Academic Pediatrics最新文献_第10页

Potentially Avoidable Emergency Department Transfers for Acute Pediatric Respiratory Illness. 小儿急性呼吸道疾病可能避免的急诊科转院。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-08-02 DOI: 10.1016/j.acap.2024.07.020

Kaileen Jafari, Apeksha Gupta, Derya Caglar, Emily Hartford

Background: Acute pediatric respiratory illness is one of the most common reasons for emergency department (ED) transfer; however, few studies have examined predictors of potentially avoidable ED transfer (PAT) in this subpopulation. This study aimed to characterize patterns and predictors of PATs in children with acute respiratory illness.

Methods: Cross-sectional analysis of 8,402,577 visits for patients ≤17 years from 2018 to 2019 Health Care Utilization Project State ED and Inpatient Datasets from New York, Maryland, Wisconsin, and Florida. ED transfers matched to a visit at a receiving facility with a primary diagnosis of pneumonia, croup/other upper respiratory infection (URI), bronchiolitis, or asthma were included. PAT was defined as discharge from receiving ED or within 24 hours of inpatient admission without specialized procedures, as previously described. PATs were compared with necessary transfers using a 3-level generalized linear mixed model with adjustment for patient and hospital covariates.

Results: Among 4409 matched respiratory transfers, 25.5% were potentially avoidable. Most PATs originated from EDs within the third highest quartile of annual pediatric ED visits (n = 472, 42.0%). In the multivariable model, the likelihood of PAT was higher for patients with croup/other URI ((odds ratio) OR 2.72 (2.09-3.5) and if referring ED was in the highest quartile of annual pediatric ED volumes (OR 0.48 95% (confidence interval) CI 0.26-0.88).

Conclusions: Pediatric respiratory transfers with a diagnosis of croup/other URI were the most likely to be potentially avoidable. Future implementation efforts to reduce PATs should consider focusing on croup management in EDs in the lower 3 quartiles of pediatric volume.

背景：急性儿科呼吸道疾病是急诊科（ED）转院的最常见原因之一，但很少有研究对该亚群中潜在可避免的急诊科转院（PAT）进行预测。本研究旨在描述急性呼吸道疾病患儿转院的模式和预测因素：方法：对 8,402,577 名就诊患者进行横断面分析：在 4,409 例匹配的呼吸道转运病例中，25.5% 的病例可能是可以避免的。大多数 PAT 来自儿科急诊室年就诊量第三高四分位数的急诊室（472 人，42.0%）。在多变量模型中，如果患者患有咳嗽/其他URI（OR 2.72 (2.09 -3.5)），且转诊急诊室位于儿科急诊室年门诊量的最高四分位数（OR 0.48 95% CI 0.26-0.88），则发生PAT的可能性更高：结论：诊断为咳嗽/其他URI的儿科呼吸道转院最有可能避免。未来减少 PAT 的实施工作应考虑将重点放在儿科急诊量较低的三个四分位数的急诊室的分组管理上。

{"title":"Potentially Avoidable Emergency Department Transfers for Acute Pediatric Respiratory Illness.","authors":"Kaileen Jafari, Apeksha Gupta, Derya Caglar, Emily Hartford","doi":"10.1016/j.acap.2024.07.020","DOIUrl":"10.1016/j.acap.2024.07.020","url":null,"abstract":"<p><strong>Background: </strong>Acute pediatric respiratory illness is one of the most common reasons for emergency department (ED) transfer; however, few studies have examined predictors of potentially avoidable ED transfer (PAT) in this subpopulation. This study aimed to characterize patterns and predictors of PATs in children with acute respiratory illness.</p><p><strong>Methods: </strong>Cross-sectional analysis of 8,402,577 visits for patients ≤17 years from 2018 to 2019 Health Care Utilization Project State ED and Inpatient Datasets from New York, Maryland, Wisconsin, and Florida. ED transfers matched to a visit at a receiving facility with a primary diagnosis of pneumonia, croup/other upper respiratory infection (URI), bronchiolitis, or asthma were included. PAT was defined as discharge from receiving ED or within 24 hours of inpatient admission without specialized procedures, as previously described. PATs were compared with necessary transfers using a 3-level generalized linear mixed model with adjustment for patient and hospital covariates.</p><p><strong>Results: </strong>Among 4409 matched respiratory transfers, 25.5% were potentially avoidable. Most PATs originated from EDs within the third highest quartile of annual pediatric ED visits (n = 472, 42.0%). In the multivariable model, the likelihood of PAT was higher for patients with croup/other URI ((odds ratio) OR 2.72 (2.09-3.5) and if referring ED was in the highest quartile of annual pediatric ED volumes (OR 0.48 95% (confidence interval) CI 0.26-0.88).</p><p><strong>Conclusions: </strong>Pediatric respiratory transfers with a diagnosis of croup/other URI were the most likely to be potentially avoidable. Future implementation efforts to reduce PATs should consider focusing on croup management in EDs in the lower 3 quartiles of pediatric volume.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effect of Automated and Personalized Outreach Messages on Well-Child Visit Catch Up: A Randomized Clinical Trial 自动化和个性化外展信息对儿童访视的影响:一项随机临床试验。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-08-01 DOI: 10.1016/j.acap.2023.11.017

Objective

To determine the effectiveness of text/telephone outreach messages and personal contact attempts on well-child care (WCC) scheduling and completion and measles, mumps, and rubella (MMR) vaccine receipt.

Methods

We conducted an intent-to-treat, 2 × 2 factorial randomized clinical trial with 3 replications at 3 academic pediatric primary care practices from September 27, 2020 to August 6, 2021. We randomized participants to 1 of 4 groups: 1 automated message (group 1), 2 automated messages (group 2), 1 automated message plus personal contact attempts (group 3), or 2 automated messages plus personal contact attempts (group 4). Outcomes included: 1) scheduled WCC within 2 weeks (secondary outcome), 2) completed WCC within 8 weeks (secondary outcome), 3) receipt of first MMR by 15 months of age or second MMR within 3 months of first message for 4-year-olds (primary outcome).

Results

We randomized 1312 patients (mean [SD] age = 38.8 [19.3] months, 53.5% male, 72.8% non-Hispanic Black, 86.9% Medicaid-enrolled). Scheduling rates were significantly higher in groups with personal contact attempts compared to those without (1 = 15.2%, 2 = 12.5%, 3 = 29.3%, and 4 = 31.5%). WCC completion rates also differed across groups: 1 = 27.4%, 2 = 22.3%, 3 = 32.0%, and 4 = 29.4%, with groups 3 and 4 having significantly higher rates than group 2. Similarly, groups 3 (30.2%) and 4 (31.8%) had significantly higher rates of receiving the MMR vaccine compared to group 2 (23.5%) but not group 1 (28.0%).

Conclusions

Outreach messages that were followed by personal contact attempts increased the rates of scheduling and completing WCCs and receiving the MMR vaccine, providing a useful tool to re-engage at-risk populations.

目的:确定短信/电话外展信息和个人接触尝试对儿童保健(WCC)计划和完成以及麻疹、腮腺炎和风疹(MMR)疫苗接种的有效性。方法:我们于20年9月27日至21年8月6日在三家学术儿科初级保健诊所进行了一项意向治疗、2 × 2因子、3个重复的随机临床试验。我们将参与者随机分为4组:1条自动信息(第1组)，2条自动信息(第2组)，1条自动信息加个人联系尝试(第3组)，或2条自动信息加个人联系尝试(第4组)。结果包括:1)2周内安排的WCC(次要结果)，2)8周内完成的WCC(次要结果)，3)15个月前接受第一次MMR或4岁儿童第一次MMR后3个月内接受第二次MMR(主要结果)。结果:我们随机分配了1312例患者(平均[SD]年龄=38.8[19.3]个月，53.5%为男性，72.8%为非西班牙裔黑人，86.9%为医疗补助患者)。有个人接触尝试组的预约率明显高于无个人接触尝试组(1=15.2%，2=12.5%，3=29.3%，4=31.5%)。WCC完成率在各组之间也存在差异:1=27.4%，2=22.3%，3=32.0%，4=29.4%，其中3组和4组的完成率明显高于2组。同样，第3组(30.2%)和第4组(31.8%)的MMR疫苗接种率明显高于第2组(23.5%)，但第1组(28.0%)没有。结论:外联信息之后进行的个人接触尝试提高了安排和完成wcc和接受MMR疫苗的比率，为重新接触高危人群提供了有用的工具。最新进展:在这项针对儿科患者的随机临床试验中，两组之间安排和完成WCC和接受MMR疫苗的比率存在显著差异，接受个人接触尝试的组优于仅接受自动信息的组。

{"title":"Effect of Automated and Personalized Outreach Messages on Well-Child Visit Catch Up: A Randomized Clinical Trial","authors":"","doi":"10.1016/j.acap.2023.11.017","DOIUrl":"10.1016/j.acap.2023.11.017","url":null,"abstract":"<div><h3>Objective</h3><p>To determine the effectiveness of text/telephone outreach messages and personal contact attempts on well-child care (WCC) scheduling and completion and measles, mumps, and rubella (MMR) vaccine receipt.</p></div><div><h3>Methods</h3><p><span>We conducted an intent-to-treat, 2 × 2 factorial randomized clinical trial<span> with 3 replications at 3 academic pediatric<span> primary care practices from September 27, 2020 to August 6, 2021. We randomized participants to 1 of 4 groups: 1 automated message (group 1), 2 automated messages (group 2), 1 automated message plus personal contact attempts (group 3), or 2 automated messages plus personal contact attempts (group 4). Outcomes included: 1) scheduled WCC within 2 weeks (secondary outcome), 2) completed WCC within 8 weeks (secondary outcome), 3) receipt of first </span></span></span>MMR<span> by 15 months of age or second MMR within 3 months of first message for 4-year-olds (primary outcome).</span></p></div><div><h3>Results</h3><p>We randomized 1312 patients (mean [SD] age = 38.8 [19.3] months, 53.5% male, 72.8% non-Hispanic Black, 86.9% Medicaid-enrolled). Scheduling rates were significantly higher in groups with personal contact attempts compared to those without (1 = 15.2%, 2 = 12.5%, 3 = 29.3%, and 4 = 31.5%). WCC completion rates also differed across groups: 1 = 27.4%, 2 = 22.3%, 3 = 32.0%, and 4 = 29.4%, with groups 3 and 4 having significantly higher rates than group 2. Similarly, groups 3 (30.2%) and 4 (31.8%) had significantly higher rates of receiving the MMR vaccine compared to group 2 (23.5%) but not group 1 (28.0%).</p></div><div><h3>Conclusions</h3><p>Outreach messages that were followed by personal contact attempts increased the rates of scheduling and completing WCCs and receiving the MMR vaccine, providing a useful tool to re-engage at-risk populations.</p></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138441655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

In No State 没有国家。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-08-01 DOI: 10.1016/j.acap.2024.02.004

引用次数: 0

Early Literacy Developmental Activities and Pre-Kindergarten Learning Skills in the Context of Childhood Adversity 童年逆境中的早期识字发展活动和学前学习技能

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-08-01 DOI: 10.1016/j.acap.2024.01.005

Objective

School readiness (SR) encompasses a wide range of skills that affect children’s ability to succeed in school and later in life. Shared reading is an important strategy that assists children in gaining SR skills, whereas adverse childhood experiences (ACEs) negatively affect a child’s SR. This study assessed if early literacy developmental activities (shared reading, singing, or storytelling) were associated with improved SR among children with and without ACEs.

Methods

2020–2021 National Survey of Children’s Health data were used for analysis. We identified children aged 3–5 years to assess their exposure to ACEs, participation in reading/storytelling/singing, and overall SR.

Results

In a sample of 17,545 children, 29% of children were exposed to one or more ACEs. Seventy-seven percent of children with no ACEs received daily early literacy developmental activities compared to 23% of children who experienced any ACE. On ordinal logistic regression, daily early literacy developmental activities were associated with 56% greater odds of higher SR among children not exposed to ACEs (OR: 1.56; 95% CI: 1.29, 1.88; P < .01). Among children exposed to ACEs, daily early literacy developmental activities were also associated with higher SR (OR: 1.50; 95% CI: 1.06, 2.13; P = .02).

Conclusions

Shared reading, storytelling, and singing are associated with improved SR in both children who have and have not been exposed to ACEs. However, children exposed to ACEs had fewer experiences with early literacy developmental activities. Future efforts should address the barriers that limit shared reading, singing, or storytelling for children exposed to ACEs.

目标入学准备（SR）包括一系列广泛的技能，这些技能会影响儿童在学校和今后生活中取得成功的能力。分享阅读是帮助儿童获得入学准备技能的重要策略，而不良童年经历（ACE）会对儿童的入学准备产生负面影响。本研究评估了早期识字发展活动（分享阅读、唱歌或讲故事）是否与有或没有 ACE 的儿童的 SR 改善相关。我们对 3-5 岁的儿童进行了身份识别，以评估他们接触 ACE 的情况、参与阅读/讲故事/唱歌的情况以及总体 SR。结果在 17,545 名儿童的样本中，29% 的儿童接触过一种或多种 ACE。在没有经历过 ACE 的儿童中，有 77% 的儿童每天都参加了早期识字发展活动，而在经历过任何 ACE 的儿童中，只有 23% 的儿童每天都参加了早期识字发展活动。根据序数逻辑回归，在没有经历过 ACE 的儿童中，每天进行早期识字发展活动与较高 SR 的几率有 56% 的关联（OR：1.56；95% CI：1.29，1.88；p<0.001）。结论分享阅读、讲故事和唱歌与受和未受 ACE 影响的儿童的 SR 改善有关。然而，接触过ACE的儿童参加早期识字发展活动的经历较少。未来的努力应解决限制暴露于ACE的儿童分享阅读、唱歌或讲故事的障碍。新发现早期识字活动与暴露于ACE的儿童和未暴露于ACE的儿童入学准备的改善有关，尽管暴露于ACE的儿童中接受早期识字活动的人数较少。早期识字活动可能对ACE起到缓冲作用。

{"title":"Early Literacy Developmental Activities and Pre-Kindergarten Learning Skills in the Context of Childhood Adversity","authors":"","doi":"10.1016/j.acap.2024.01.005","DOIUrl":"10.1016/j.acap.2024.01.005","url":null,"abstract":"<div><h3>Objective</h3><p>School readiness (SR) encompasses a wide range of skills that affect children’s ability to succeed in school and later in life. Shared reading is an important strategy that assists children in gaining SR skills, whereas adverse childhood experiences (ACEs) negatively affect a child’s SR. This study assessed if early literacy developmental activities (shared reading, singing, or storytelling) were associated with improved SR among children with and without ACEs.</p></div><div><h3>Methods</h3><p>2020–2021 National Survey of Children’s Health data were used for analysis. We identified children aged 3–5 years to assess their exposure to ACEs, participation in reading/storytelling/singing, and overall SR.</p></div><div><h3>Results</h3><p><span>In a sample of 17,545 children, 29% of children were exposed to one or more ACEs. Seventy-seven percent of children with no ACEs received daily early literacy developmental activities compared to 23% of children who experienced any ACE. On ordinal logistic regression, daily early literacy developmental activities were associated with 56% greater odds of higher SR among children not exposed to ACEs (OR: 1.56; 95% CI: 1.29, 1.88; </span><em>P</em> < .01). Among children exposed to ACEs, daily early literacy developmental activities were also associated with higher SR (OR: 1.50; 95% CI: 1.06, 2.13; <em>P</em> = .02).</p></div><div><h3>Conclusions</h3><p>Shared reading, storytelling, and singing are associated with improved SR in both children who have and have not been exposed to ACEs. However, children exposed to ACEs had fewer experiences with early literacy developmental activities. Future efforts should address the barriers that limit shared reading, singing, or storytelling for children exposed to ACEs.</p></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139421523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Early Literacy Promotion Using Automated Hovering Among Young Minority Children 在少数民族儿童中使用自动悬停的早期识字促进。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-08-01 DOI: 10.1016/j.acap.2023.11.010

Objective

To determine feasibility, acceptability, and explore outcomes of behavioral economic (BE) strategies to increase parent-child shared reading within a Reach Out and Read program.

Methods

We conducted rapid-cycle interviews with 10 parents to assess text messages followed by an 8-week randomized controlled trial of 3 BE strategies at 2 urban primary care practices: daily text messages (texting); daily text messages and regret messaging (regret); or daily text messages, regret messaging, and lottery participation (lottery). Parent-child dyads were eligible if children were <24 months old, Medicaid-eligible, and had access to phones capable of receiving and sending text messages. Parents completed the Read Subscale of the StimQ and Parenting Stress Index-short form (PSI-SF) pre- and postintervention, MacArthur Communicative Development Inventory (CDI), Devereux Early Childhood Assessment (DECA), and a satisfaction measure postintervention. Differences between groups were assessed using intention-to-treat analysis.

Results

Of 45 dyads randomized, 41 (91%) completed the study. Most participants were Black with incomes <$55,000. Parents reported reading on average 4 d/wk with no change in the reading frequency over time. StimQ scores increased over time, but there were no significant differences in StimQ, PSI-SF, CDI, and DECA scores between groups. Parents in all 3 groups reported satisfaction (3.8/5.0) with the intervention.

Conclusions

Implementation of BE strategies in 2 Reach Out and Read programs was feasible, near acceptable, and improved home reading environment scores. Future study should investigate BE strategies vis-à-vis usual care and be of sufficient duration and intensity to engage participants to assess its impact on patient and parent outcomes.

目的:确定行为经济(BE)策略的可行性、可接受性，并探讨在Reach Out and Read计划中增加亲子共享阅读的效果。方法:我们对10名家长进行了快速循环访谈，以评估短信的使用情况，随后在2个城市初级保健诊所进行了为期8周的3种BE策略随机对照试验:每天发短信;每天发短信和后悔短信(后悔);或者每天发短信，后悔短信，参加彩票(彩票)。结果:在随机分配的45对夫妇中，41对(91%)完成了研究。结论:在两个接触和阅读计划中实施BE策略是可行的，接近可接受的，并且改善了家庭阅读环境得分。未来的研究应针对-à-vis常规护理调查BE策略，并应有足够的持续时间和强度，以吸引参与者评估其对患者和家长结局的影响。最新消息:行为经济学策略已被用于改变吸烟、减肥和其他行为，但尚未在亲子共同阅读中进行过测试。我们发现这些策略是可行的，几乎可以接受的，并且改善了低收入父母的家庭阅读环境。

{"title":"Early Literacy Promotion Using Automated Hovering Among Young Minority Children","authors":"","doi":"10.1016/j.acap.2023.11.010","DOIUrl":"10.1016/j.acap.2023.11.010","url":null,"abstract":"<div><h3>Objective</h3><p>To determine feasibility, acceptability, and explore outcomes of behavioral economic (BE) strategies to increase parent-child shared reading within a Reach Out and Read program.</p></div><div><h3>Methods</h3><p>We conducted rapid-cycle interviews with 10 parents to assess text messages followed by an 8-week randomized controlled trial<span> of 3 BE strategies at 2 urban primary care practices: daily text messages (texting); daily text messages and regret messaging (regret); or daily text messages, regret messaging, and lottery participation (lottery). Parent-child dyads were eligible if children were <24 months old, Medicaid-eligible, and had access to phones capable of receiving and sending text messages. Parents completed the Read Subscale of the StimQ and Parenting Stress Index-short form (PSI-SF) pre- and postintervention, MacArthur Communicative Development Inventory (CDI), Devereux Early Childhood Assessment (DECA), and a satisfaction measure postintervention. Differences between groups were assessed using intention-to-treat analysis.</span></p></div><div><h3>Results</h3><p>Of 45 dyads randomized, 41 (91%) completed the study. Most participants were Black with incomes <$55,000. Parents reported reading on average 4 d/wk with no change in the reading frequency over time. StimQ scores increased over time, but there were no significant differences in StimQ, PSI-SF, CDI, and DECA scores between groups. Parents in all 3 groups reported satisfaction (3.8/5.0) with the intervention.</p></div><div><h3>Conclusions</h3><p>Implementation of BE strategies in 2 Reach Out and Read programs was feasible, near acceptable, and improved home reading environment scores. Future study should investigate BE strategies vis-à-vis usual care and be of sufficient duration and intensity to engage participants to assess its impact on patient and parent outcomes.</p></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92157239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Racial and Ethnic Disparities in Receipt of Pediatric Mental Health Care 接受儿科精神保健的种族和民族差异。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-08-01 DOI: 10.1016/j.acap.2024.01.024

Background

Studies suggest increasing mental health care needs among children but limited capacity to meet those needs, potentially leaving some needs unmet. There are no recent national studies examining the receipt of mental health treatment among children. We sought to identify the correlates of treatment receipt in a nationally representative sample of children in the United States.

Methods

We conducted a cross-sectional analysis of the 2019 National Health Interview Survey. Parents reported on their child’s sociodemographic characteristics, general health care engagement, mental health using the Strengths and Difficulties Questionnaire, and whether their child received therapy or medication in the prior year. Weighted logistic regressions tested associations among child characteristics and receipt of mental health treatment while controlling for parental report of child mental health symptoms.

Results

Among 7168 children surveyed, 1044 (15%) received mental health treatment, equating to over 7 million US children. Hispanic children (adjusted odds ratio [AOR]: 0.46 [95% confidence interval (CI): 0.34–0.62]) and non-Hispanic Black children (AOR: 0.35 [95% CI: 0.23–0.54]) had lower odds of receiving treatment compared to non-Hispanic White children, controlling for mental health symptoms. Children with a well-child visit in the last year (AOR: 2.05 [95% CI: 1.20–3.52]) and whose usual place of care was a doctor’s office (AOR 2.10 [95% CI: 1.33–3.34]) had higher odds of treatment receipt.

Conclusions

Racially and ethnically minoritized children and those without primary care access have disproportionately low levels of receipt of mental health treatment. Interventions to meet the needs of these groups should be prioritized to reduce mental health disparities.

背景：研究表明，儿童的心理保健需求在不断增加，但满足这些需求的能力却很有限，有可能导致一些需求得不到满足。最近还没有针对儿童接受心理健康治疗情况的全国性研究。我们试图从具有全国代表性的美国儿童样本中找出接受治疗的相关因素：我们对 2019 年全国健康访谈调查进行了横断面分析。父母报告了他们孩子的社会人口特征、一般医疗保健参与情况、使用优势与困难问卷调查的心理健康情况，以及他们的孩子在上一年是否接受了治疗或药物治疗。加权逻辑回归检验了儿童特征与接受心理健康治疗之间的关系，同时控制了父母对儿童心理健康症状的报告：在接受调查的 7,168 名儿童中，1,044 人（15%）接受了心理健康治疗，相当于 700 多万美国儿童。西班牙裔儿童（调整后的几率比 [AOR]：与非西班牙裔白人儿童相比，在控制了心理健康症状的情况下，西班牙裔儿童（调整后的几率比 [AOR]：0.46 [95% 置信区间 (CI)：0.34-0.62]）和非西班牙裔黑人儿童（调整后的几率比 [AOR]：0.35 [95% 置信区间 (CI)：0.23-0.54]）接受治疗的几率较低。在过去一年中接受过儿童健康检查（AOR：2.05 [95% CI：1.20-3.52]）且通常就诊于医生办公室（AOR：2.10 [95% CI：1.33-3.34]）的儿童接受治疗的几率更高：结论：少数种族和少数族裔儿童以及无法获得初级保健服务的儿童接受心理健康治疗的比例过低。新发现：在这一具有全国代表性的样本中，15% 的美国儿童接受了心理健康治疗，相当于 700 多万美国儿童。少数种族和族裔儿童以及没有持续初级保健服务的儿童未接受治疗的比例过高。

{"title":"Racial and Ethnic Disparities in Receipt of Pediatric Mental Health Care","authors":"","doi":"10.1016/j.acap.2024.01.024","DOIUrl":"10.1016/j.acap.2024.01.024","url":null,"abstract":"<div><h3>Background</h3><p>Studies suggest increasing mental health care needs among children but limited capacity to meet those needs, potentially leaving some needs unmet. There are no recent national studies examining the receipt of mental health treatment among children. We sought to identify the correlates of treatment receipt in a nationally representative sample of children in the United States.</p></div><div><h3>Methods</h3><p>We conducted a cross-sectional analysis of the 2019 National Health Interview Survey. Parents reported on their child’s sociodemographic characteristics, general health care engagement, mental health using the Strengths and Difficulties Questionnaire, and whether their child received therapy or medication in the prior year. Weighted logistic regressions tested associations among child characteristics and receipt of mental health treatment while controlling for parental report of child mental health symptoms.</p></div><div><h3>Results</h3><p>Among 7168 children surveyed, 1044 (15%) received mental health treatment, equating to over 7 million US children. Hispanic children (adjusted odds ratio [AOR]: 0.46 [95% confidence interval (CI): 0.34–0.62]) and non-Hispanic Black children (AOR: 0.35 [95% CI: 0.23–0.54]) had lower odds of receiving treatment compared to non-Hispanic White children, controlling for mental health symptoms. Children with a well-child visit in the last year (AOR: 2.05 [95% CI: 1.20–3.52]) and whose usual place of care was a doctor’s office (AOR 2.10 [95% CI: 1.33–3.34]) had higher odds of treatment receipt.</p></div><div><h3>Conclusions</h3><p>Racially and ethnically minoritized children and those without primary care access have disproportionately low levels of receipt of mental health treatment. Interventions to meet the needs of these groups should be prioritized to reduce mental health disparities.</p></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S187628592400024X/pdfft?md5=71c1e6abab9502426300aa1fe4d92987&pid=1-s2.0-S187628592400024X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Quality Improvement Initiative to Improve Health Care Transition Planning at Adolescent Well Visits 在青少年健康检查中改进医疗保健过渡规划的质量改进计划。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-08-01 DOI: 10.1016/j.acap.2024.03.013

Objective

Health care transition (HCT) planning supports adolescents as they move from pediatric to adult health care and is recommended for all youth. HCT planning uptake remains low, with little known about HCT in the adolescent well child check (WCC) setting. We sought to increase rates of HCT planning at WCCs by adapting best practices for HCT from specialty and chronic care.

Methods

This quality improvement initiative at 12 to 17-year-old WCCs at four Internal Medicine-Pediatrics primary care clinics, was based on the first three of the “Six Core Elements” of HCT framework and integrated into the electronic health record. Two uptake measures were assessed via chart review after three plan-do-study-act (PDSA) cycles, with two provider surveys and an implementation science analysis further informing interpretation.

Results

By the final PDSA cycle, the percentage of 14 to 17-year-old WCCs at which HCT planning was discussed and a screening tool completed increased from 5% to 31%, and the percentage of 12 to 13-year-old WCCs at which the HCT policy was discussed increased from 6% to 47%. Provider survey results revealed endorsement of HCT goals, but time and technological barriers, which were further elucidated in the implementation science analysis.

Conclusions

This quality improvement initiative increased rates of HCT planning during adolescent WCCs. While limited to three Core Elements and Internal Medicine-Pediatrics clinics, strengths include measures capturing all WCCs, contextualized by provider surveys and an implementation science framework. Lessons from this effort can inform future tailored HCT initiatives at adolescent WCCs.

目标：医疗保健过渡（HCT）规划可在青少年从儿科医疗保健转入成人医疗保健时为他们提供支持，建议所有青少年都应制定该规划。目前，HCT 计划的采用率仍然很低，而且人们对青少年健康儿童检查（WCC）中的 HCT 也知之甚少。我们试图通过借鉴专科和慢性病护理中的 HCT 最佳实践来提高 WCC 中的 HCT 规划率：在四家内科-儿科初级保健诊所的 12 至 17 岁儿童健康检查中开展的这项质量改进活动，以 HCT "六大核心要素 "框架的前三项为基础，并将其整合到电子健康记录中。在三个 "计划-实施-研究-行动"（PDSA）周期后，通过病历审查评估了两项吸收措施，并通过两项医疗服务提供者调查和一项实施科学分析为解释提供了进一步信息：在最后一个 PDSA 周期中，讨论过 HCT 计划并完成筛查工具的 14 至 17 岁 WCC 的比例从 5% 提高到 31%，讨论过 HCT 政策的 12 至 13 岁 WCC 的比例从 6% 提高到 47%。提供者调查结果显示，HCT 目标得到了认可，但存在时间和技术障碍，实施科学分析进一步阐明了这一点：这项质量改进措施提高了青少年 WCC 期间的 HCT 规划率。虽然仅限于三个核心要素和内科-儿科诊所，但其优点包括通过提供者调查和实施科学框架对所有 WCC 进行测量。新内容：我们介绍了一项质量改进措施，该措施提高了青少年健康检查中医疗保健过渡规划的比例。这一过程以及从中汲取的经验教训可为今后在青少年健康访视中开展量身定制的 HCT 规划工作提供参考。

{"title":"A Quality Improvement Initiative to Improve Health Care Transition Planning at Adolescent Well Visits","authors":"","doi":"10.1016/j.acap.2024.03.013","DOIUrl":"10.1016/j.acap.2024.03.013","url":null,"abstract":"<div><h3>Objective</h3><p>Health care transition (HCT) planning supports adolescents as they move from pediatric to adult health care and is recommended for all youth. HCT planning uptake remains low, with little known about HCT in the adolescent well child check (WCC) setting. We sought to increase rates of HCT planning at WCCs by adapting best practices for HCT from specialty and chronic care.</p></div><div><h3>Methods</h3><p>This quality improvement initiative at 12 to 17-year-old WCCs at four Internal Medicine-Pediatrics primary care clinics, was based on the first three of the “Six Core Elements” of HCT framework and integrated into the electronic health record. Two uptake measures were assessed via chart review after three plan-do-study-act (PDSA) cycles, with two provider surveys and an implementation science analysis further informing interpretation.</p></div><div><h3>Results</h3><p>By the final PDSA cycle, the percentage of 14 to 17-year-old WCCs at which HCT planning was discussed and a screening tool completed increased from 5% to 31%, and the percentage of 12 to 13-year-old WCCs at which the HCT policy was discussed increased from 6% to 47%. Provider survey results revealed endorsement of HCT goals, but time and technological barriers, which were further elucidated in the implementation science analysis.</p></div><div><h3>Conclusions</h3><p>This quality improvement initiative increased rates of HCT planning during adolescent WCCs. While limited to three Core Elements and Internal Medicine-Pediatrics clinics, strengths include measures capturing all WCCs, contextualized by provider surveys and an implementation science framework. Lessons from this effort can inform future tailored HCT initiatives at adolescent WCCs.</p></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1876285924001128/pdfft?md5=d2ee51dc93d7e9cefc99524e10cd7a27&pid=1-s2.0-S1876285924001128-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140190396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Vision for Children in America 美国儿童的愿景

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-08-01 DOI: 10.1016/j.acap.2024.06.004

引用次数: 0

Language Disparities in Caregiver Satisfaction with Physician Communication at Well Visits from 0-2 Years 护理人员对 0-2 岁健康检查中医生沟通满意度的语言差异

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-08-01 DOI: 10.1016/j.acap.2024.03.004

Objective

This study aimed to describe caregiver satisfaction with physician communication over the first two years of life and examine differences by preferred language and the relationship to physician continuity.

Methods

Longitudinal data were collected at well visits (2 months to 2 years) from participants in a randomized controlled trial to prevent childhood obesity. Satisfaction with communication was assessed using the validated Communication Assessment Tool (CAT) questionnaire. Changes in the odds of optimal scores were estimated in mixed-effects logistic regression models to evaluate the associations between satisfaction over time and language, interpreter use, and physician continuity.

Results

Of 865 caregivers, 35% were Spanish-speaking. Spanish-speaking caregivers without interpreters had lower odds of an optimal satisfaction score compared with English speakers during the first 2 years, beginning at 2 months [OR 0.64 (95% CI: 0.43, 0.95)]. There was no significant difference in satisfaction between English-speaking caregivers and Spanish-speaking caregivers with an interpreter. The odds of optimal satisfaction scores increased over time for both language groups. For both language groups, odds of an optimal satisfaction score decreased each time a new physician was seen for a visit [OR 0.82 (95% CI: 0.69, 0.97)].

Conclusion

Caregiver satisfaction with physician communication improves over the first two years of well-child visits for both English- and Spanish-speakers. A loss of physician continuity over time was also associated with lower satisfaction. Future interventions to ameliorate communication disparities should ensure adequate interpreter use for primarily Spanish-speaking patients and address continuity issues to improve communication satisfaction.

本研究旨在描述照顾者在孩子出生后头两年内对医生沟通的满意度，并研究首选语言的差异以及与医生连续性的关系。研究人员在一项预防儿童肥胖的随机对照试验的参与者进行健康检查（2 个月至 2 年）时收集了纵向数据。使用有效的沟通评估工具（CAT）问卷对沟通满意度进行评估。在混合效应逻辑回归模型中估算了最佳得分几率的变化，以评估满意度随时间推移与语言、翻译使用和医生连续性之间的关联。在 865 名护理人员中，35% 讲西班牙语。与讲英语的护理人员相比，讲西班牙语但没有口译员的护理人员在最初 2 年中从 2 个月开始获得最佳满意度评分的几率较低[OR 0.64 (95% CI: 0.43, 0.95)]。会说英语的护理人员和会说西班牙语的护理人员在满意度方面没有明显差异。随着时间的推移，两个语言组的最佳满意度得分几率均有所上升。对于两个语言组，每次换一位医生就诊时，最佳满意度得分的几率都会下降[OR 0.82 (95% CI: 0.69, 0.97)]。对于讲英语和西班牙语的人来说，照顾者对医生沟通的满意度在最初两年的儿童健康检查中都有所提高。随着时间的推移，医生连续性的丧失也与满意度降低有关。未来为改善沟通差异而采取的干预措施应确保为主要讲西班牙语的患者提供足够的翻译，并解决连续性问题，以提高沟通满意度。照顾者对医生沟通的满意度在健康儿童就诊的头两年有所提高，并因语言、翻译的使用和医生的连续性而异。

{"title":"Language Disparities in Caregiver Satisfaction with Physician Communication at Well Visits from 0-2 Years","authors":"","doi":"10.1016/j.acap.2024.03.004","DOIUrl":"10.1016/j.acap.2024.03.004","url":null,"abstract":"<div><h3>Objective</h3><p>This study aimed to describe caregiver satisfaction with physician communication over the first two years of life and examine differences by preferred language and the relationship to physician continuity.</p></div><div><h3>Methods</h3><p>Longitudinal data were collected at well visits (2 months to 2 years) from participants in a randomized controlled trial to prevent childhood obesity. Satisfaction with communication was assessed using the validated Communication Assessment Tool (CAT) questionnaire. Changes in the odds of optimal scores were estimated in mixed-effects logistic regression models to evaluate the associations between satisfaction over time and language, interpreter use, and physician continuity.</p></div><div><h3>Results</h3><p>Of 865 caregivers, 35% were Spanish-speaking. Spanish-speaking caregivers without interpreters had lower odds of an optimal satisfaction score compared with English speakers during the first 2 years, beginning at 2 months [OR 0.64 (95% CI: 0.43, 0.95)]. There was no significant difference in satisfaction between English-speaking caregivers and Spanish-speaking caregivers with an interpreter. The odds of optimal satisfaction scores increased over time for both language groups. For both language groups, odds of an optimal satisfaction score decreased each time a new physician was seen for a visit [OR 0.82 (95% CI: 0.69, 0.97)].</p></div><div><h3>Conclusion</h3><p>Caregiver satisfaction with physician communication improves over the first two years of well-child visits for both English- and Spanish-speakers. A loss of physician continuity over time was also associated with lower satisfaction. Future interventions to ameliorate communication disparities should ensure adequate interpreter use for primarily Spanish-speaking patients and address continuity issues to improve communication satisfaction.</p></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140054032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Childhood Exposure to Firearm Violence in Chicago and Its Impact on Mental Health 芝加哥儿童期遭遇枪支暴力及其对心理健康的影响

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics

Pub Date : 2024-08-01 DOI: 10.1016/j.acap.2023.12.001

Objective

To describe how often Chicago children are exposed to firearm violence, the types of exposure, and the parent-reported impact of these exposures on child mental health symptoms.

Methods

Data were collected in May-July 2022 using the Voices of Child Health in Chicago Parent Panel Survey, administered to parents with children aged 2–17 years from all 77 Chicago neighborhoods. Firearm violence exposure was characterized as indirect (hearing gunshots or knowing someone who was shot) or direct (witnessing a shooting, being threatened with a firearm, being shot at but not injured, or being shot and injured). Parents indicated if children in their household had any of the following mental health symptoms associated with firearm violence exposure: fear, anxiety, sadness, isolation, difficulty concentrating, difficulty in school, or aggression. Chi-squared tests and multivariable logistic regression models were used for statistical analysis.

Results

Responses were received from 989 Chicago parents. More than one third (37%) of children were exposed to firearm violence with an indirect exposure prevalence of 32% and a direct exposure prevalence of 10%. Mental health symptoms associated with firearm violence exposure were reported for 20% of children. Mental health symptoms were reported for 7% of children without firearm violence exposure compared to 31% with indirect exposure (aOR 6.2, 95% CI: 3.7, 10.6) and 68% with direct exposure (aOR 36.1, 95% CI: 16.6, 78.6)

Conclusions

Chicago children with indirect and direct exposure to firearm violence had more parent-reported mental health symptoms than unexposed children. Trauma informed care approaches to mitigate the negative mental health effects of both direct and indirect firearm violence exposure are critical.

方法 2022 年 5 月至 7 月，通过 "芝加哥儿童健康之声 "家长小组调查（Voices of Child Health in Chicago Parent Panel Survey）收集数据，调查对象为芝加哥所有 77 个社区 2-17 岁儿童的家长。接触枪支暴力的情况分为间接接触（听到枪声或知道有人中枪）或直接接触（目睹枪击、受到枪支威胁、中枪但未受伤或中枪受伤）。家长需说明家中儿童是否有以下与枪支暴力相关的心理健康症状：恐惧、焦虑、悲伤、孤独、注意力难以集中、学业困难或攻击行为。统计分析采用了卡方检验和多变量逻辑回归模型。超过三分之一（37%）的儿童接触过枪支暴力，间接接触率为 32%，直接接触率为 10%。据报告，有 20% 的儿童出现了与枪支暴力相关的心理健康症状。据报告，7%未接触过枪支暴力的儿童有心理健康症状，而31%间接接触过枪支暴力的儿童有心理健康症状（aOR 6.2，95% CI：3.7，10.6），68%直接接触过枪支暴力的儿童有心理健康症状（aOR 36.1，95% CI：16.6，78.6）。采用创伤知情护理方法来减轻直接和间接接触枪支暴力对心理健康造成的负面影响至关重要。最新情况芝加哥的许多儿童间接接触枪支暴力的机会多于直接接触枪支暴力的机会。近三分之一间接接触枪支暴力的儿童和超过三分之二直接接触枪支暴力的儿童有家长报告的心理健康症状。

{"title":"Childhood Exposure to Firearm Violence in Chicago and Its Impact on Mental Health","authors":"","doi":"10.1016/j.acap.2023.12.001","DOIUrl":"10.1016/j.acap.2023.12.001","url":null,"abstract":"<div><h3>Objective</h3><p>To describe how often Chicago children are exposed to firearm violence, the types of exposure, and the parent-reported impact of these exposures on child mental health symptoms.</p></div><div><h3>Methods</h3><p>Data were collected in May-July 2022 using the Voices of Child Health in Chicago Parent Panel Survey, administered to parents with children aged 2–17 years from all 77 Chicago neighborhoods. Firearm violence exposure<span> was characterized as indirect (hearing gunshots or knowing someone who was shot) or direct (witnessing a shooting, being threatened with a firearm, being shot at but not injured, or being shot and injured). Parents indicated if children in their household had any of the following mental health symptoms associated with firearm violence exposure: fear, anxiety, sadness, isolation, difficulty concentrating, difficulty in school, or aggression. Chi-squared tests and multivariable logistic regression models were used for statistical analysis.</span></p></div><div><h3>Results</h3><p>Responses were received from 989 Chicago parents. More than one third (37%) of children were exposed to firearm violence with an indirect exposure prevalence of 32% and a direct exposure prevalence of 10%. Mental health symptoms associated with firearm violence exposure were reported for 20% of children. Mental health symptoms were reported for 7% of children without firearm violence exposure compared to 31% with indirect exposure (aOR 6.2, 95% CI: 3.7, 10.6) and 68% with direct exposure (aOR 36.1, 95% CI: 16.6, 78.6)</p></div><div><h3>Conclusions</h3><p>Chicago children with indirect and direct exposure to firearm violence had more parent-reported mental health symptoms than unexposed children. Trauma informed care approaches to mitigate the negative mental health effects of both direct and indirect firearm violence exposure are critical.</p></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138687028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0