Hospital pediatrics最新文献_第3页

The Multidimensional Nature of Pediatric Patient Complexity. 儿科患者复杂性的多维本质。

IF 2.2

Hospital pediatrics Pub Date : 2026-10-05 DOI: 10.1542/hpeds.2026-009283

Carly E Milliren, Phillip D Hahn, Al Ozonoff

{"title":"The Multidimensional Nature of Pediatric Patient Complexity.","authors":"Carly E Milliren, Phillip D Hahn, Al Ozonoff","doi":"10.1542/hpeds.2026-009283","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009283","url":null,"abstract":"Objective: Patient complexity is defined in a variety of ways and is associated with health care costs and use. In this study, we evaluate whether pediatric inpatient complexity represents a single construct or multiple domains using multiple measures of diagnostic burden, health care use, and intensity.Methods: We analyzed administrative billing data from pediatric hospitals in the Pediatric Health Information System (PHIS) including medical and surgical hospitalizations discharged from 2021 to 2023 for patients aged 0 to 17 years with lengths of stay (LOS) of 30 days or fewer. We extracted measures of hospital use and clinical characteristics including LOS, readmissions, diagnosis and procedure codes, billing codes, and clinical classifications. For each discharge, we calculated measures capturing diagnostic burden, overall use and intensity, including unique diagnosis codes, unique items, services, and medications received, and complex chronic organ systems. We performed a principal components analysis (PCA) to examine patterns of shared variation and underlying dimensions among the included measures.Results: We included N = 2 090 139 discharges from 48 hospitals. Over three-quarters (79.5%) were medical admissions and 85% stayed less than 1 week. Our PCA identified 9 factors accounting for 74.1% of the variance. The first 3 factors comprised measures of diagnostic complexity (accounting for 20% of variance), use of medications, supply, and other items or services (17%), and procedural and overall use including LOS and intensive care unit use (10%).Conclusions: Our findings indicate pediatric inpatient complexity is multidimensional, with 9 distinct factors identified by PCA that may have important implications for health services research, quality measurement, and risk adjustment.","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Enhancing Care for Hospitalized Children With Medical Complexity via Targeted Education. 通过针对性教育加强对住院复杂医学患儿的护理。

IF 2.2

Hospital pediatrics Pub Date : 2026-10-05 DOI: 10.1542/hpeds.2026-009484

Kelci Butler, Amanda Luff, Sarah Klein, Amogha Dahal, Christian Etnyre, Mariane Cindy Ndiaye, Melanie Marsh

{"title":"Enhancing Care for Hospitalized Children With Medical Complexity via Targeted Education.","authors":"Kelci Butler, Amanda Luff, Sarah Klein, Amogha Dahal, Christian Etnyre, Mariane Cindy Ndiaye, Melanie Marsh","doi":"10.1542/hpeds.2026-009484","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009484","url":null,"abstract":"Objectives: Children with medical complexity (CMC) and their caregivers face multifaceted challenges during hospitalization. Pediatric residents are often frontline clinicians for these patients but frequently identify feelings of inadequate preparedness to meet their care needs. We assessed the impact of a multimodal curriculum on common acute and chronic medical devices in CMC on caregiver-reported resident communication. We hypothesized that targeted education would translate to improved caregiver perception of family-centered communication.Methods: We implemented a novel medical device curriculum for pediatric residents at 2 children's hospitals. Caregivers of hospitalized CMC completed a modified 14-item Communication Assessment Tool pre- and post-curricular intervention. We used generalized estimating equations at the caregiver level and paired t tests at the resident level to evaluate pre-post changes. We compared postintervention scores with those of a cohort of unexposed residents.Results: We collected 253 surveys on 39 pediatric residents. At the resident level, there was a statistical increase in overall mean score following intervention (pre, 4.844/5 [SD = 0.213]; post, 4.934/5 [SD = 0.132]; P = .0328). At the caregiver level, mean survey scores increased, although this was not statistically significant. Four of 14 survey items showed statistical improvement following intervention. Caregiver-level outcomes were consistent in the sensitivity analysis using an unexposed control, indicating robustness of findings.Conclusion: Caregivers of CMC reported modest improvements in resident collaborative communication behaviors following intervention. Ongoing deliberate practice, including expanded educational models and the integration of caregiver feedback into physician evaluation tools, may further support skill development for clinicians caring for hospitalized CMC.","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

One Step at a Time: Design and Rationale for Stepped-Wedge Cluster Randomized Trials. 一步一步：楔形步群随机试验的设计和基本原理。

IF 2.2

Hospital pediatrics Pub Date : 2026-10-05 DOI: 10.1542/hpeds.2025-009158

Sahar N Rooholamini, Corrie E McDaniel, Sunitha V Kaiser

引用次数: 0

Pediatric Institutions' Instagram Response to the 2025 Acetaminophen-Autism Controversy. 儿科机构在Instagram上对2025年扑热息痛与自闭症争议的回应。

IF 2.2

Hospital pediatrics Pub Date : 2026-10-02 DOI: 10.1542/hpeds.2026-009767

Katherine Poole, Jessica Visone, Shivani Srivastava, Kathryn Whitehill

{"title":"Pediatric Institutions' Instagram Response to the 2025 Acetaminophen-Autism Controversy.","authors":"Katherine Poole, Jessica Visone, Shivani Srivastava, Kathryn Whitehill","doi":"10.1542/hpeds.2026-009767","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009767","url":null,"abstract":"Abstract: Objective: To describe the timing, frequency, and accessibility of Instagram posts from pediatric health institutions during the 2025 acetaminophen-autism controversy.Methods: Cross-sectional audit of public Instagram accounts of 62 pediatric health institutions from September 22 to November 15, 2025. The a priori sampling frame comprised the top 50 US children's hospitals for pediatric behavioral health, the top 10 Honor Roll children's hospitals (US News and World Report), 5 national medical societies, and health departments of the 10 states with the largest pediatric populations. Posts were extracted with a web-scraping tool and manually verified. Two reviewers independently coded relevant posts for prespecified content and accessibility features. Readability was assessed with two validated measures.Results: Twelve of 62 institutions (19%) posted relevant content. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists posted on day 0, while hospital time to first post ranged from 3 to 51 days. No state health department posted. Nonresponding institutions remained active: 1 hospital published 108 unrelated posts. The 26 relevant posts had a mean Flesch-Kincaid Grade Level of 11.4 and SMOG Index of 10.2. Among coded features, 88% included resource links, 73% directed audiences to a health care provider, 46% featured a named clinician, 42% discussed risks and benefits, and none were multilingual.Conclusions: Most sampled institutions published no relevant content during an active health controversy despite remaining active. Readability of relevant posts exceeded recommended targets, and none were multilingual. These gaps in institutional communication infrastructure could be addressed.","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Bridging Practice and Publication: Reexamining Quality Improvement in Pediatric Scholarship. 衔接实践与出版：重新审视儿科学术的质量改进。

IF 2.2

Hospital pediatrics Pub Date : 2026-10-01 DOI: 10.1542/hpeds.2026-009488

Preston Simmons, Brittany M Hunter, Alejandra Frauenfelder Sánchez, Patrick Brady, David P Johnson

{"title":"Bridging Practice and Publication: Reexamining Quality Improvement in Pediatric Scholarship.","authors":"Preston Simmons, Brittany M Hunter, Alejandra Frauenfelder Sánchez, Patrick Brady, David P Johnson","doi":"10.1542/hpeds.2026-009488","DOIUrl":"10.1542/hpeds.2026-009488","url":null,"abstract":"Quality improvement (QI) publication rates in pediatrics surged through the early 21st century yet have noticeably plateaued since that time, a paradoxical shift given the volume of ongoing improvement work across pediatric health systems. We propose that the gap lies not in the quality of work being performed but in the disconnect between rigorous local improvement and publishable scholarship. Key deficits include inadequately specified aims, absent or implicit theories of change, analytic approaches that cannot distinguish intervention-related improvement from routine variation, and insufficient attention to sustainability. Closing this gap requires renewed commitment to 4 foundational components through clear operational definitions and specific, measurable, achievable, relevant, time-bound (SMART) aims that signal prospective planning to reviewers, an explicit theory of change operationalized through a well-constructed key driver diagram, time-series analytic methods capable of demonstrating special cause variation attributable to the intervention, and demonstrated sustainability evidenced by replicable change rather than temporary disruption. Rigorous single-center QI with well-described context and an explicit theory of change remains the foundation of the field. Protecting its integrity is a shared responsibility among authors, mentors, journals, and health systems and is essential to advancing evidence-based care for children.","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e815-e818"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Preparing Pediatric Hospital Medicine Physicians to Care for Transgender Youths: A Call to Action. 准备儿科医院内科医生照顾跨性别青年：行动呼吁。

IF 2.2

Hospital pediatrics Pub Date : 2026-10-01 DOI: 10.1542/hpeds.2026-009295

Sophie Lieberman, Olivia O Familusi, Aditi Vasan, Nicole Washington, Morgan Congdon

引用次数: 0

The Cost of Uncertainty: Operational Consequences of Eliminating Routine DAT Screening. 不确定性的代价：取消常规DAT筛查的操作后果。

IF 2.2

Hospital pediatrics Pub Date : 2026-10-01 DOI: 10.1542/hpeds.2026-009359

Kimberly Horstman, Ha Nguyen

引用次数: 0

Surgical Hospitalist Assisted REcovery (SHARe): Preventing Post-Operative Emergency Transfers. 外科医生协助恢复（SHARe）：防止术后紧急转移。

IF 2.2

Hospital pediatrics Pub Date : 2026-10-01 DOI: 10.1542/hpeds.2025-008778

Jason Zamkoff, Shannon N Acker, Adriana Martin, Lauren Anderson, Heather Bennett, Jessica Thysens, James J Thomas, Miriam Conant, Molly Kurtz, Rachita Gupta, Jacquelyn Scarberry, Meghan Burke, Richele Koehler, Elise Rolison, Gina Whitney, Sonja I Ziniel, Kevin P Carney, Duncan Wilcox, Justin M Lockwood

{"title":"Surgical Hospitalist Assisted REcovery (SHARe): Preventing Post-Operative Emergency Transfers.","authors":"Jason Zamkoff, Shannon N Acker, Adriana Martin, Lauren Anderson, Heather Bennett, Jessica Thysens, James J Thomas, Miriam Conant, Molly Kurtz, Rachita Gupta, Jacquelyn Scarberry, Meghan Burke, Richele Koehler, Elise Rolison, Gina Whitney, Sonja I Ziniel, Kevin P Carney, Duncan Wilcox, Justin M Lockwood","doi":"10.1542/hpeds.2025-008778","DOIUrl":"10.1542/hpeds.2025-008778","url":null,"abstract":"Background and objectives: We observed an increase in emergency transfers (ET) among post-operative patients at our health system's largest free-standing children's hospital. We aimed to reduce ET rates by 50%-from 0.21 to 0.11 events per 10 000 post-operative days-on our 72-bed inpatient surgical unit within 1 year.Methods: An interdisciplinary team applied quality improvement methods to design and implement a hospitalist surgical co-management model for children with medical complexity, Surgical Hospitalist Assisted REcovery (SHARe), along with several unit-level safety interventions. We addressed key drivers centered on safety culture, safety processes, post-operative patient placement, and post-operative provider care models. We defined ETs as unplanned intensive care unit (ICU) transfers requiring vasopressors, intubation, or high-volume fluid resuscitation within the first ICU hour. We evaluated outcomes using statistical process control charts.Results: Over an 8-year period-4 years of baseline and 4 years of intervention-we included 17 221 surgical encounters. Hospitalist management of post-operative patients increased from 7% to 27%. We reached our aim, observing special cause variation following our interventions with an ET rate decrease from 0.21 to 0 events per 10 000 post-operative days that was sustained throughout the 4-year intervention period with 7552 surgical encounters without an ET.Conclusions: We observed a sustained reduction in ETs associated with our multifaceted quality improvement initiative that integrated a hospitalist surgical co-management model for children with medical complexity (SHARe) with unit-level safety interventions.","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"839-849"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Leveraging the Data to Make Your Case: Demonstrating the Value of Pediatric Hospital Medicine to Hospital Leadership. 利用数据来证明你的观点：向医院领导层展示儿科医院医学的价值。

IF 2.2

Hospital pediatrics Pub Date : 2026-10-01 DOI: 10.1542/hpeds.2026-009284

Kristen Meredith, H Barrett Fromme

引用次数: 0

Scope, Scholarship, Sustainability: Unpacking the Pediatric Hospitalist Workforce. 范围，奖学金，可持续性：拆开儿科医院工作人员的包装。

IF 2.2

Hospital pediatrics Pub Date : 2026-10-01 DOI: 10.1542/hpeds.2026-009303

Christina M McKinney, Brittany B Hubbell

引用次数: 0