Academic Pediatrics最新文献

Microaggressions undermine health professionals' performance in patient care, research, and education. This study aimed to develop and evaluate an intervention addressing microaggressions in healthcare settings by empowering bystanders to act as upstanders across an academic medical center (AMC). This was achieved through an educational intervention that included a novel framework, didactics, video demonstrations, and practice with realistic scenarios. Methods Participants were faculty, trainees, education experts, clinical and administrative staff from a large, urban pediatric AMC. Participants were recruited from 3 training sessions, and taught the "Be Aware" and "ACT" framework, a novel tool for bystanders to use when witnessing microaggressions. Pre-training, retrospective pre-post, and 10-week follow-up surveys evaluated changes in awareness, confidence, and intervention rates. Quantitative analyses were conducted using generalized linear mixed effects models across the 3 surveys to assess participants' changes in confidence. Qualitative analysis used inductive content analysis. Results Among the 205 attendees, 134 (65.4%) completed the pre-training survey. The study cohort (n=108) included those who completed the pre-training survey with either the retrospective pre-post (n=24), 10-week follow-up (n=26), or both (n=58). Participants reported increased confidence in intervening during microaggressions, with confidence rising from 7.5% pre-training to 24.2% at 10-week follow-up (p=0.004). Qualitative analysis revealed a shift from passive response to active intervention, with participants applying the "Be Aware" and "ACT" framework during actual incidents. Conclusions The "Be Aware" and "ACT" framework increased and sustained awareness and confidence in addressing microaggressions. This AMC-wide intervention successfully equipped participants to move from passive bystanders to active upstanders.

Objectives: Outpatient follow-up visits are often recommended for children with ambulatory care-sensitive conditions (ACSCs) who are discharged from emergency departments or urgent care centers (acute care settings). We sought to assess whether attending a follow-up visit within 7 days is associated with seeking initial office-based care rather than acute care during a subsequent ACSC illness. Understanding this association is crucial to guide recommendations for routine short-term follow-up visits in children who seek acute care for these common conditions.

Methods: This was a cohort study of Medicaid-insured children younger than 18 years diagnosed with ACSCs and discharged from acute care settings in a multistate claims database in 2017-2019. We used generalized estimating equations to assess the association between a follow-up visit within 7 days and the site of initial care (office vs. acute care) during a subsequent ACSC illness. Models were adjusted for demographics, clinical characteristics, and prior patterns of healthcare utilization.

Results: Among 866,392 acute care visits for ACSCs, 250,578 (28.9%) had an outpatient follow-up visit within 7 days. Follow-up was independently associated with increased odds of initial office-based care rather than initial acute care during the subsequent ACSC illness (adjusted OR [aOR], 1.41, 95% CI, 1.39-1.42).

Conclusions: Outpatient follow-up after acute care visits for ACSCs was associated with increased odds of initial office-based care during the next illness episode. This association may support recommendations for follow-up visits for certain children to promote subsequent utilization of office-based settings during acute illnesses.

Objectives: To describe children with medical complexity (CMC) in Montana according to their clinical characteristics, rurality and distance from specialty care, and to assess for disparities in geographic access to specialty care for American Indian children.

Methods: In this cross-sectional study we categorized children in 2016-2021 Montana Medicaid claims data using the Pediatric Medical Complexity Algorithm and compared the associations of medical complexity and demographic traits using Chi-squared tests. Using a database of providers we calculated drive times from children's residences to the nearest pediatric subspecialist and calculated bootstrap confidence intervals for the difference in median driving distances by complexity and race.

Results: Among 126,873 children, 23% lived in rural areas and 20% were reported as American Indian. In all, 10,766 children (8.5%) had complex chronic conditions (CMC) and 27431 (21.6%) had non-complex chronic conditions. Medical complexity was associated with age, race, ethnicity, sex, CHIP enrollment, disability, and rurality. CMC had shorter median drive times to care than children with noncomplex medical conditions and children without chronic conditions (28 vs 34 and 43 minutes, 95% CI of differences 4-9 and 6-11). At each level of medical complexity, the median distance from care was greater for American Indian children than children of other races.

Conclusions: Although children with medical complexity tend to live closer to specialists than other children, many CMC live far from subspecialty care. American Indian children live farther from specialists than other children, regardless of complexity. Future work should support access to care for rural and American Indian CMC.