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https://www.readbyqxmd.com/read/28929269/behavioral-health-integration-in-health-care-settings-lessons-learned-from-a-pediatric-hospital-primary-care-system
#1
Leandra Godoy, Melissa Long, Donna Marschall, Stacy Hodgkinson, Brooke Bokor, Hope Rhodes, Howard Crumpton, Mark Weissman, Lee Beers
Behavioral health integration within primary care has been evolving, but literature traditionally focuses on smaller scale efforts. We detail how behavioral health has been integrated across a large, urban pediatric hospital system's six primary care clinics (serving over 35,000 children annually and insured predominately through Medicaid) and discuss strategies for success in sustaining and expanding efforts to achieve effective integration of behavioral health into primary care. In a time span of 3 years, the clinics have implemented routine, universal behavioral health screening at well child visits, participated in a 15-month behavioral health screening quality improvement learning collaborative, and integrated the work of psychologists and psychiatrists...
September 19, 2017: Journal of Clinical Psychology in Medical Settings
https://www.readbyqxmd.com/read/28928288/association-between-insurance-and-transfer-of-injured-children-from-emergency-departments
#2
Yunru Huang, Jamie L Kissee, Parul Dayal, Nancy Ewen Wang, Ilana S Sigal, James P Marcin
OBJECTIVES: To determine if injured children presenting to nondesignated trauma centers are more or less likely to be transferred relative to being admitted based on insurance status. METHODS: We conducted a cross-sectional study by using the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample. Pediatric trauma patients receiving care in emergency departments (EDs) at nontrauma centers who were either admitted locally or transferred to another hospital were included...
September 19, 2017: Pediatrics
https://www.readbyqxmd.com/read/28864710/principles-of-child-health-care-financing
#3
Mark L Hudak, Mark E Helm, Patience H White
After passage of the Patient Protection and Affordable Care Act, more children and young adults have become insured and have benefited from health care coverage than at any time since the creation of the Medicaid program in 1965. From 2009 to 2015, the uninsurance rate for children younger than 19 years fell from 9.7% to 5.3%, whereas the uninsurance rate for young adults 19 to 25 years of age declined from 31.7% to 14.5%. Nonetheless, much work remains to be done. The American Academy of Pediatrics (AAP) believes that the United States can and should ensure that all children, adolescents, and young adults from birth through the age of 26 years who reside within its borders have affordable access to high-quality and comprehensive health care, regardless of their or their families' incomes...
September 2017: Pediatrics
https://www.readbyqxmd.com/read/28853957/reducing-emergency-department-visits-utilizing-a-primary-care-asthma-specialty-clinic-in-a-high-risk-patient-population
#4
Dane A Snyder, Olivia W Thomas, Sean P Gleeson, David R Stukus, LaQuita M Jones, Christopher Regan, Ashley Shamansky, Elizabeth D Allen
OBJECTIVE: Asthma is a leading cause of pediatric emergency department(ED) use. Optimizing asthma outcomes is a goal of Nationwide Children's Hospital(NCH) and its affiliated Accountable Care Organization. NCH's Primary Care Network, comprised of 12 offices serving a predominantly Medicaid population, sought to determine whether an Asthma Specialty Clinic (ASC) operated within a single primary care office could reduce ED asthma rates and improve quality measures, relative to all other network offices...
August 30, 2017: Journal of Asthma: Official Journal of the Association for the Care of Asthma
https://www.readbyqxmd.com/read/28816917/factors-associated-with-developmental-behavioral-pediatricians-prescribing-psychotropic-medication-to-children-with-autism-spectrum-disorder-a-study-of-three-dbpnet-sites
#5
Carissa Jackel, Justine Shults, Susan Wiley, Jareen Meinzen-Derr, Marilyn Augustyn, Nathan Blum
OBJECTIVE: Psychotropic medications are frequently prescribed to children with autism spectrum disorder (ASD), but little is known about the prescribing practices of developmental-behavioral pediatricians (DBPs). Our objective was to determine whether clinical site, age, insurance, or comorbidities influenced DBPs prescribing psychotropic medication for children with ASD. METHODS: A retrospective analysis was performed using electronic health record data of all patients with ASD seen at 3 academic developmental-behavioral pediatrics (DBP) clinical programs from January 2010 to December 2011...
August 10, 2017: Journal of Developmental and Behavioral Pediatrics: JDBP
https://www.readbyqxmd.com/read/28816891/computed-tomography-use-plateaus-among-children-with-emergency-visits-for-abdominal-pain
#6
Jahan Fahimi, Aaron E Kornblith, Hemal Kanzaria, Andrew Herring, Ralph C Wang
OBJECTIVES: Abdominal pain is a common pediatric complaint to emergency departments (EDs), and clinicians often rely on imaging for diagnosis. Studies have demonstrated an increase in computed tomography (CT) in this population. Following emphasis on radiation reduction by researchers and organizations, this study evaluates recent national trends in CT use among pediatric patients presenting to EDs with abdominal pain. METHODS: This is a cross-sectional analysis of ED patients 18 years or younger with chief complaint of abdominal pain in the National Hospital Ambulatory Medical Care Survey from 2008 to 2011...
August 14, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28815608/factors-associated-with-patient-no-show-rates-in-an-academic-otolaryngology-practice
#7
Caitlin E Fiorillo, Allyson L Hughes, Chen I-Chen, Philip M Westgate, Thomas J Gal, Matthew L Bush, Brett T Comer
OBJECTIVES/HYPOTHESIS: Factors affecting access to healthcare is an expanding area of research. This study seeks to identify factors associated with no-show rates in an academic otolaryngology practice to improve clinical efficiency and patient access to care. STUDY DESIGN: Retrospective review. METHODS: A retrospective review of scheduled clinical appointments from February 1, 2015 to January 30, 2016 at a single academic otolaryngology department was performed...
August 16, 2017: Laryngoscope
https://www.readbyqxmd.com/read/28800266/impact-of-shared-decision-making-on-asthma-quality-of-life-and-asthma-control-among-children
#8
Yhenneko J Taylor, Hazel Tapp, Lindsay E Shade, Tsai-Ling Liu, Jessica Lauren Mowrer, Michael F Dulin
OBJECTIVE: Few studies have examined the effectiveness of shared decision making (SDM) in clinical practice. This study evaluated the impact of SDM on quality of life and symptom control in children with asthma. METHODS: We conducted a prospective 3-year study in six community-based practices serving a low-income patient population. Practices received training on SDM using an evidence-based toolkit. Patients aged 2 to 17 with a diagnosis of asthma were identified from scheduling and billing data...
August 11, 2017: Journal of Asthma: Official Journal of the Association for the Care of Asthma
https://www.readbyqxmd.com/read/28771405/pediatric-readmissions-after-hospitalizations-for-lower-respiratory-infections
#9
Mari M Nakamura, Alan M Zaslavsky, Sara L Toomey, Carter R Petty, Maria C Bryant, Alexandra T Geanacopoulos, Ashish K Jha, Mark A Schuster
BACKGROUND AND OBJECTIVE: Lower respiratory infections (LRIs) are among the most common reasons for pediatric hospitalization and among the diagnoses with the highest number of readmissions. Characterizing LRI readmissions would help guide efforts to prevent them. We assessed variation in pediatric LRI readmission rates, risk factors for readmission, and readmission diagnoses. METHODS: We analyzed 2008-2009 Medicaid Analytic eXtract data for patients <18 years of age in 26 states...
August 2017: Pediatrics
https://www.readbyqxmd.com/read/28765382/health-care-expenditures-and-utilization-for-children-with-noncomplex-chronic-disease
#10
Erik R Hoefgen, Annie L Andrews, Troy Richardson, Matthew Hall, John M Neff, Michelle L Macy, Jessica L Bettenhausen, Samir S Shah, Katherine A Auger
BACKGROUND: Pediatric health care expenditures and use vary by level of complexity and chronic illness. We sought to determine expenditures and use for children with noncomplex chronic diseases (NC-CDs). METHODS: We performed a retrospective, cross-sectional analysis of Medicaid enrollees (ages 0-18 years) from January 1, 2012, through December 31, 2013, using administrative claims (the Truven MarketScan Medicaid Database). Patients were categorized by chronicity of illness by using 3M Health Information System's Clinical Risk Groups (CRGs) as follows: without chronic diseases (WO-CDs) (CRG 1-2), NC-CDs (CRG 3-5), and complex chronic diseases (C-CDs) (CRG 6-9)...
September 2017: Pediatrics
https://www.readbyqxmd.com/read/28765380/high-expenditure-pharmaceutical-use-among-children-in-medicaid
#11
Eyal Cohen, Matt Hall, Ruth Lopert, Brian Bruen, Lisa J Chamberlain, Naomi Bardach, Jennifer Gedney, Bonnie T Zima, Jay G Berry
BACKGROUND AND OBJECTIVES: Medication use may be a target for quality improvement, cost containment, and research. We aimed to identify medication classes associated with the highest expenditures among pediatric Medicaid enrollees and to characterize the demographic, clinical, and health service use of children prescribed these medications. METHODS: Retrospective, cross-sectional study of 3 271 081 Medicaid-enrolled children. Outpatient medication spending among high-expenditure medication classes, defined as the 10 most expensive among 261 mutually exclusive medication classes, was determined by using transaction prices paid to pharmacies by Medicaid agencies and managed care plans among prescriptions filled and dispensed in 2013...
September 2017: Pediatrics
https://www.readbyqxmd.com/read/28730629/emergency-department-use-for-acute-rhinosinusitis-insurance-dependent-for-children-and-adults
#12
Regan W Bergmark, Stacey L Ishman, Katie M Phillips, Michael J Cunningham, Ahmad R Sedaghat
OBJECTIVES/HYPOTHESIS: Patients with Medicaid or self-pay insurance status are more likely to present to the emergency department (ED) for uncomplicated acute rhinosinusitis (ARS). Our aim was to determine if this pattern holds true for both pediatric and adult visits. STUDY DESIGN: Cross-sectional study using the 2005 to 2012 National Hospital Ambulatory Medical Care Surveys and National Ambulatory Medical Care Surveys. METHODS: We included all visits with International Classification of Diseases, Ninth Revision codes for ARS and without codes for ARS complications...
July 21, 2017: Laryngoscope
https://www.readbyqxmd.com/read/28719499/a-retrospective-cohort-study-of-the-incidence-healthcare-resource-utilization-and-costs-of-icd-9-diagnosed-influenza-and-related-complications-in-us-children
#13
Philip O Buck, David M Smith, Rahul Shenolikar, Debra E Irwin
BACKGROUND: There is a paucity of data on the clinical and economic impact of seasonal influenza in children. This study estimated the incidence of diagnosed influenza and related complications, and associated healthcare resource utilization (HRU) and costs in US children. METHODS: Children ≥6 months and <18 years old diagnosed with influenza using ICD-9 codes and enrolled in a health plan during at least one influenza season between 2010-2014 were matched to similar patients without diagnosed influenza (GSK study identifier: HO-15-15728)...
July 14, 2017: Pediatric Infectious Disease Journal
https://www.readbyqxmd.com/read/28715295/prevalence-of-home-parenteral-and-enteral-nutrition-in-the-united-states
#14
Manpreet S Mundi, Adele Pattinson, Megan T McMahon, Jacob Davidson, Ryan T Hurt
BACKGROUND: Malnutrition is highly prevalent and associated with increased morbidity and mortality. Studies continue to reveal significant clinical benefits with nutrition support, including improved wound healing, reduction in complications and length of stay, and mortality. Due to these benefits, the prevalence of home parenteral and enteral nutrition (HPEN) continues to increase worldwide. In the United States, given our healthcare insurance landscape, it has been very difficult to ascertain the true prevalence of HPEN...
July 1, 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28688994/comparison-of-30-day-emergency-department-bouncebacks-after-pediatric-versus-adult-urologic-surgery
#15
Courtney L Shepard, Julian Wan
INTRODUCTION: More pediatric patients seem to present to the emergency department (ED) for non-urgent matters after urologic procedures than adult patients. Under new and expanding healthcare reform, pediatric urologists may be penalized for these visits. We compare our 30-day postoperative bounceback rates to the ED and the acuity of the concerns in these populations. MATERIALS AND METHODS: All urology consults at our institution are maintained on a prospectively tracked database...
June 20, 2017: Journal of Pediatric Urology
https://www.readbyqxmd.com/read/28679018/underdiagnosis-and-lower-rates-of-office-visits-for-overweight-obese-pediatric-patients-in-rural-compared-with-urban-areas
#16
COMPARATIVE STUDY
Christine SanGiovanni, James McElligott, Kristen Morella, William Basco
OBJECTIVES: This study compared the number of children enrolled in Medicaid in rural and urban areas of South Carolina with an overweight/obesity diagnosis and the mean rates of office visits with overweight/obesity diagnosed. METHODS: Medicaid claims data from 2012 for children in three South Carolina counties, categorized as urban, rural high resource, and rural low resource, were used to identify those who had been diagnosed as being overweight/obese during any encounter...
July 2017: Southern Medical Journal
https://www.readbyqxmd.com/read/28676248/the-weekend-effect-on-morbidity-and-mortality-among-pediatric-epilepsy-admissions
#17
Timothy Wen, Daniel R Kramer, Steve Sirot, Lianne Ho, Alimohammad S Moalem, Steven Y Cen, David Millett, Christianne Heck, R Aaron Robison, William J Mack, Charles Y Liu
BACKGROUND: Pediatric epilepsy is one of the most common neurological disorders with low mortality and high morbidity, often requiring hospitalization. Weekend admissions have been shown to be associated with worse outcomes compared with their weekday counterparts. To date, no study has assessed the impact of weekend admission on clinical and quality outcomes in the pediatric epilepsy population. METHODS: Children with epilepsy were identified from the 2000, 2003, 2006, and 2009 Kids Inpatient Database...
September 2017: Pediatric Neurology
https://www.readbyqxmd.com/read/28669287/prevalence-of-psychotherapy-surrounding-initiation-of-psychotropic-polypharmacy-in-the-medicaid-insured-population-1999-2010
#18
Juan M Hincapie-Castillo, Xinyue Liu, Regina Bussing, Almut G Winterstein
OBJECTIVE: This research aimed to quantify the prevalence of psychotherapy among Medicaid-insured patients within six months of initiating psychotropic medication polypharmacy (PMP). METHODS: Using the Medicaid Analytic eXtract database for 29 states from 1999 to 2010, investigators established ten two-year cohorts of pediatric and adult patients who received two or more psychotropic drugs with a 45-day overlapping days' supply. Among PMP initiators, the prevalence of psychotherapy services, identified from encounter claims via Current Procedural Terminology and Healthcare Common Procedure Coding System codes, was calculated for the six months before and the six months after initiation of PMP...
July 3, 2017: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/28654202/socioeconomic-factors-affect-the-selection-of-proton-radiation-therapy-for-children
#19
Colette J Shen, Chen Hu, Matthew M Ladra, Amol K Narang, Craig E Pollack, Stephanie A Terezakis
BACKGROUND: Proton radiotherapy remains a limited resource despite its clear potential for reducing radiation doses to normal tissues and late effects in children in comparison with photon therapy. This study examined the impact of race and socioeconomic factors on the use of proton therapy in children with solid malignancies. METHODS: This study evaluated 12,101 children (age ≤ 21 years) in the National Cancer Data Base who had been diagnosed with a solid malignancy between 2004 and 2013 and had received photon- or proton-based radiotherapy...
June 27, 2017: Cancer
https://www.readbyqxmd.com/read/28650250/a-retrospective-longitudinal-claims-based-comparison-of-concomitant-diagnoses-between-individuals-with-and-without-down-syndrome
#20
Amanda M Kong, Dana Hurley, Kristin A Evans, Diana Brixner, Csilla Csoboth, Jeannie Visootsak
BACKGROUND: Individuals with Down syndrome (DS) experience various comorbidities in excess of the prevalence seen among the non-DS population. However, the extent of the excess burden of comorbidities specifically within commercially and publicly insured DS populations aged < 21 years is not currently known. OBJECTIVES: To (a) describe the most common diagnoses among individuals with DS who have either commercial or Medicaid insurance and (b) compare the prevalence of those diagnoses between DS cases and non-DS controls...
July 2017: Journal of Managed Care & Specialty Pharmacy
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