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Pulcini CD, Luan X, Brooks ES, Hogan A, Penrose T, Kenyon CC, Rubin DM. Pediatric Population Management Classification for Children with Medical Complexity. Popul Health Manag 2024. [PMID: 38613470 DOI: 10.1089/pop.2023.0303] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2024] Open
Abstract
Improving the overall care of children with medical complexity (CMC) is often beset by challenges in proactively identifying the population most in need of clinical management and quality improvement. The objective of the current study was to create a system to better capture longitudinal risk for sustained and elevated utilization across time using real-time electronic health record (EHR) data. A new Pediatric Population Management Classification (PPMC), drawn from visit diagnoses and continuity problem lists within the EHR of a tristate health system, was compared with an existing complex chronic conditions (CCC) system for agreement (with weighted κ) on identifying CCMC, as well as persistence of elevated charges and utilization from 2016 to 2019. Agreement of assignment PPMC was lower among primary care provider (PCP) populations than among other children traversing the health system for specialty or hospital services only (weighted κ 62% for PCP vs. 82% for non-PCP). The PPMC classification scheme, displaying greater precision in identifying CMC with persistently high utilization and charges for those who receive primary care within a large integrated health network, may offer a more pragmatic approach to selecting children with CMC for longitudinal care management.
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Affiliation(s)
- Christian D Pulcini
- Department of Emergency Medicine & Pediatrics, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Xianqun Luan
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Elizabeth S Brooks
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Annique Hogan
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Tina Penrose
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Chen C Kenyon
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - David M Rubin
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Pulcini CD, Schneider S, Wolfley H, Collins B, Li J. Assessment of statewide initiative for children boarding in rural emergency departments with mental health concerns. Acad Emerg Med 2024; 31:86-88. [PMID: 37399296 DOI: 10.1111/acem.14772] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/08/2023] [Accepted: 06/27/2023] [Indexed: 07/05/2023]
Affiliation(s)
- Christian D Pulcini
- Department of Emergency Medicine, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
- Department of Pediatrics, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Samantha Schneider
- Department of Emergency Medicine, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Hillary Wolfley
- Vermont Program for Quality in Health Care, Inc., Montpelier, Vermont, USA
| | - Bonnie Collins
- Vermont Program for Quality in Health Care, Inc., Montpelier, Vermont, USA
| | - Joyce Li
- Department of Pediatrics, Division of Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
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Gutman CK, Aronson PL, Singh NV, Pickett ML, Bouvay K, Green RS, Roach B, Kotler H, Chow JL, Hartford EA, Hincapie M, St. Pierre-Hetz R, Kelly J, Sartori L, Hoffmann JA, Corboy JB, Bergmann KR, Akinsola B, Ford V, Tedford NJ, Tran TT, Gifford S, Thompson AD, Krack A, Piroutek MJ, Lucrezia S, Chung S, Chowdhury N, Jackson K, Cheng T, Pulcini CD, Kannikeswaran N, Truschel LL, Lin K, Chu J, Molyneaux ND, Duong M, Dingeldein L, Rose JA, Theiler C, Bhalodkar S, Powers E, Waseem M, Lababidi A, Yan X, Lou XY, Fernandez R, Lion KC. Race, Ethnicity, Language, and the Treatment of Low-Risk Febrile Infants. JAMA Pediatr 2024; 178:55-64. [PMID: 37955907 PMCID: PMC10644247 DOI: 10.1001/jamapediatrics.2023.4890] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/02/2023] [Indexed: 11/14/2023]
Abstract
Importance Febrile infants at low risk of invasive bacterial infections are unlikely to benefit from lumbar puncture, antibiotics, or hospitalization, yet these are commonly performed. It is not known if there are differences in management by race, ethnicity, or language. Objective To investigate associations between race, ethnicity, and language and additional interventions (lumbar puncture, empirical antibiotics, and hospitalization) in well-appearing febrile infants at low risk of invasive bacterial infection. Design, Setting, and Participants This was a multicenter retrospective cross-sectional analysis of infants receiving emergency department care between January 1, 2018, and December 31, 2019. Data were analyzed from December 2022 to July 2023. Pediatric emergency departments were determined through the Pediatric Emergency Medicine Collaborative Research Committee. Well-appearing febrile infants aged 29 to 60 days at low risk of invasive bacterial infection based on blood and urine testing were included. Data were available for 9847 infants, and 4042 were included following exclusions for ill appearance, medical history, and diagnosis of a focal infectious source. Exposures Infant race and ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White, and other race or ethnicity) and language used for medical care (English and language other than English). Main Outcomes and Measures The primary outcome was receipt of at least 1 of lumbar puncture, empirical antibiotics, or hospitalization. We performed bivariate and multivariable logistic regression with sum contrasts for comparisons. Individual components were assessed as secondary outcomes. Results Across 34 sites, 4042 infants (median [IQR] age, 45 [38-53] days; 1561 [44.4% of the 3516 without missing sex] female; 612 [15.1%] non-Hispanic Black, 1054 [26.1%] Hispanic, 1741 [43.1%] non-Hispanic White, and 352 [9.1%] other race or ethnicity; 3555 [88.0%] English and 463 [12.0%] language other than English) met inclusion criteria. The primary outcome occurred in 969 infants (24%). Race and ethnicity were not associated with the primary composite outcome. Compared to the grand mean, infants of families that use a language other than English had higher odds of the primary outcome (adjusted odds ratio [aOR]; 1.16; 95% CI, 1.01-1.33). In secondary analyses, Hispanic infants, compared to the grand mean, had lower odds of hospital admission (aOR, 0.76; 95% CI, 0.63-0.93). Compared to the grand mean, infants of families that use a language other than English had higher odds of hospital admission (aOR, 1.08; 95% CI, 1.08-1.46). Conclusions and Relevance Among low-risk febrile infants, language used for medical care was associated with the use of at least 1 nonindicated intervention, but race and ethnicity were not. Secondary analyses highlight the complex intersectionality of race, ethnicity, language, and health inequity. As inequitable care may be influenced by communication barriers, new guidelines that emphasize patient-centered communication may create disparities if not implemented with specific attention to equity.
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Affiliation(s)
- Colleen K. Gutman
- Department of Emergency Medicine, University of Florida College of Medicine, Gainesville
- Department of Pediatrics, University of Florida College of Medicine, Gainesville
| | - Paul L. Aronson
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Nidhi V. Singh
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Kamali Bouvay
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Rebecca S. Green
- Division of Emergency Medicine, Department of Pediatrics, Harvard Medical School and Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Britta Roach
- Division of Pediatric Emergency Medicine, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - Hannah Kotler
- Division of Emergency Medicine, The George Washington University School of Medicine and Health Sciences and Children’s National Health System, Washington, DC
| | - Jessica L. Chow
- Division of Emergency Medicine, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Emergency Medicine, University of California, Los Angeles
| | - Emily A. Hartford
- Department of Pediatrics, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle
| | - Mark Hincapie
- Department of Pediatrics, University of Pittsburgh Medical Center and Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
- Division of Pediatric Emergency Medicine, Nicklaus Children’s Hospital, Miami, Florida
| | - Ryan St. Pierre-Hetz
- Department of Pediatrics, University of Pittsburgh Medical Center and Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jessica Kelly
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Laura Sartori
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jennifer A. Hoffmann
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jacqueline B. Corboy
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kelly R. Bergmann
- Department of Pediatric Emergency Medicine, Children’s Minnesota, Minneapolis, Minnesota
| | - Bolanle Akinsola
- Department of Pediatrics and Emergency Medicine, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Vanessa Ford
- Department of Pediatrics and Emergency Medicine, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Natalie J. Tedford
- Division of Pediatric Emergency Medicine, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City
| | - Theresa T. Tran
- Division of Pediatric Emergency Medicine, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City
| | - Sasha Gifford
- Ronald O. Perelman Department of Emergency Medicine/New York University Langone Health, New York, New York
- Department of Emergency Medicine, Weill Cornell Medical College, New York, New York
| | - Amy D. Thompson
- Department of Pediatrics, Nemours Children’s Hospital of Delaware, Wilmington
| | - Andrew Krack
- Department of Pediatrics, School of Medicine, Section of Emergency Medicine, University of Colorado and Children’s Hospital Colorado, Aurora
| | - Mary Jane Piroutek
- Department of Emergency Medicine, University of California Irvine and Children’s Hospital of Orange County, Orange
| | - Samantha Lucrezia
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
| | - SunHee Chung
- Department of Emergency Medicine, Oregon Health and Science University, Portland
- Department of Pediatrics, Oregon Health and Science University, Portland
| | - Nabila Chowdhury
- Division of Pediatric Emergency Medicine, Johns Hopkins Children’s Center, Baltimore, Maryland
| | - Kathleen Jackson
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston
| | - Tabitha Cheng
- Department of Emergency Medicine, Harbor University of California Los Angeles Medical Center and the David Geffen School of Medicine at the University of California, Los Angeles
| | - Christian D. Pulcini
- Department of Pediatrics, University of Vermont Larner College of Medicine, Burlington
- Department of Emergency Medicine, University of Vermont Larner College of Medicine, Burlington
| | - Nirupama Kannikeswaran
- Department of Pediatrics, Central Michigan University College of Medicine and Children’s Hospital of Michigan, Detroit
| | - Larissa L. Truschel
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Karen Lin
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Jamie Chu
- Department of Emergency Medicine, McGovern Medical School, UTHealth Houston, Houston, Texas
- Texas Children’s Pediatrics, Houston
| | - Neh D. Molyneaux
- Department of Emergency Medicine, McGovern Medical School, UTHealth Houston, Houston, Texas
| | - Myto Duong
- Division of Pediatric Emergency Medicine, Southern Illinois University, Carbondale
| | - Leslie Dingeldein
- Rainbow Babies and Children’s Hospital and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jerri A. Rose
- Rainbow Babies and Children’s Hospital and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Carly Theiler
- Department of Emergency Medicine, University of Iowa, Iowa City
| | - Sonali Bhalodkar
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Emily Powers
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Muhammad Waseem
- Department of Pediatrics, Lincoln Medical Center, Bronx, New York
- Department of Emergency Medicine, Lincoln Medical Center, Bronx, New York
| | - Ahmed Lababidi
- Department of Emergency Medicine, University of Florida College of Medicine, Gainesville
- Department of Pediatrics, University of Florida College of Medicine, Gainesville
| | - Xinyu Yan
- Department of Biostatistics, University of Florida College of Medicine and College of Public Health and Health Professions, Gainesville
| | - Xiang-Yang Lou
- Department of Biostatistics, University of Florida College of Medicine and College of Public Health and Health Professions, Gainesville
| | - Rosemarie Fernandez
- Department of Emergency Medicine and the Center for Experiential Learning and Simulation, University of Florida College of Medicine, Gainesville
| | - K. Casey Lion
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
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Pulcini CD, Hoffmann JA, Alpern ER, Chaudhary S, Ehrlich PF, Fein JA, Fleegler EW, Goyal MK, Hall M, Jeffries KN, Myers R, Sheehan KM, Zamani M, Zima BT, Hargarten S. A Holistic Approach to Childhood Firearm Injuries. Pediatrics 2024; 153:e2023063322. [PMID: 38087959 PMCID: PMC10752822 DOI: 10.1542/peds.2023-063322] [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: 08/31/2023] [Indexed: 12/30/2023] Open
Affiliation(s)
- Christian D. Pulcini
- Department of Emergency Medicine & Pediatrics, University of Vermont Medical Center and Children’s Hospital, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Jennifer A. Hoffmann
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth R. Alpern
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sofia Chaudhary
- Department of Pediatrics and Emergency Medicine, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Peter F. Ehrlich
- Section of Pediatric Surgery, CS Mott Children’s Hospital, University of Michigan Ann Arbor, Ann Arbor, Michigan
| | - Joel A. Fein
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eric W. Fleegler
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School; Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Monika K. Goyal
- Department of Pediatrics, Children’s National Hospital, George Washington University, Washington
| | - Matt Hall
- Children’s Hospital Association, Lenexa, Kansas
| | - Kristyn N. Jeffries
- Department of Pediatrics, Section of Hospital Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Rachel Myers
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karen M. Sheehan
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mark Zamani
- Children’s Hospital Association, Lenexa, Kansas
| | - Bonnie T. Zima
- UCLA-Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California
| | - Stephen Hargarten
- Department of Emergency Medicine, Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, Wisconsin
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Pulcini CD, Coller RJ, Houtrow AJ, Belardo Z, Zorc JJ. Further Developments in Preventing Emergency Department Visits for Children with Medical Complexity. Acad Pediatr 2024; 24:10-12. [PMID: 37714426 PMCID: PMC10843297 DOI: 10.1016/j.acap.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/28/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023]
Affiliation(s)
- Christian D Pulcini
- University of Vermont (CD Pulcini), Department of Emergency Medicine & Pediatrics, Burlington, Vt.
| | - Ryan J Coller
- Department of Pediatrics (RJ Coller), University of Wisconsin-Madison
| | - Amy J Houtrow
- Department of Physical Medicine and Rehabilitation (AJ Houtrow), University of Pittsburgh, Pittsburgh, Pa
| | - Zoe Belardo
- University of Pennsylvania (Z Belardo), Philadelphia, Pa
| | - Joseph J Zorc
- Children's Hospital of Philadelphia (JJ Zorc), Division of Emergency Medicine, Philadelphia, Pa
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Hoffmann JA, Pulcini CD, Hall M, De Souza HG, Alpern ER, Chaudhary S, Ehrlich PF, Fein JA, Fleegler EW, Goyal MK, Hargarten S, Jeffries KN, Zima BT. Timing of Mental Health Service Use After a Pediatric Firearm Injury. Pediatrics 2023; 152:e2023061241. [PMID: 37271760 PMCID: PMC10694862 DOI: 10.1542/peds.2023-061241] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Accepted: 04/10/2023] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVES To examine how timing of the first outpatient mental health (MH) visit after a pediatric firearm injury varies by sociodemographic and clinical characteristics. METHODS We retrospectively studied children aged 5 to 17 years with a nonfatal firearm injury from 2010 to 2018 using the IBM Watson MarketScan Medicaid database. Logistic regression estimated the odds of MH service use in the 6 months after injury, adjusted for sociodemographic and clinical characteristics. Cox proportional hazard models, stratified by previous MH service use, evaluated variation in timing of the first outpatient MH visit by sociodemographic and clinical characteristics. RESULTS After a firearm injury, 958 of 2613 (36.7%) children used MH services within 6 months; of these, 378 of 958 (39.5%) had no previous MH service use. The adjusted odds of MH service use after injury were higher among children with previous MH service use (adjusted odds ratio, 10.41; 95% confidence interval [CI], 8.45-12.82) and among non-Hispanic white compared with non-Hispanic Black children (adjusted odds ratio, 1.29; 95% CI, 1.02-1.63). The first outpatient MH visit after injury occurred sooner among children with previous MH service use (adjusted hazard ratio, 6.32; 95% CI, 5.45-7.32). For children without previous MH service use, the first MH outpatient visit occurred sooner among children with an MH diagnosis made during the injury encounter (adjusted hazard ratio, 2.72; 95% CI, 2.04-3.65). CONCLUSIONS More than 3 in 5 children do not receive MH services after firearm injury. Previous engagement with MH services and new detection of MH diagnoses during firearm injury encounters may facilitate timelier connection to MH services after injury.
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Affiliation(s)
- Jennifer A. Hoffmann
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christian D. Pulcini
- Department of Emergency Medicine & Pediatrics, University of Vermont Medical Center and Children’s Hospital, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Matt Hall
- Children’s Hospital Association, Lenexa, KS, USA
| | | | - Elizabeth R. Alpern
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sofia Chaudhary
- Department of Pediatrics and Emergency Medicine, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Peter F. Ehrlich
- Section of Pediatric Surgery, CS Mott Children’s Hospital University of Michigan Ann Arbor, Michigan, USA
| | - Joel A. Fein
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Eric W. Fleegler
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School; Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Monika K. Goyal
- Department of Pediatrics, Children’s National Hospital, George Washington University, Washington, DC, USA
| | - Stephen Hargarten
- Department of Emergency Medicine, Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kristyn N. Jeffries
- Department of Pediatrics, Section of Hospital Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Bonnie T. Zima
- UCLA-Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA, USA
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Pulcini CD, Fleegler EW. Ensuring Precision in Methodology for Nonfatal Firearm Injuries. JAMA Pediatr 2023:2803662. [PMID: 37036723 DOI: 10.1001/jamapediatrics.2023.0352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Affiliation(s)
- Christian D Pulcini
- Department of Emergency Medicine, University of Vermont Larner College of Medicine, University of Vermont Medical Center and Children's Hospital, Burlington
| | - Eric W Fleegler
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Dunbar PJ, Sobotka SA, Rodean J, Pulcini CD, Macy ML, Thomson J, Harris D, Coller RJ, Desmarais A, Hall M, Berry JG. Prevalence of and Spending on Ear, Nose, Throat, and Respiratory Infections Among Children With Chronic Complex Conditions. Acad Pediatr 2023; 23:434-440. [PMID: 36122827 PMCID: PMC10767753 DOI: 10.1016/j.acap.2022.07.004] [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: 12/19/2021] [Revised: 06/25/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Ear, nose, throat, and respiratory infections (ENTRI) may affect children with complex chronic conditions (CCC) differently than their peers. We compared ENTRI prevalence and spending in children with and without CCCs. METHODS Retrospective analysis of 3,880,456 children ages 0-to-18 years enrolled in 9 US state Medicaid programs in 2018 contained in the IBM Watson Marketscan Database. Type and number of CCCs were distinguished with Feudtner's system. ENTRI prevalence, defined as ≥1 healthcare encounters for ENTRI, and Medicaid spending on ENTRI were compared by CCC using chi-square tests and logistic regression. RESULTS ENTRIs were greater in children with vs. without a CCC (57.7% vs 43.5% [P < .001]). Children with a CCC (5.5%, n = 213,425) accounted for nearly one-fourth ($145.8 million [US]) of total spending on ENTRI. Aside from throat and sinus infection, ENTRI prevalence increased with number of CCCs (P < .001). For example, as number of CCCs increased from zero to ≥3, lower-airway infection increased from 12.5% to 37.5%, P < .001 (OR 4.10; 95% CI 3.95-4.26). ENTRI spending attributable to inpatient care increased from 9.7% to 92.8% (P < .001) as the number of CCCs increased from zero to ≥3. CONCLUSION Most children with a CCC pursued care for ENTRI in 2018 and these children accounted for a disproportionate share of ENTRI spending. Children with multiple CCCs had a high prevalence of lower-airway infection; most of their ENTRI spending was for inpatient care. Providers can use these findings to counsel patients and families and to inform future investigations on how best to manage ENTRI in children with CCCs.
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Affiliation(s)
- Peter J Dunbar
- Department of Medicine, Brigham and Women's Hospital (PJ Dunbar), Boston, Mass.
| | - Sarah A Sobotka
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, The University of Chicago (SA Sobotka), Chicago, Ill
| | - Jonathan Rodean
- Children's Hospital Association (J Rodean and M Hall), Lenexa, Kans
| | - Christian D Pulcini
- Department of Surgery and Pediatrics, University of Vermont Medical Center and Children's Hospital (CD Pulcini), Burlington
| | - Michelle L Macy
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University (ML Macy), Chicago, Ill
| | - Joanna Thomson
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center (J Thomson), Ohio; Department of Pediatrics, University of Cincinnati College of Medicine (J Thomson), Ohio
| | | | - Ryan J Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (RJ Coller), Madison
| | - Anna Desmarais
- Complex Care, Department of Medicine, Division of General Pediatrics, Boston Children's Hospital (A Desmarais), Mass
| | - Matthew Hall
- Children's Hospital Association (J Rodean and M Hall), Lenexa, Kans
| | - Jay G Berry
- Complex Care, Department of Medicine, Division of General Pediatrics, Boston Children's Hospital (A Desmarais), Mass
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Pulcini CD, Raphael JL, Lopez KN. Translating Research into Child Health Policy: Aligning Incentives and Building a New Discourse. Pediatr Clin North Am 2023; 70:151-164. [PMID: 36402465 DOI: 10.1016/j.pcl.2022.09.012] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Research has led to major achievements in public policy and child health. Despite the gains, the need for research to inform policy remains paramount against a backdrop of inadequate public health investments, health inequities, and public skepticism toward science. However, the translation of research into child health policy has often been slow due to misalignments in incentives between researchers and policy makers and a paucity of conceptual models to inform translation. This article outlines barriers to translation, provides examples of discordance between evidence and policy, summarizes models to inform translation, and offers strategies to improve translation of research to policy.
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Affiliation(s)
- Christian D Pulcini
- Department of Emergency Medicine and Pediatrics, University of Vermont Larner College of Medicine, Fletcher House 301, 111 Colchester Avenue, Burlington, VT 05401, USA.
| | - Jean L Raphael
- Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Keila N Lopez
- Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
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Pulcini CD, Goyal MK, Hall M, De Souza HG, Chaudhary S, Alpern ER, Fein JA, Fleegler EW. Two-Year Utilization and Expenditures for Children After a Firearm Injury. Am J Prev Med 2022; 63:875-882. [PMID: 36075816 DOI: 10.1016/j.amepre.2022.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 03/16/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Firearm injuries are a leading cause of morbidity among children, but data on healthcare utilization and expenditures after injury are limited. This study sought to analyze healthcare encounters and expenditures for 2 years after a nonfatal firearm injury. METHODS A retrospective cohort study was conducted between 2020 and 2022 of children aged 0-18 years with International Classification of Diseases, Ninth Revision/ICD-10 diagnosis codes for firearm injury from 2010 to 2016 in the Medicaid MarketScan claims database. Outcomes included the difference in healthcare encounters and expenditures, including mental health. Descriptive statistics characterized patient demographics and healthcare utilization. Changes in health expenditures were evaluated with Wilcoxon sign rank tests. RESULTS Among 911 children, there were 12,757 total healthcare encounters in the year before the index firearm injury, 15,548 1 encounters in the year after (p<0.001), and 10,228 total encounters in the second year (p<0.001). Concomitantly, there was an overall increase of $14.4 million in health expenditures ($11,415 per patient) 1 year after (p<0.001) and a $0.8 million decrease 2 years after the firearm injury (p=0.001). The children with low previous expenditures (majority of sample) had sustained increases throughout the second year after injury. There was a 31% and 37% absolute decrease in mental health utilization and expenditures, respectively, among children 2 years after the firearm injury. CONCLUSIONS Children who experience nonfatal firearm injury have an increased number of healthcare encounters and healthcare expenditures in the year after firearm injury, which is not sustained for a second year. Mental health utilization and expenditures remain decreased up to 2 years after a firearm injury. More longitudinal research on the morbidity associated with nonfatal firearm injuries is needed.
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Affiliation(s)
- Christian D Pulcini
- Department of Emergency Medicine and Pediatrics, University of Vermont Medical Center and Children's Hospital, Larner College of Medicine, The University of Vermont, Burlington, Vermont.
| | - Monika K Goyal
- Department of Pediatrics, Children's National Hospital, The George Washington University, Washington, District of Columbia
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | | | - Sofia Chaudhary
- Department of Pediatrics and Emergency Medicine, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Elizabeth R Alpern
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joel A Fein
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eric W Fleegler
- Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts; Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
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11
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Pulcini CD, Goyal MK, De Souza HG, Davidson A, Hall M, Chaudhary S, Alpern ER, Fein JA, Fleegler EW. A firearm violence research methodologic pitfall to avoid. Acad Emerg Med 2022; 29:1140-1145. [PMID: 35332976 DOI: 10.1111/acem.14491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Christian D Pulcini
- Department of Surgery & Pediatrics, University of Vermont Medical Center and Children's Hospital, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Monika K Goyal
- Department of Pediatrics, Children's National Hospital, George Washington University, Washington, DC, USA
| | | | | | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas, USA
| | - Sofia Chaudhary
- Department of Pediatrics and Emergency Medicine, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Elizabeth R Alpern
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joel A Fein
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eric W Fleegler
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
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12
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Ehrlich PF, Pulcini CD, De Souza HG, Hall M, Andrews A, Zima BT, Fein JA, Chaudhary S, Hoffmann JA, Fleegler EW, Jeffries KN, Goyal MK, Hargarten S, Alpern ER. Mental Health Care Following Firearm and Motor Vehicle-related Injuries: Differences Impacting Our Treatment Strategies. Ann Surg 2022; 276:463-471. [PMID: 35762587 PMCID: PMC9388584 DOI: 10.1097/sla.0000000000005557] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare new mental health diagnoses (NMHD) in children after a firearm injury versus following a motor vehicle collision (MVC). BACKGROUND A knowledge gap exists regarding childhood mental health diagnoses following firearm injuries, notably in comparison to other forms of traumatic injury. METHODS We utilized Medicaid MarketScan claims (2010-2016) to conduct a matched case-control study of children ages 3 to 17 years. Children with firearm injuries were matched with up to 3 children with MVC injuries. Severity was determined by injury severity score and emergency department disposition. We used multivariable logistic regression to measure the association of acquiring a NMHD diagnosis in the year postinjury after firearm and MVC mechanisms. RESULTS We matched 1450 children with firearm injuries to 3691 children with MVC injuries. Compared to MVC injuries, children with firearm injuries were more likely to be black, have higher injury severity score, and receive hospital admission from the emergency department ( P <0.001). The adjusted odds ratio (aOR) of NMHD diagnosis was 1.55 [95% confidence interval (95% CI): 1.33-1.80] greater after firearm injuries compared to MVC injuries. The odds of a NMHD were higher among children admitted to the hospital compared to those discharged. The increased odds of NMHD after firearm injuries was driven by increases in substance-related and addictive disorders (aOR: 2.08; 95% CI: 1.63-2.64) and trauma and stressor-related disorders (aOR: 2.07; 95% CI: 1.55-2.76). CONCLUSIONS Children were found to have 50% increased odds of having a NMHD in the year following a firearm injury as compared to MVC. Programmatic interventions are needed to address children's mental health following firearm injuries.
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Affiliation(s)
- Peter F. Ehrlich
- Section of Pediatric Surgery CS Mott Children’s Hospital University of Michigan Ann Arbor, Michigan, USA
| | - Christian D. Pulcini
- Department of Surgery & Pediatrics, University of Vermont Medical Center and Children’s Hospital, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | | | - Matt Hall
- Children’s Hospital Association, Lenexa, KS, USA
| | - Annie Andrews
- Department of Pediatrics, Medical College of South Carolina, Charleston, SC, USA
| | - Bonnie T. Zima
- UCLA-Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA, USA
| | - Joel A. Fein
- Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Sofia Chaudhary
- Department of Pediatrics and Emergency Medicine, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer A. Hoffmann
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Eric W. Fleegler
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Kristyn N Jeffries
- Department of Pediatrics, Division of Hospital Medicine, Children’s Mercy Hospitals, Kansas City, MO, USA
| | - Monika K. Goyal
- Department of Pediatrics, Children’s National Hospital, George Washington University, Washington, DC, USA
| | - Stephen Hargarten
- Department of Emergency Medicine and the Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Elizabeth R. Alpern
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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13
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Pulcini CD, Berman RS, Raphael JL, Patel M. The politicization of children: implications for child health and public policy. Pediatr Res 2022; 92:345-346. [PMID: 35688961 DOI: 10.1038/s41390-022-02155-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/22/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Christian D Pulcini
- Department of Emergency Medicine and Pediatrics, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Rachel S Berman
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jean L Raphael
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Mona Patel
- Department of Pediatrics, Keck School of Medicine of USC, Los Angeles, CA, USA.
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14
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Pulcini CD, Dubuque A, Lamberson M, Macy ML, Mistry RD, Pruitt CM, Schnadower D, Zorc JJ, Stevens MW. Pediatric Emergency Medicine Physicians' Perspectives on Emergency Care of Children With Medical Complexity: A Multi-institution Mixed-Methods Assessment. Pediatr Emerg Care 2022; 38:e1423-e1427. [PMID: 35436769 DOI: 10.1097/pec.0000000000002712] [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: 11/25/2022]
Abstract
OBJECTIVE Children with medical complexity (CMC) compose 1% of the pediatric population but account for 20% of pediatric emergency department (ED) visits. Previous descriptions of challenges and interventions to ensure quality of care are limited. Our objective was to elicit pediatric emergency medicine (PEM) physicians' perspectives on challenges and opportunities for improvement of emergency care of CMC, with a focus on emergency information forms (EIFs). METHODS We conducted a web-based survey of PEM physicians participating the American Academy of Pediatrics Section on Emergency Medicine Survey listserv. The survey was designed using an expert panel, and subsequently piloted and revised to an 18-item survey. Data were analyzed with descriptive statistics. RESULTS One hundred fifty-one of 495 respondents (30%) completed the survey. Most respondents (62.9%) reported caring for >10 CMC per month. Whereas overall medical fragility and time constraints were major contributors to the challenges of caring for CMC in the ED, communication with known providers and shared care plans were identified as particularly helpful. Most respondents did not report routine use of EIFs. Anticipated emergencies/action plan was deemed the most important component of EIFs. CONCLUSIONS Most PEM physicians view the care for CMC in the ED as challenging despite practicing in high-resource environments. Further research is needed to develop and implement strategies to improve care of CMC in the ED. Understanding experiences of providers in general ED settings is also an important next step given that 80% of CMC present for emergency care outside of major children's hospitals.
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Affiliation(s)
- Christian D Pulcini
- From the Division of Emergency Medicine, Department of Surgery and Pediatrics
| | - Amy Dubuque
- Division of Emergency Medicine, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT
| | - Miles Lamberson
- Division of Emergency Medicine, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT
| | - Michelle L Macy
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | - David Schnadower
- Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Joseph J Zorc
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Martha W Stevens
- From the Division of Emergency Medicine, Department of Surgery and Pediatrics
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15
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Marquis T, Callas P, Schweitzer N, Bisanzo M, McGowan H, Sexton RJ, Pulcini CD. Characteristics of children boarding in emergency departments for mental health conditions in a rural state. Acad Emerg Med 2022; 29:1024-1026. [PMID: 35438820 DOI: 10.1111/acem.14509] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/13/2022] [Accepted: 04/16/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Taylor Marquis
- University of Vermont Larner College of Medicine Burlington Vermont USA
| | - Peter Callas
- College of Engineering and Mathematical Sciences University of Vermont Burlington Vermont USA
| | - Nathan Schweitzer
- University of Vermont Larner College of Medicine Burlington Vermont USA
| | - Mark Bisanzo
- Division of Emergency Medicine, Department of Surgery University of Vermont Larner College of Medicine Burlington Vermont USA
| | - Haley McGowan
- Department of Psychiatry University of Vermont Larner College of Medicine Burlington Vermont USA
| | - Ryan J. Sexton
- Northeastern Vermont Regional Hospital St. Johnsbury Vermont USA
| | - Christian D. Pulcini
- Division of Emergency Medicine, Department of Surgery and Pediatrics University of Vermont Larner College of Medicine Burlington Vermont USA
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16
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Pulcini CD, Coller RJ, Macy ML, Alpern E, Harris D, Rodean J, Hall M, Chung PJ, Berry JG. Low-Resource Emergency Department Visits for Children With Complex Chronic Conditions. Pediatr Emerg Care 2022; 38:e856-e862. [PMID: 34009894 DOI: 10.1097/pec.0000000000002437] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/26/2022]
Abstract
OBJECTIVE Reducing emergency department (ED) use in children with complex chronic conditions (CCC) is a national health system priority. Emergency department visits with minimal clinical intervention may be the most avoidable. We assessed characteristics associated with experiencing such a low-resource ED visit among children with a CCC. METHODS A retrospective study of 271,806 ED visits between 2014 and 2017 among patients with a CCC in the Pediatric Health Information System database was performed. The main outcome was a low-resource ED visit, where no medications, laboratory, procedures, or diagnostic tests were administered and the patient was not admitted to the hospital. χ2 Tests and generalized linear models were used to assess bivariable and multivariable relationships of patients' demographic, clinical, and health service characteristics with the likelihood of a low- versus higher-resource ED visit. RESULTS Sixteen percent (n = 44,111) of ED visits among children with CCCs were low-resource. In multivariable analysis, the highest odds of experiencing a low- versus higher-resource ED visit occurred in patients aged 0 year (vs 16+ years; odds ratio [OR], 3.9 [95% confidence interval {CI}, 3.7-4.1]), living <5 (vs 20+) miles from the ED (OR, 1.7 [95% CI, 1.7-1.8]), and who presented to the ED in the day and evening versus overnight (1.5 [95% CI, 1.4-1.5]). CONCLUSIONS Infant age, living close to the ED, and day/evening-time visits were associated with the greatest likelihood of experiencing a low-resource ED visit in children with CCCs. Further investigation is needed to assess key drivers for ED use in these children and identify opportunities for diversion of ED care to outpatient and community settings.
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Affiliation(s)
- Christian D Pulcini
- From the Department of Surgery and Pediatrics, University of Vermont Medical Center and Children's Hospital, University of Vermont Larner College of Medicine, Burlington, VT
| | - Ryan J Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Michelle L Macy
- Division of Emergency Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
| | - Elizabeth Alpern
- Division of Emergency Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
| | | | | | | | - Paul J Chung
- Health Systems Science, Kaiser Permanente School of Medicine, Departments of Pediatrics and Health Policy & Management, UCLA RAND Health, RAND Corporation, Los Angeles, CA
| | - Jay G Berry
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
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17
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Holland JE, Varni SE, Pulcini CD, Simon TD, Harder VS. Assessing the Relationship Between Well-Care Visit and Emergency Department Utilization Among Adolescents and Young Adults. J Adolesc Health 2022; 70:64-69. [PMID: 34625377 PMCID: PMC10494705 DOI: 10.1016/j.jadohealth.2021.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 01/15/2021] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate the association between adolescent and young adult (AYA) well-care visits and emergency department (ED) utilization. METHODS Vermont's all-payer claims data were used to evaluate visits for 49,089 AYAs (aged 12-21 years) with a health-care claim from January 1 through December 31, 2018. We performed multiple logistic regression analyses to determine the association between well-care visits and ED utilization, investigating potential moderating effects of age, insurance type, and medical complexity. RESULTS Nearly half (49%) of AYAs who engaged with the health-care system did not attend a well-care visit in 2018. AYAs who did not attend a well-care visit had 24% greater odds (95% confidence interval [CI]: 1.19-1.30) of going to the ED at least once in 2018, controlling for age, sex, insurance type, and medical complexity. Older age, female sex, Medicaid insurance, and greater medical complexity independently predicted greater ED utilization in the adjusted model. In stratified analyses, late adolescents and young adults (aged 18-21 years) who did not attend a well-care visit had 47% greater odds (95% CI: 1.37 - 1.58) of ED visits, middle adolescents (aged 15-17 years) had 9% greater odds (95% CI: 1.01-1.18), and early adolescents (aged 12-14 years) had 16% greater odds (95% CI: 1.06 - 1.26). CONCLUSIONS Not attending well-care visits is associated with greater ED utilization among AYAs engaged in health care. Focus on key quality performance metrics such as well-care visit attendance, especially for 18- to 21-year-olds during their transition to adult health care, may help reduce ED utilization.
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Affiliation(s)
- Jennifer E Holland
- The Robert Larner, MD College of Medicine at The University of Vermont, Burlington, Vermont
| | - Susan E Varni
- The Robert Larner, MD College of Medicine at The University of Vermont, Burlington, Vermont; Department of Pediatrics at The University of Vermont, Burlington, Vermont
| | - Christian D Pulcini
- The Robert Larner, MD College of Medicine at The University of Vermont, Burlington, Vermont; Department of Pediatrics at The University of Vermont, Burlington, Vermont; Department of Surgery at The University of Vermont, Burlington, Vermont
| | - Tamara D Simon
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Valerie S Harder
- The Robert Larner, MD College of Medicine at The University of Vermont, Burlington, Vermont; Department of Pediatrics at The University of Vermont, Burlington, Vermont; Department of Psychiatry at The University of Vermont, Burlington, Vermont.
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18
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Pulcini CD, Lentz S, Saladino RA, Bounds R, Herrington R, Michaels MG, Maurer SH. Emergency management of fever and neutropenia in children with cancer: A review. Am J Emerg Med 2021; 50:693-698. [PMID: 34879488 DOI: 10.1016/j.ajem.2021.09.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Care of pediatric cancer patients is increasingly being provided by physicians in community settings, including general emergency departments. Guidelines based on current evidence have standardized the care of children undergoing chemotherapy or hematopoietic stem cell transplantation (HSCT) presenting with fever and neutropenia (FN). OBJECTIVE This narrative review evaluates the management of pediatric patients with cancer and neutropenic fever and provides comparison with the care of the adult with neutropenic fever in the emergency department. DISCUSSION When children with cancer and FN first present for care, stratification of risk is based on a thorough history and physical examination, baseline laboratory and radiologic studies and the clinical condition of the patient, much like that for the adult patient. Prompt evaluation and initiation of intravenous broad-spectrum antibiotics after cultures are drawn but before other studies are resulted is critically important and may represent a practice difference for some emergency physicians when compared with standardized adult care. Unlike adults, all high-risk and most low-risk children with FN undergoing chemotherapy require admission for parenteral antibiotics and monitoring. Oral antibiotic therapy with close, structured outpatient monitoring may be considered only for certain low-risk patients at pediatric centers equipped to pursue this treatment strategy. CONCLUSIONS Although there are many similarities between the emergency approach to FN in children and adults with cancer, there are differences that every emergency physician should know. This review provides strategies to optimize the care of FN in children with cancer in all emergency practice settings.
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Affiliation(s)
- Christian D Pulcini
- Division of Emergency Medicine, Department of Surgery and Pediatrics, University of Vermont Larner College of Medicine, Burlington, VT, United States of America.
| | - Skyler Lentz
- Division of Emergency Medicine and Critical Care, Department of Surgery and Medicine, University of Vermont Larner College of Medicine, Burlington, VT, United States of America
| | - Richard A Saladino
- Division of Pediatric Emergency Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
| | - Richard Bounds
- Division of Emergency Medicine, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT, United States of America.
| | - Ramsey Herrington
- Division of Emergency Medicine, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT, United States of America.
| | - Marian G Michaels
- Division of Infectious Diseases, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
| | - Scott H Maurer
- Division of Hematology/Oncology, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
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19
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Pulcini CD, Goyal MK, Hall M, Gruhler De Souza H, Chaudhary S, Alpern ER, Fein JA, Fleegler EW. Nonfatal firearm injuries: Utilization and expenditures for children pre- and postinjury. Acad Emerg Med 2021; 28:840-847. [PMID: 34435413 DOI: 10.1111/acem.14318] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/07/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Firearm injuries are one of the leading preventable causes of morbidity and mortality among children. Limited information exists about the impact of nonfatal firearm injuries on utilization and expenditures. Our objective was to compare health care encounters and expenditures 1 year before and 1 year following a nonfatal firearm injury. METHODS This was a retrospective cohort study of children 0 to 18 years with ICD-9/ICD-10 diagnosis codes for firearm injury (excluding nonpowder) in the emergency department or inpatient setting from 2010 to 2016 in the Medicaid MarketScan claims database. Outcomes included: (1) difference in health care encounters for 1 year before and 1 year after injury, (2) difference in health care expenditures, and (3) difference in complex chronic disease status. Descriptive statistics characterized patient demographics and health care utilization. Health expenditures were evaluated with Wilcoxon signed-rank tests. RESULTS Among 1,821 children, there were 22,398 health care encounters before the injury and 28,069 after. Concomitantly, there was an overall increase of $16.5 million in health expenditures ($9,084 per patient). There was a 50% increase in children qualifying for complex chronic condition status after firearm injury. CONCLUSIONS Children who experience nonfatal firearm injury have increased number of health care encounters, chronic disease classification, and health care expenditures in the year following the injury. Prevention of firearm injuries in this vulnerable age group may result in considerable reductions in morbidity and health care costs.
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Affiliation(s)
- Christian D. Pulcini
- Department of Surgery & Pediatrics University of Vermont Medical Center and Children’s Hospital Larner College of Medicine University of Vermont Burlington Vermont USA
| | - Monika K. Goyal
- Department of Pediatrics Children’s National HospitalGeorge Washington University Washington DC USA
| | - Matt Hall
- Children’s Hospital Association Lenexa Kansas USA
| | | | - Sofia Chaudhary
- Department of Pediatrics and Emergency Medicine Children’s Healthcare of AtlantaEmory University School of Medicine Atlanta Georgia USA
| | - Elizabeth R. Alpern
- Department of Pediatrics Feinberg School of Medicine Ann & Robert H. Lurie Children’s HospitalNorthwestern University Chicago Illinois USA
| | - Joel A. Fein
- Department of Pediatrics Children’s Hospital of PhiladelphiaUniversity of Pennsylvania Philadelphia Pennsylvania USA
| | - Eric W. Fleegler
- Division of Emergency Medicine Departments of Pediatrics and Emergency Medicine Harvard Medical SchoolBoston Children’s Hospital Boston Massachusetts USA
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20
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Pulcini CD, Goyal MK, Hall M, De Souza HG, Chaudhary S, Alpern ER, Fein JA, Fleegler EW. Mental Health Utilization and Expenditures for Children Pre-Post Firearm Injury. Am J Prev Med 2021; 61:133-135. [PMID: 33744062 PMCID: PMC8217206 DOI: 10.1016/j.amepre.2021.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/05/2021] [Accepted: 01/18/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Christian D Pulcini
- Department of Surgery, Larner College of Medicine, University of Vermont Medical Center, The University of Vermont, Burlington, Vermont; Department of Pediatrics, Larner College of Medicine, University of Vermont Medical Center, The University of Vermont, Burlington, Vermont.
| | - Monika K Goyal
- The Department of Pediatrics, Children's National Hospital, George Washington University, Washington, District of Columbia
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | | | - Sofia Chaudhary
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia; Department of Emergency Medicine, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Elizabeth R Alpern
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joel A Fein
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eric W Fleegler
- Departments of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
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21
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Pulcini CD, Coller RJ, Houtrow AJ, Belardo Z, Zorc JJ. Preventing Emergency Department Visits for Children With Medical Complexity Through Ambulatory Care: A Systematic Review. Acad Pediatr 2021; 21:605-616. [PMID: 33486099 DOI: 10.1016/j.acap.2021.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 08/17/2020] [Revised: 12/09/2020] [Accepted: 01/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children with medical complexity (CMC) represent a growing population with high emergency department (ED) utilization. How to reduce preventable ED visits is poorly understood. OBJECTIVE We sought to determine what components of ambulatory care programs focused on CMC were most effective in preventing ED visits. DATA SOURCES PubMed Plus, Cochrane Central Register of Controlled Trials, Web of Science, Scopus, and Cumulative Index to Nursing and Allied Health Literature databases through October 2019, and hand search of bibliographies. STUDY ELIGIBILITY CRITERIA Two independent reviewers used a structured screening protocol to include English language articles summarizing studies that included CMC, emergency care, or ED utilization. Data on ED utilization were extracted. RESULTS Sixteen included studies described outpatient interventions to prevent ED utilization. Of these, studies that included 24/7 access to knowledgeable providers for acute care needs by phone (telehealth) or expedited or next-day appointments were the most consistently successful in reducing ED visits. LIMITATIONS Risk of bias was mixed across studies. The evidence base is currently small and observational nature of interventions and their evaluations limit definitive, generalizable recommendations. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Current research suggests that real-time access to knowledgeable providers and expedited appointments can prevent ED visits. Further study is needed to generalize these findings as well as investigate novel strategies such as telehealth to improve quality of care, decrease utilization, and provide cost-effective care for this vulnerable population.
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Affiliation(s)
- Christian D Pulcini
- Division of Emergency Medicine, Department of Surgery, University of Vermont (CD Pulcini), Burlington, Vt.
| | - Ryan J Coller
- Department of Pediatrics, University of Wisconsin-Madison (RJ Coller), Madison, Wis
| | - Amy J Houtrow
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh (AJ Houtrow), Pittsburgh, Pa
| | - Zoe Belardo
- University of Pennsylvania (Z Belardo), Philadelphia, Pa
| | - Joseph J Zorc
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia (JJ Zorc), Philadelphia, Pa
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Pulcini CD, Belardo Z, Ketterer T, Zorc JJ, Mollen CJ. Improving Emergency Care for Children With Medical Complexity: Parent and Physicians' Perspectives. Acad Pediatr 2021; 21:513-520. [PMID: 32947009 DOI: 10.1016/j.acap.2020.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/18/2020] [Revised: 09/08/2020] [Accepted: 09/13/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Children with medical complexity (CMC) have high rates of emergency department (ED) utilization, but little evidence exists on the perceptions of parents and pediatric emergency medicine (PEM) physicians about emergency care. We sought to explore parent and PEM physicians' perspectives about 1) ED care for CMC, and 2) how emergency care can be improved. METHODS We performed semistructured interviews with parents and PEM physicians at a single academic, children's hospital. English-speaking parents were selected utilizing a standard definition of CMC during an ED visit in which their child was admitted to the hospital. All PEM physicians were eligible. We developed separate interview guides utilizing open-ended questions. The trained study team developed and modified a coding tree through an iterative process, double-coded transcripts, monitored inter-rater reliability to ensure adherence, and performed thematic analysis. RESULTS Twenty interviews of parents of CMC and 16 of PEM physicians were necessary for saturation. Parents identified specific challenges related to ED care of their children involving time, information gathering, logistics/convenience, and multifaceted communication between health teams and parents. PEM physicians identified time, data accessibility and availability, and communication as inter-related challenges in caring for CMC in the ED. Suggestions reflected potential solutions to the challenges identified. CONCLUSIONS Time, data, and communication challenges were the main focus for both parents and PEM physicians, and suggestions mirrored these challenges. Further research and quality improvement efforts to better characterize and mitigate the identified challenges could be of value for this vulnerable population.
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Affiliation(s)
- Christian D Pulcini
- Department of Surgery & Pediatrics, University of Vermont Medical Center and Children's Hospital, University of Vermont Larner College of Medicine (CD Pulcini) Burlington, VT.
| | - Zoe Belardo
- University of Pennsylvania (Z Belardo), Philadelphia, Pa
| | - Tara Ketterer
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia (T Ketterer, JJ Zorc, and CJ Mollen), Philadelphia, Pa
| | - Joseph J Zorc
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia (T Ketterer, JJ Zorc, and CJ Mollen), Philadelphia, Pa
| | - Cynthia J Mollen
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia (T Ketterer, JJ Zorc, and CJ Mollen), Philadelphia, Pa
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Pulcini CD, Goyal MK, Hall M, Gruhler De Souza H, Chaudhary S, Alpern ER, Fein J, Fleegler EW. Retracted Nonfatal firearm injuries: Utilization and expenditures for children pre- and postinjury. Acad Emerg Med 2021; 28. [PMID: 33730446 DOI: 10.1111/acem.14252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/26/2021] [Accepted: 03/14/2021] [Indexed: 11/30/2022]
Abstract
Firearm injuries are one of the leading preventable causes of morbidity and mortality among children. Limited information exists about the impact of nonfatal firearm injuries on utilization and expenditures. Our objective was to compare health care encounters and expenditures 1 year before and 1 year following a nonfatal firearm injury. This was a retrospective cohort study of children 0 to 18 years with ICD-9/ICD-10 diagnosis codes for firearm injury in the emergency department or inpatient setting from 2010 to 2016 in the Medicaid MarketScan claims database. Outcomes included 1) difference in health care encounters for 1 year before and 1 year after injury, 2) difference in health care expenditures, and 3) difference in complex chronic disease status. Descriptive statistics characterized patient demographics and health care utilization. Health expenditures were evaluated with Wilcoxon signed-rank tests. Among 3,296 children, there were 47,660 health care encounters before the injury and 61,660 after. Concomitantly, there was an overall increase of $18.5 million in health expenditures ($5,612 per patient). There was a 40% increase in children qualifying for complex chronic condition status after firearm injury. Children who experience nonfatal firearm injury have increased number of health care encounters, chronic disease classification, and health care expenditures in the year following the injury. Prevention of firearm injuries in this vulnerable age group may result in considerable reductions in morbidity and health care costs.
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Affiliation(s)
- Christian D Pulcini
- Department of Surgery & Pediatrics, University of Vermont Medical Center, Children's Hospital, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Monika K Goyal
- Department of Pediatrics, Children's National Hospital, George Washington University, Washington, DC, USA
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas, USA
| | | | - Sofia Chaudhary
- Department of Pediatrics and Emergency Medicine, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Elizabeth R Alpern
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joel Fein
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eric W Fleegler
- Departments of Pediatrics and Emergency Medicine, Division of Emergency Medicine, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
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24
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Pulcini CD, Turner TL, First LR. Generational Empathy: An Approach for Addressing Generational Differences. Pediatrics 2021; 147:peds.2020-0191. [PMID: 33536329 DOI: 10.1542/peds.2020-0191] [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: 05/12/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Christian D Pulcini
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
| | - Teri L Turner
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas; and
| | - Lewis R First
- Department of Pediatrics, The Robert Larner College of Medicine, The University of Vermont and The University of Vermont Children's Hospital, Burlington, Vermont
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Affiliation(s)
| | - David M Rubin
- General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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26
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Abstract
OBJECTIVES For asthma, attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD), the objectives were to (1) describe the percent increases in prevalence and comorbidity and how these vary by poverty status, and (2) examine the extent to which poverty status is a predictor of higher than average comorbid conditions. METHODS Secondary analyses of the National Survey of Children's Health for years 2003, 2007, and 2011-2012 were conducted to identify trends in parent reported lifetime prevalence and comorbidity among children with asthma, ADHD, and ASD and examine variation by sociodemographic characteristics, poverty status, and insurance coverage. Using 2011-2012 data, multivariable regression was used to examine whether poverty status predicted higher than average comorbid conditions after adjusting for other sociodemographic characteristics. RESULTS Parent-reported lifetime prevalence of asthma and ADHD rose 18% and 44%, respectively, whereas the lifetime prevalence of ASD rose almost 400% (from 0.5% to 2%). For asthma, the rise was most prominent among the poor at 25.8%. For ADHD, the percent change by poverty status was similar (<100% federal poverty level [FPL]: 43.20%, 100% to 199% FPL: 52.38%, 200% to 399% FPL: 43.67%), although rise in ASD was associated with being nonpoor (200% to 399% FPL: 43.6%, ≥400% FPL: 36.0%). Publicly insured children with asthma, ADHD, and ASD also had significantly higher odds (1.9×, 1.6×, 3.0×, respectively) of having higher than average comorbidities. CONCLUSIONS Poverty status differentially influenced parent-reported lifetime prevalence and comorbidities of these target disorders. Future research is needed to examine parent and system-level characteristics that may further explain poverty's variable impact.
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Affiliation(s)
- Christian D Pulcini
- Department of Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Bonnie T Zima
- UCLA-Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California
| | - Kelly J Kelleher
- Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio; and
| | - Amy J Houtrow
- Department of Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; .,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania
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Affiliation(s)
| | | | - Arvind Srinath
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA
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28
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Pulcini CD. It's Not "Just a Virus". Acad Emerg Med 2016; 23:753-4. [PMID: 26921104 DOI: 10.1111/acem.12947] [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: 11/27/2022]
Affiliation(s)
- Christian D Pulcini
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA.
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Pulcini CD. Terminal C, Gate 23. Fam Syst Health 2016; 34:71. [PMID: 27845538 DOI: 10.1037/fsh0000176] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This poem focuses on 19-year-old Anthony. At an airport terminal, his head is slumped and he reeks of alcohol. Anthony is unresponsive and has a pulse of 58. The author calls the paramedics and Anthony pulls through. (PsycINFO Database Record
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30
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Pulcini CD, Perrin JM, Houtrow AJ, Sargent J, Shui A, Kuhlthau K. Examining Trends and Coexisting Conditions Among Children Qualifying for SSI Under ADHD, ASD, and ID. Acad Pediatr 2015; 15:439-43. [PMID: 26142070 DOI: 10.1016/j.acap.2015.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 03/11/2015] [Revised: 05/02/2015] [Accepted: 05/07/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine the prevalence trends and coexisting conditions in attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and intellectual disability (ID) in the pediatric Supplemental Security Income (SSI) population and general population. METHODS The Social Security Administration (SSA) provided data on primary and secondary diagnoses of children qualifying for SSI for years 2000 to 2011. We compared SSA data with 2000-2011 National Health Interview Survey data on the prevalence of mental health diagnoses among children in the general population living between 0 and 199% of the federal poverty line. We utilized linear regression analysis to test the statistical significance of differences in the trends of the conditions' prevalence. RESULTS Over this time period, the SSI population experienced increases in ADHD (5.8%) and ASD (7.2%) and a decrease in ID (-10.3%). Comparison with change in the general population indicated no significant difference in ADHD but significant differences in ASD and ID. Relative percentage changes reflect similar changes. The SSI population qualifying for SSI with ADHD (70.8%) had higher rates of coexisting conditions than the general population (66.1%), but lower rates of coexisting conditions for ASD and ID. CONCLUSIONS ADHD is on the rise among children receiving SSI and in the general population. This suggests that the rise of ADHD in the SSI population is expected and does not represent a misallocation of resources. Changes described among the SSI population in ASD and ID may allude to diagnostic/coding trends and/or true changes in prevalence. Limitations arise from the comparability of the 2 data sets.
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Affiliation(s)
- Christian D Pulcini
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pa; Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA.
| | - James M Perrin
- Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Mass
| | - Amy J Houtrow
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pa; Departments of Physical Medicine and Pediatrics, University of Pittsburgh, Pittsburgh, PA
| | - John Sargent
- Tufts Medical Center, Boston, Mass; Departments of Pediatrics and Psychiatry, Tufts Floating Hospital for Children, Tufts University School of Medicine, Boston, MA
| | - Amy Shui
- Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Mass
| | - Karen Kuhlthau
- Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Mass
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Broder-Fingert S, Shui A, Pulcini CD, Kurowski D, Perrin JM. Racial and Ethnic Differences in Subspecialty Service Use by Children With Autism. Pediatrics 2013. [PMID: 23776121 DOI: 10.1542/peds.2012-3886d] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sarabeth Broder-Fingert
- Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, and Center for Child and Adolescent Health Research and Policy, Boston, MA, USA.
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Abstract
OBJECTIVE To describe racial differences in use of specialty care among children with autism spectrum disorder. METHODS We identified patients ages 2 to 21 years with an International Classification of Diseases, Ninth Revision code of autism (299.0) seen from 2000 to 2011 at a major academic health center by using a research patient data repository and determined rates of specialty provider visits and procedures by race. We then used logistic regression to determine the associations of rates of subspecialty visits and procedures with race and ethnicity, controlling for gender, age, and payer type. RESULTS We identified 3615 patients (2935 white, 243 Hispanic, 188 African American, and 249 other). The most striking differences were in use of gastroenterology (GI)/nutrition services. Nonwhite children were less likely to use GI/nutrition specialty providers (African American, odds ratio = 0.32 [95th percentile confidence interval: 0.18-0.55]; Hispanic, 0.32 [0.20-0.51]; other, 0.56 [0.34-0.92]) as well as neurology (African American, 0.52 [0.33-0.83]; Hispanic, 0.40 [0.27-0.59]) and psychiatry/psychology (African American, 0.44 [0.27-0.72]; Hispanic, 0.60 [0.41-0.88]; other, 0.62 [0.38-0.99]). Nonwhite children were less likely to have had GI studies: colonoscopy (African American, 0.23 [0.10-0.53]; Hispanic, 0.26 [0.14-0.50]), endoscopy (African American, 0.31 [0.16-0.58]; Hispanic, 0.27 [0.16-0.46]; other, 0.53 [0.31-0.90]), and stool studies (African American, 0.49 [0.30-0.91]). Hispanic children had lower rates of neurologic and other testing: EEG (Hispanic, 0.53 [0.35-0.78]), brain MRI (African American, 0.37 [0.22-0.63]; Hispanic, 0.62 [0.42-0.90]), sleep study (Hispanic, 0.18 [0.04-0.76]), and neuropsychiatric testing (Hispanic, 0.55 [0.32-0.96]). CONCLUSIONS We found racial and ethnic differences among children diagnosed with autism in use of care and procedures. Possible explanations for these findings include differences in presentation, referral rates, or referral follow through.
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Affiliation(s)
- Sarabeth Broder-Fingert
- Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, and Center for Child and Adolescent Health Research and Policy, Boston, MA, USA.
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