Hospital pediatrics最新文献

{"title":"The Moderating Effects of Waiver Enrollment and Home Nursing Care on Hospitalization Risk.","authors":"Caitlin Koob, Elizabeth Mack, Sarah Griffin","doi":"10.1542/hpeds.2024-008215","DOIUrl":"10.1542/hpeds.2024-008215","url":null,"abstract":"<p><strong>Objectives: </strong>This study identifies factors associated with hospitalization and examines the moderating effects of South Carolina Medicaid's Medically Complex Children's Waiver (MCCW) enrollment and receipt of home nursing care (HNC) on hospitalization risk among Medicaid-insured children with medical complexity in South Carolina from 2019 to 2022.</p><p><strong>Methods: </strong>We analyzed retrospective Medicaid claims data from 783 149 billed home health care claims among 4484 children aged 0 to 21 years in South Carolina from 2019 to 2022. The outcome of interest was experiencing at least 1 hospitalization from 2019 to 2022. The Pediatric Medical Complexity Algorithm version 3.0 was applied, using International Classification of Diseases, Tenth Revision (ICD-10) codes to classify diagnoses as either a complex chronic disease (C-CD) or a noncomplex chronic disease (NC-CD).</p><p><strong>Results: </strong>Children with a C-CD aged 0 to 4 and 20 to 21 years who identified with a race and ethnicity other than non-Hispanic white, were primarily insured by Medicaid, and received services in 2020 and 2021 had significantly higher hospitalization risk compared with other children. Controlling for MCCW, HNC had a mediating effect on hospitalization risk for CMC with a C-CD (odds ratio [OR] 1.03, 95% CI: 1.02-1.04, compared with children with an NC-CD). Children with a C-CD who received HNC had significantly lower hospitalization risk (adjusted OR [AOR] 0.87, 95% CI: 0.85-0.89) compared with children with an NC-CD. Children who received HNC in 2020 (AOR 0.90, 95% CI: 0.84-0.96) and 2021 (OR 0.92, 95% CI: 0.86-0.98) had significantly lower odds of hospitalization(s) compared with those without nursing in 2019.</p><p><strong>Conclusions: </strong>MCCW enrollment lowers hospitalization risk to an extent; however, HNC may have reduced hospitalization risk throughout the COVID-19 pandemic. Further research is needed to understand the intricacies of South Carolina Medicaid's MCCW and to improve health among Medicaid-insured children in South Carolina.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"667-675"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144745332","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}

{"title":"Components of Family Meetings for Hospitalized Children With Serious Illness: A Scoping Review.","authors":"Aisling Semple, Melissa Finlay, Asiya Ali, Kate Tsiandoulas, Vishu Chakravarti, Francine Buchanan, Kimberley Widger, Catherine Diskin, Katherine E Nelson","doi":"10.1542/hpeds.2024-008302","DOIUrl":"10.1542/hpeds.2024-008302","url":null,"abstract":"<p><strong>Context: </strong>Family meetings between pediatric clinicians and parents are used to facilitate in-depth discussions and decision-making about patient care. To guide implementation of family meetings for hospitalized children with medical complexity, this scoping review identified the common components of family meetings for hospitalized pediatric patients with serious illness across pediatric subspecialties.</p><p><strong>Objective: </strong>To describe key components of family meetings for hospitalized pediatric patients with serious illness.</p><p><strong>Data sources: </strong>With the assistance of a professional librarian, we searched 5 databases.</p><p><strong>Study selection: </strong>We included primary research studies describing planned interactions between 2 or more health care providers and family decision-makers for hospitalized children with serious illness.</p><p><strong>Data extraction: </strong>We extracted components of family meetings, which we organized based on timing (before, during, and after the meeting) and combined thematically.</p><p><strong>Results: </strong>We evaluated 11 151 title/abstracts, reviewed 77 full-text articles, and included 23 articles describing 21 studies. Most studies focused on meetings in intensive care units (96%), were conducted in the United States (91%), and were published after 2020 (52%). We identified 15 components occurring before (n = 4), during (n = 8), and after (n = 3) family meetings. Components included both specific tasks (identify need for a meeting) and communication goals (assess and support understanding). Most components were identified through study observations rather than recommendations made by the researchers.</p><p><strong>Conclusion: </strong>There is a developing body of evidence about family meetings, which is largely focused on intensive care settings, that can inform development of targeted research to support implementation of family meetings in pediatric hospital medicine.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e392-e403"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545266","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}

{"title":"Future-Proofing Pediatric Hospital Medicine: Medical Education in Workforce Sustainability.","authors":"Monisha Sachdev, Averi E Wilson, Kelci B Butler","doi":"10.1542/hpeds.2025-008523","DOIUrl":"10.1542/hpeds.2025-008523","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e386-e388"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062563","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}

{"title":"Characterization of Potentially Avoidable Pediatric Intensive Care Unit Transfers.","authors":"Anna Jane Sibilia, Maya Dewan, Abigail Gauthier, Imogen Clover-Brown, Ellen Pittman, Ranjit S Chima","doi":"10.1542/hpeds.2025-008338","DOIUrl":"10.1542/hpeds.2025-008338","url":null,"abstract":"<p><strong>Background and objective: </strong>Rapid response systems (RRSs) assess and transfer patients from general care units to the pediatric intensive care unit (PICU) and are necessary to safely care for hospitalized patients. A proportion of patients who transfer to the PICU do not receive PICU-specific care and may be considered potentially avoidable transfers (PATs). The objective of this study is to describe and characterize PATs at a quaternary free-standing children's hospital.</p><p><strong>Patients and methods: </strong>Reasons for RRS activation were collected using a prospective survey at the time of RRS activation. Retrospective chart review was conducted on PICU transfers to determine if they met criteria for PAT. PATs were identified if the patient did not experience a critical deterioration event, could not be classified as an emergent transfer, or did not undergo any PICU-specific interventions.</p><p><strong>Results: </strong>Nearly half (110/255; 43%) of transfers to the PICU via RRS were classified as PATs. Median time from admission to transfer was 32 hours (interquartile range 13.2-99.4) with a median age of 6 years (interquartile range 1.52-14.74). PATs most commonly came from the general pediatrics unit (33%). The most common reason for transfer for PATs was respiratory distress.</p><p><strong>Conclusions: </strong>PATs made up nearly half of transfers from the general care unit to the PICU. We propose that PATs can be considered a balancing metric in the assessment of RRSs, especially as inpatient pediatric care is becoming increasingly limited.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"660-666"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609819","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}

{"title":"If It Were That Simple, We Would Have Done It Already: Perspectives From the Sandwich Generation of Inpatient Physicians.","authors":"Erica Andrist, Naomi Laventhal","doi":"10.1542/hpeds.2025-008622A","DOIUrl":"https://doi.org/10.1542/hpeds.2025-008622A","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":"15 8","pages":"e420"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761678","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}

{"title":"A Window Into Life as a Newborn Hospitalist: What Can the Next Generation Expect?","authors":"Grace Rivera Owen, Paul H Lerou, Leela Sarathy","doi":"10.1542/hpeds.2025-008401","DOIUrl":"10.1542/hpeds.2025-008401","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e389-e391"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052142","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}

{"title":"Burden of \"Pokes\" in Newborns With Hypoglycemia Who Require IV Dextrose.","authors":"Adam Frymoyer, Erika M Monasch, Ming Yeh Lee, David M Maahs","doi":"10.1542/hpeds.2025-008375","DOIUrl":"10.1542/hpeds.2025-008375","url":null,"abstract":"<p><strong>Objective: </strong>Neonatal hypoglycemia is one of the most common reasons for neonatal intensive care unit (NICU) admission in otherwise healthy late preterm and term newborns. Routine care requires frequent blood glucose (BG) measurements, typically via painful heel lances, to titrate intravenous (IV) dextrose during treatment. However, little is known about the care for these newborns including the burden of BG measurements.</p><p><strong>Patients and methods: </strong>This was a retrospective medical record review (July 2018 to July 2024) of newborns at least 35 weeks gestational age who had hypoglycemia screening in a university-affiliated newborn nursery and subsequently required NICU admission for IV dextrose. IV dextrose was initiated if target glucose levels per national guidelines were not achieved with buccal dextrose gel with or without oral supplementation. BG measurements before feeds typically via heel lance and point-of-care glucometers continued until euglycemia was achieved with enteral feeds alone. Descriptive statistics of newborn characteristics, number of BG measurements, and length of stay were analyzed.</p><p><strong>Results: </strong>Among 7823 newborns screened for hypoglycemia in the newborn nursery, 298 (3.8%) required IV dextrose and NICU admission. Newborns who received IV dextrose experienced a median 29 (IQR, 19-40) BG measurements while hospitalized. More than 25% of newborns had at least 40 BG measurements and almost half had at least 30 glucose measurements. The median length of stay was 6 (IQR, 4-9) days.</p><p><strong>Conclusions: </strong>Newborns with hypoglycemia requiring IV dextrose experience a high burden of BG measurements. Evidence-based practices along with noninvasive glucose monitoring approaches that may safely reduce the number of painful \"pokes\" during clinical care should be investigated.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e377-e381"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691796","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}

{"title":"Discrimination as a Social Determinant of Health in Transgender and Gender-Expansive Adolescents.","authors":"Sophie Lieberman, Emma Gerstenzang, Anna Kiesnowski, Aditi Vasan","doi":"10.1542/hpeds.2024-008203","DOIUrl":"10.1542/hpeds.2024-008203","url":null,"abstract":"<p><p>Travis, a 17-year-old transgender boy, was admitted to an inpatient general pediatrics service for pyelonephritis and was also found to have severe constipation and weight loss. Detailed history revealed avoidance of eating, drinking, or urinating during daytime hours to avoid bathroom use at school, precipitating his presentation. His case was complicated by discomfort with genitourinary examination and constipation therapies. Through this case, we explore discrimination as a root cause for health disparities and adverse outcomes among transgender and gender-expansive (TGE) youth. We discuss how clinician discomfort, lack of knowledge, and inability to provide trauma-informed care may exacerbate patients' gender dysphoria and contribute to negative experiences with the health care system. We also discuss the minority stress model as a framework to understand health disparities and describe the current federal- and state-level legal landscape with regard to TGE youth and their activities of daily living, including their access to school facilities, participation in athletics, and access to health care. We propose concrete action steps that hospital clinicians and health systems can take to increase access to care and improve health outcomes for TGE youth, with a focus on affirmation, family and clinician support for children, and advocacy.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"693-699"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592539","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}

{"title":"Implementation Frameworks, Strategies, and Outcomes in Optimizing Central Venous Access Device Practice in Neonates: A Scoping Review.","authors":"Elouise R Comber, Deanne August, Linda N Nguyen, Sabrina de Souza, Amanda Judith Ullman, Joshua Byrnes, Samantha Keogh","doi":"10.1542/hpeds.2024-008248","DOIUrl":"10.1542/hpeds.2024-008248","url":null,"abstract":"<p><strong>Background and objectives: </strong>Central venous access devices (CVADs) are critical for neonatal care, but inconsistent CVAD practices remain a challenge and impact clinical outcomes. This scoping review aimed to determine which implementation frameworks, strategies, and outcomes are reported for neonates with CVADs.</p><p><strong>Methods: </strong>EMBASE, CINAHL (EBSCO), PubMed, Web of Science, and Cochrane Library (CENTRAL) databases were searched. All included studies examined were relevant to study aims, published from 2012 to August 2024, and in English. Two reviewers independently screened each study to determine inclusion eligibility, with a third resolving conflicts. The Mixed Methods Appraisal Tool was used to assess study quality.</p><p><strong>Results: </strong>Of the 2176 studies identified, 44 studies were included, predominantly performed in intensive care units (n = 41; 93%), at a single site (n = 39; 89%), and over a 1- to 5-year period (n = 33; 75%). \"Quality improvement\" was the most popular implementation framework (n = 27; 61%). Implementation strategies commonly cited were health professional education (n = 35; 80%), audits and surveillance (n = 34; 77%), and bundles (n = 29; 66%). Multiple implementation strategies were often used simultaneously (n = 43; 98%), and effectiveness and implementation outcomes were combined (n = 20; 45%). Infection was the most commonly reported outcome (n = 37; 84%), and intervention compliance was reported in 50% of studies (n = 22).</p><p><strong>Conclusions: </strong>Current implementation frameworks for CVAD practice are largely driven by unstructured quality improvement initiatives, focusing on a limited range of strategies for health care professionals. Broader, outcome-focused approaches to implementation research in neonatal CVAD practice have not been completed to date.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e404-e415"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683333","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}

{"title":"The Evolving PHM Workforce: Shortages and Opportunities.","authors":"Alexandra Kilinsky, Jennifer Reese","doi":"10.1542/hpeds.2025-008420","DOIUrl":"10.1542/hpeds.2025-008420","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e382-e385"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048702","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}