. Roberts Center for Pediatric Research, 10th Floor, Philadelphia, PA, USA.
| | - Polina Krass
- Department of Pediatrics, Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, USA.,National Clinician Scholars Program, Perelman School of Medicine, University of Pennsylvania, Blockley Hall, 13th Floor, 423 Guardian Drive, Philadelphia, PA, 19104, USA.,PolicyLab, Children's Hospital of Philadelphia, 2716 South St. Roberts Center for Pediatric Research, 10th Floor, Philadelphia, PA, USA
| | - Leah Seifu
- Department of Pediatrics, Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, USA
| | - Talia A Hitt
- Department of Pediatrics, Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, USA
| | - Nadir Ijaz
- Department of Pediatrics, Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, USA.,Department of Pediatrics, Division of Critical Care Medicine, Columbia University, 630 West 168th Street, New York, NY, USA
| | - Leonela Villegas
- Department of Pediatrics, Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, USA
| | - Kathryn Pallegedara
- Department of Pediatrics, Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, USA
| | - Sindhu Pandurangi
- Department of Pediatrics, Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, USA.,Cincinnati Children's Hospital Medical Center, Division of Gastroenterology, 3333 Burnet Ave, Cincinnati, OH, USA
| | - Morgan Congdon
- Department of Pediatrics, Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, USA
| | - Beth Rezet
- Department of Pediatrics, Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, USA
| | - Chén C Kenyon
- Department of Pediatrics, Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, USA.,PolicyLab, Children's Hospital of Philadelphia, 2716 South St. Roberts Center for Pediatric Research, 10th Floor, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, USA
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25
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Vasan A, Morgan JW, Mitra N, Xu C, Long JA, Asch DA, Kangovi S. Effects of a standardized community health worker intervention on hospitalization among disadvantaged patients with multiple chronic conditions: A pooled analysis of three clinical trials. Health Serv Res 2020; 55 Suppl 2:894-901. [PMID: 32643163 PMCID: PMC7518822 DOI: 10.1111/1475-6773.13321] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To analyze the effects of a standardized community health worker (CHW) intervention on hospitalization. DATA SOURCES/STUDY SETTING Pooled data from three randomized clinical trials (n = 1340) conducted between 2011 and 2016. STUDY DESIGN The trials in this pooled analysis were conducted across diseases and settings, with a common study design, intervention, and outcome measures. Participants were patients living in high-poverty regions of Philadelphia and were predominantly Medicaid insured. They were randomly assigned to receive usual care versus IMPaCT, an intervention in which CHWs provide tailored social support, health behavior coaching, connection with resources, and health system navigation. Trial one (n = 446) tested two weeks of IMPaCT among hospitalized general medical patients. Trial two (n = 302) tested six months of IMPaCT among outpatients at two academic primary care clinics. Trial three (n = 592) tested six months of IMPaCT among outpatients at academic, Veterans Affairs (VA), and Federally Qualified Health Center primary care practices. DATA COLLECTION/EXTRACTION METHODS The primary outcome for this study was all-cause hospitalization, as measured by total number of hospital days per patient. Hospitalization data were collected from statewide or VA databases at 30 days postenrollment in Trial 1, twelve months postenrollment in Trial 2, and nine months postenrollment in Trial 3. PRINCIPAL FINDINGS Over 9398 observed patient months, the total number of hospital days per patient in the intervention group was 66 percent of the total in the control group (849 days for 674 intervention patients vs 1258 days for 660 control patients, incidence rate ratio (IRR) 0.66, P < .0001). This reduction was driven by fewer hospitalizations per patient (0.27 vs 0.34, P < .0001) and shorter mean length of stay (4.72 vs 5.57 days, P = .03). The intervention also decreased rates of hospitalization outside patients' primary health system (18.8 percent vs 34.8 percent, P = .0023). CONCLUSIONS Data from three randomized clinical trials across multiple settings show that a standardized CHW intervention reduced total hospital days and hospitalizations outside the primary health system. This is the largest analysis of randomized trials to demonstrate reductions in hospitalization with a health system-based social intervention.
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Affiliation(s)
- Aditi Vasan
- National Clinician Scholars Program, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,PolicyLab and Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John W Morgan
- National Clinician Scholars Program, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Nandita Mitra
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Chang Xu
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Judith A Long
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Corporal Michael J Crescenz VA Medical Center, Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania
| | - David A Asch
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Corporal Michael J Crescenz VA Medical Center, Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania
| | - Shreya Kangovi
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Corporal Michael J Crescenz VA Medical Center, Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania.,Penn Center for Community Health Workers, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Abstract
OBJECTIVES The American Academy of Pediatrics recommends that all pediatricians screen for social determinants of health to identify families in need and connect them to available resources. We examined pediatric residents' screening practices for social needs in different clinical settings and explored the influence of electronic health record (EHR) prompts on screening. METHODS In this cross-sectional study, pediatric residents participated in a brief electronic survey assessing (1) screening practices for unmet social needs and (2) perceived barriers to and facilitators of routine screening in the inpatient and outpatient settings. The differences in screening by care setting were assessed by using Fisher's exact test. Mixed-effects logistic regression was used to examine the association between EHR prompts and resident screening practices. RESULTS Ninety-two pediatric residents (64% of the residency program) responded to the survey. Respondents reported significantly higher rates of social needs screening in the outpatient as compared with the inpatient setting (98% vs 37%; P < .001). Residents cited time constraints, lack of knowledge about available resources, and discomfort with screening questions as barriers to screening in both settings. Residents were more likely to screen for social needs when screening questions were embedded in the EHR (odds ratio = 9.6; 95% confidence interval: 6.7-13.9). CONCLUSIONS Pediatric residents were more likely to screen for unmet social needs in the outpatient than in the inpatient setting despite reporting similar barriers to screening in both settings. EHR-based social needs screening templates could be used to increase rates of screening and reach additional families in need.
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Affiliation(s)
- Aditi Vasan
- National Clinician Scholars Program and .,PolicyLab and Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Chén C Kenyon
- PolicyLab and Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Deepak Palakshappa
- Division of Public Health Sciences and Departments of Internal Medicine and Pediatrics, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
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27
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Palakshappa D, Doupnik S, Vasan A, Khan S, Seifu L, Feudtner C, Fiks AG. Suburban Families' Experience With Food Insecurity Screening in Primary Care Practices. Pediatrics 2017. [PMID: 28634248 DOI: 10.1542/peds.2017-0320] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Food insecurity (FI) remains a major public health problem. With the rise in suburban poverty, a greater understanding of parents' experiences of FI in suburban settings is needed to effectively screen and address FI in suburban practices. METHODS We conducted 23 semistructured interviews with parents of children <4 years of age who presented for well-child care in 6 suburban pediatric practices and screened positive for FI. In the interviews, we elicited parents' perceptions of screening for FI, how FI impacted the family, and recommendations for how practices could more effectively address FI. All interviews were audio recorded and transcribed. We used a modified grounded theory approach to code the interviews inductively and identified emerging themes through an iterative process. Interviews continued until thematic saturation was achieved. RESULTS Of the 23 parents interviewed, all were women, with 39% white and 39% African American. Three primary themes emerged: Parents expressed initial surprise at screening followed by comfort discussing their unmet food needs; parents experience shame, frustration, and helplessness regarding FI, but discussing FI with their clinician helped alleviate these feelings; parents suggested practices could help them more directly access food resources, which, depending on income, may not be available to them through government programs. CONCLUSIONS Although most parents were comfortable discussing FI, they felt it was important for clinicians to acknowledge their frustrations with FI and facilitate access to a range of food resources.
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Affiliation(s)
- Deepak Palakshappa
- Department of Pediatrics, .,Center for Pediatric Clinical Effectiveness and PolicyLab, and.,Healthy Weight Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephanie Doupnik
- Department of Pediatrics.,Center for Pediatric Clinical Effectiveness and PolicyLab, and
| | | | - Saba Khan
- Healthy Weight Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Leah Seifu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chris Feudtner
- Department of Pediatrics.,Center for Pediatric Clinical Effectiveness and PolicyLab, and.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander G Fiks
- Department of Pediatrics.,Center for Pediatric Clinical Effectiveness and PolicyLab, and.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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28
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Abstract
BACKGROUND National organizations recommend pediatricians screen for food insecurity (FI). Although there has been growing research in urban practices, little research has addressed FI screening in suburban practices. We evaluated the feasibility, acceptability, and impact of screening in suburban practices. METHODS We conducted a mixed methods study that implemented FI screening in 6 suburban pediatric primary care practices. We included all children presenting for either a 2-, 15-, or 36-month well-child visit (N = 5645). Families who screened positive were eligible to be referred to our community partner that worked to connect families to the Supplemental Nutrition Assistance Program. We conducted focus groups with clinicians to determine their perceptions of screening and suggestions for improvement. RESULTS Of the 5645 children eligible, 4371 (77.4%) were screened, of which 122 (2.8%) screened positive for FI (range: 0.9%-5.9% across practices). Of the 122 food-insecure families, only 1 received new Supplemental Nutrition Assistance Program benefits. In focus groups, 3 themes emerged: (1) Time and workflow were not barriers to screening, but concerns about embarrassing families and being unable to provide adequate resources were; (2) Clinicians reported that parents felt the screening showed caring, which reinforced clinicians' continued screening; (3) Clinicians suggested implementing screening before the visit. CONCLUSIONS We found it is feasible and acceptable for clinicians to screen for FI in suburban practices, but the referral method used in this study was ineffective in assisting families in obtaining benefits. Better approaches to connect families to local resources may be needed to maximize the effectiveness of screening in suburban settings.
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Affiliation(s)
- Deepak Palakshappa
- Department of Pediatrics, .,Center for Pediatric Clinical Effectiveness and PolicyLab, and.,Healthy Weight Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Saba Khan
- Healthy Weight Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Leah Seifu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chris Feudtner
- Department of Pediatrics.,Center for Pediatric Clinical Effectiveness and PolicyLab, and.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander G Fiks
- Department of Pediatrics.,Center for Pediatric Clinical Effectiveness and PolicyLab, and.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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29
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Gomes A, Monteleone P, Vasan A, Bukata S, Sayre J. Ethylene vinyl alcohol copolymer in the treatment of high flow arteriovenous vascular malformations: long term results and histology. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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30
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Abstract
OBJECTIVE To examine associations between use of on-site multidisciplinary services at a pediatric primary care clinic, perceptions of the clinic, and health care utilization. STUDY DESIGN Eighty caregivers were interviewed during clinic visits assessing on-site service use, satisfaction, and perception of the clinic as a medical home. Acute care, emergency department, and well-child visit data were abstracted from children's medical records. Student's t test and multivariate regression were used to examine associations between service use, satisfaction, and health care utilization. RESULTS Use of ≥3 clinic services was associated with improved satisfaction (Client Satisfaction Questionnaire-8 mean: 31.8 vs 31.0, P < .05), stronger perception of the clinic as a medical home (Parents' Perception of Primary Care mean: 97.6 vs 93.4, P < .01), and increased missed well-child care visits (mean: 0.49 vs 0.20, P < .05). CONCLUSIONS On-site service use was associated with improved caregiver satisfaction but decreased well-child visit adherence. Caregivers using support services may face barriers to accessing preventive care.
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Affiliation(s)
- Aditi Vasan
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Barry S Solomon
- Johns Hopkins University School of Medicine, Baltimore, MD, USA Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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31
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Gandage AS, Rao VV, Sivakumar M, Vasan A, Venu M, Yaswanth A. Effect of Perlite on Thermal Conductivity of Self Compacting Concrete. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.sbspro.2013.11.111] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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32
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Seung KJ, Rigodon J, Finch M, Gove S, Vasan A, Satti H. Distribution of adult respiratory illnesses at a primary health centre in Lesotho. Int J Tuberc Lung Dis 2012; 16:418-22. [PMID: 22640456 DOI: 10.5588/ijtld.11.0280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Primary health centre in the highlands of Lesotho. BACKGROUND There is limited information about the relative frequencies of common respiratory illnesses in resource-limited settings, particularly in sub-Saharan Africa. OBJECTIVE To examine whether the distribution of respiratory illnesses in this region is unique due to the high prevalence of human immunodeficiency virus infection. DESIGN In a prospective, cross-sectional study of adults and adolescents with cough or difficulty breathing recruited from the waiting areas of the health centre, the primary outcome was the respiratory diagnosis for each participant, which was based on history, physical examination, response to antibiotics and the results of chest radiography (CXR) and sputum examinations. RESULTS Acute respiratory infections accounted for 65% of all diagnoses among 696 patients who were evaluated by a clinician and CXR. Pneumonia accounted for 10% of all diagnoses, and confirmed or probable tuberculosis (TB) accounted for 13%. Chronic respiratory conditions, including asthma, chronic obstructive pulmonary disease, silicosis and old TB, accounted for 14% of all diagnoses. Excluding 61 patients with an uninterpretable CXR, 36% (228) of the participants had significant pathology on CXR. CONCLUSION A high proportion of patients presenting to a primary health centre in Lesotho with routine respiratory complaints have serious respiratory illnesses.
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Affiliation(s)
- K J Seung
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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33
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Vasan A, Raju KS. Comparative analysis of Simulated Annealing, Simulated Quenching and Genetic Algorithms for optimal reservoir operation. Appl Soft Comput 2009. [DOI: 10.1016/j.asoc.2007.09.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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34
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Levitzky YS, Guo CY, Rong J, Larson MG, Walter RE, Keaney JF, Sutherland PA, Vasan A, Lipinska I, Evans JC, Benjamin EJ. Relation of smoking status to a panel of inflammatory markers: the framingham offspring. Atherosclerosis 2008; 201:217-24. [PMID: 18289552 DOI: 10.1016/j.atherosclerosis.2007.12.058] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Revised: 12/12/2007] [Accepted: 12/21/2007] [Indexed: 10/22/2022]
Abstract
AIMS We sought to investigate the hypothesis that smoking is accompanied by systemic inflammation. METHODS AND RESULTS We examined the relation of smoking to 11 systemic inflammatory markers in Framingham Study participants (n=2944, mean age 60 years, 55% women, 12% ethnic minorities) examined from 1998-2001. The cohort was divided into never (n=1149), former (n=1424), and current smokers with last cigarette >6h (n=134) or < or =6h (n=237) prior to phlebotomy. In multivariable-adjusted models there were significant overall between-smoking group differences (defined as p<0.0045 to account for multiple testing) for every inflammatory marker tested, except for serum CD40 ligand (CD40L), myeloperoxidase (MPO) and tumor necrosis factor receptor-2 (TNFR2). With multivariable-adjustment, pair-wise comparisons with never smokers revealed that former smokers had significantly lower concentrations of plasma CD40L (p<0.0001) and higher concentrations of (CRP) C-reactive protein (p=0.002). CONCLUSIONS As opposed to never smokers, those with acute cigarette smoke exposure (< or =6h) had significantly higher concentrations of all markers (p<0.0001) except serum CD40L, MPO, and TNFR2; plasma CD40L were significantly lower. Compared with never smokers, cigarette smokers have significantly elevated concentrations of most circulating inflammatory markers, consistent with the hypothesis that smoking is associated with a systemic inflammatory state.
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Affiliation(s)
- Yamini S Levitzky
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA 01702-5827, United States
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