Academic Pediatrics最新文献

{"title":"An Untold Story: The Feelings of Pediatric Residents Early in the Covid-19 Pandemic and What They Can Teach Us Today.","authors":"Ariel S Winn, Monique M Naifeh, Sarah Hilgenberg, Ndidi I Unaka, H Mollie Grow, Ross E Myers, Alan Schwartz, Rhett Lieberman, Daniel J Schumacher","doi":"10.1016/j.acap.2024.102602","DOIUrl":"https://doi.org/10.1016/j.acap.2024.102602","url":null,"abstract":"<p><strong>Objective: </strong>To understand the feelings of pediatrics residents early in the COVID-19 pandemic and to offer insights still relevant today.</p><p><strong>Methods: </strong>We performed a thematic analysis exploring resident feelings early in the pandemic using free-text responses on a national survey distributed between May and June 2020. We analyzed responses from the following multi-part free text question embedded in the larger survey, \"Which of the following feelings have you experienced in your role as a pediatric resident during the COVID-19 pandemic\" with response prompts including relief, guilt, pride, sadness, worry, fear, and other.</p><p><strong>Results: </strong>While many feelings that respondents shared were common to society at large, some were specific to their intersecting roles as healthcare workers, pediatricians, and trainees. Some issues uncovered have continued relevance today including varied interactions with program and institutional leadership, training away from established support networks and during an important life stage, and societal concerns.</p><p><strong>Conclusions: </strong>This study uncovered vulnerabilities inherent to being a trainee such as limited control over one's own schedule or institutional policies and training away from established supports. Their feelings shine light on the moral distress experienced in residency and the role program and institutional leadership can play in the experiences of residents.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102602"},"PeriodicalIF":3.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631774","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}

{"title":"The Effect of Mandatory Medicaid Health Maintenance Organizations on Health Access, Utilization, and Health Outcomes for Children.","authors":"Patience Toyin-Thomas, George Wehby","doi":"10.1016/j.acap.2024.102604","DOIUrl":"10.1016/j.acap.2024.102604","url":null,"abstract":"<p><strong>Objective: </strong>Mandatory enrollment into Medicaid-contracted health maintenance organizations (HMOs) is the most common form of Medicaid managed care (MMC), but the effects of this enrollment on children are unclear. We leveraged variation in MMC implementation within and across states over time to examine the effect of mandatory Medicaid HMO enrollment on children's access, utilization, and health outcomes.</p><p><strong>Methods: </strong>Using Medical Expenditure Panel Survey data from 2000 to 2018 and multivariable regression models, we estimated the effects of living in a county with mandatory Medicaid HMO enrollment only, compared to other MMC types and fee-for-service (FFS) combined in 1 comparison group, on outcomes for children under 18 years. We also evaluated potential effect heterogeneity across age, race and ethnicity, and for children with special health care needs (CSHCNs).</p><p><strong>Results: </strong>There were small and nonsignificant associations between mandatory HMO enrollment and most outcome measures. However, mandatory HMO enrollment was associated with a 1.8%-point decline in the likelihood of having a usual source of care, 95% confidence interval (CI) [-0.035, -0.001], a 4.2%-point increase in the likelihood of delayed access to care, 95% CI [0.012, 0.072], and a 2.2%-point reduction in the likelihood of having any outpatient physician visits, 95% CI [-0.043, -0.0004], compared to other MMC and FFS combined in 1 group. Mandatory HMO enrollment was associated with more difficulty seeing a specialist for CSHCNs.</p><p><strong>Conclusions: </strong>Overall, there is little evidence that mandatory Medicaid HMO enrollment has discernable and consistent effects across a broad range of outcomes. Evaluating how mandatory Medicaid HMOs affect more nuanced health care measures, especially for children with greater health care needs, remains an important future research question.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102604"},"PeriodicalIF":3.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631797","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}

{"title":"Assembling the Pediatric Emergency Medicine Social Care Toolkit: A Modified Delphi Study.","authors":"Hannah Barber Doucet, Raymen Rammy Assaf, Kristol Das, Natalie J Tedford, Danielle Graff, Eric W Fleegler","doi":"10.1016/j.acap.2024.102599","DOIUrl":"https://doi.org/10.1016/j.acap.2024.102599","url":null,"abstract":"<p><strong>Background: </strong>The pediatric emergency department is a high-value site for screening and resource referral for health-related social needs. However, best practices for this unique environment remain unclear. This study's objective was to introduce a consensus-based social care training toolkit for the pediatric emergency medicine (PEM) setting.</p><p><strong>Methods: </strong>We conducted a modified Delphi study to establish consensus on social care practice and develop a user-friendly toolkit. Initially, five priority areas (sections) were identified. Participants reviewed literature and shared their expertise to draft preliminary sections of the toolkit. Two rounds of the modified Delphi process were conducted, involving a ranking system, significant qualitative feedback, and a final approval stage, resulting in the finalized toolkit.</p><p><strong>Results: </strong>Seventeen participants were included in the Delphi process, including pediatric and general EM faculty and trainees, as well as a social worker and public health professor. Forty-two content items were ranked in the first Delphi round. Based on a combination of score cut-off and extensiveness of qualitative comments, items were either minorly edited and kept (29%) or sent back to their section for review (71%). The second Delphi round integrated further suggested edits, and all participants in this final round approved the publicly available version of the toolkit.</p><p><strong>Conclusion: </strong>By utilizing diverse sources of information and a consensus-driven process of the modified Delphi, we generated best practice recommendations for the design, implementation, and training of social care programs in the PEM setting.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102599"},"PeriodicalIF":3.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631796","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}

{"title":"Pediatric Practices' Experiences with Massachusetts' Medicaid Accountable Care Organizations.","authors":"Shriya Jamakandi, Joan Li, Alyna T Chien, Matthew Alcusky, Michaela Kerrissey","doi":"10.1016/j.acap.2024.102601","DOIUrl":"https://doi.org/10.1016/j.acap.2024.102601","url":null,"abstract":"<p><strong>Objective: </strong>To examine the experience of Medicaid Accountable Care Organizations (ACOs) that include pediatric practices, including their motivations and experiences working together.</p><p><strong>Methods: </strong>This mixed methods study is set within the first two years of the Massachusetts Medicaid ACO Program, which created 17 Medicaid ACOs across the Commonwealth in 2018. It combines qualitative interviews from organizational leaders across three Medicaid ACOs with pediatric representation (N=28; purposive sample; 2018) with a 44-item primary care practice leader survey (N=225 after 64% response rate; statewide stratified random sample of primary care practices; 2019). Interviews gathered information about organizational motivations and experiences with becoming a Medicaid ACO; the survey asked five domains of questions describing the experience of pediatric- and adult-focused primary care practices in joining Medicaid ACOs (e.g., how much practices solved problems jointly with the ACO). We used ordinary least squares regression to describe differences in experiences across pediatric vs. non-pediatric practices.</p><p><strong>Results: </strong>Leaders of Medicaid ACO with pediatric representation expressed a desire to voice pediatric concerns regarding state Medicaid payment policy and to integrate social services as part of routine medical care. Relative to the experience of adult-focused primary care practice leaders, pediatric-focused practices reported less collaboration within the Medicaid ACO (95% confidence interval 0.81 to 0.05; p = 0.03) and less change toward standardization of policies such as physician compensation (95% confidence interval 0.61 to 0.02; p = 0.04).</p><p><strong>Conclusions: </strong>Initial Medicaid ACO experiences can differ based on the degree to which organizations joining Medicaid ACO programs serve pediatric populations.</p><p><strong>Article summary: </strong>Early in Massachusetts' implementation of Medicaid Accountable Care Organizations (ACO), pediatric-focused practices reported less collaboration and standardization within their Medicaid ACOs than adult-focused practices.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102601"},"PeriodicalIF":3.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606743","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}

{"title":"Associations between preschooler screen time trajectories and executive function.","authors":"Caroline Fitzpatrick, Elena Florit, Annie Lemieux, Gabrielle Garon-Carrier, Lucia Mason","doi":"10.1016/j.acap.2024.102603","DOIUrl":"https://doi.org/10.1016/j.acap.2024.102603","url":null,"abstract":"<p><strong>Objectives: </strong>To examine associations between preschooler screen time trajectories and executive functions and effortful control at age 5.</p><p><strong>Methods: </strong>Prospective, community-based convenience sample of 315 parents of preschoolers (54% male), studied at the ages of 3.5 (2020), 4.5 (2021), and 5.5 (2022). Parent-reported screen use at the ages of 3.5, 4.5, and 5.5 was used to estimate preschooler screen use trajectories. Using latent growth modeling, we identified low (mean=.9 hrs/day, 23%), medium (mean=3.0 hrs/day, 56%), and high (mean=6.38 hrs/day, 21%) screen time groups. Children completed assessments of inhibitory control and cognitive flexibility at age 5.5. Both tasks are from the NIH Toolbox. Parents reported child effortful control at the age of 3.5 and 5.5 using the Children's Behavior Questionnaire, educational attainment, and parenting stress.</p><p><strong>Results: </strong>Children in the average (b =-5.24) and high (b=.9.30) screen time trajectories scored significantly lower on inhibitory control than those in the low screen time group. Children in the average and high screen time groups also scored higher than children in the low screen time group on cognitive flexibility (b =-4.50) and (b=-10.12), respectively. Finally, children in the average and high screen time groups scored lower than children in the low screen time groups on effortful control (b =-.41) and (b=-.61), respectively.</p><p><strong>Conclusions: </strong>The present study shows that stability in high levels of screen use is common among preschoolers and may forecast higher risk of cognitive difficulty and lower levels of cognitive control by the time of school entry.</p><p><strong>Summary: </strong>High levels of preschooler screen use were associated with lower scores on assessments of inhibitory control, cognitive flexibility, and effortful control.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102603"},"PeriodicalIF":3.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606716","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}

{"title":"Is \"No News is Good News\" Enough? A Thematic Analysis Exploring Clinical Reasoning Assessment in Pediatric Residency Programs.","authors":"James Bowen, Matthew Kelleher, Benjamin Kinnear, Daniel Schumacher, David A Turner, Lisa E Herrmann","doi":"10.1016/j.acap.2024.102600","DOIUrl":"10.1016/j.acap.2024.102600","url":null,"abstract":"<p><strong>Objective: </strong>Clinical reasoning (CR) includes numerous essential skills for clinicians, but how these skills are assessed in pediatric residency training is not well described. This study aimed to explore pediatric residency program leader perspectives on CR assessment and identification of trainee deficiencies in this area.</p><p><strong>Methods: </strong>Taking a social constructionist worldview, we conducted a thematic analysis of 20 semistructured interviews with pediatric residency program leaders. Interviews explored how pediatric residency programs assess CR and how deficiencies are identified. Recruitment and analysis continued iteratively until thematic sufficiency was reached. Member checking enhanced the trustworthiness of the results.</p><p><strong>Results: </strong>Participants noted a perceived lack of a shared mental model for CR assessment between program leaders and clinical supervisors. Four themes were generated to highlight CR assessment in pediatric residency programs: 1) Clinical supervisors escalate concerns about behaviors representing symptoms of CR deficits rather than diagnosing CR competency deficiencies and that CR assessment requires, 2) an outward display of autonomous decision-making, 3) psychologically safe environments for inquiry, and 4) longitudinal, individualized observation. Elements of pediatric residency programs that impede CR assessment were identified, including family-centered rounds and team-based clinical care.</p><p><strong>Conclusions: </strong>This study identified key components necessary for CR assessment and barriers that may lead to missed identification of deficiencies. While no single solution can create an ideal environment for CR assessment, this study identifies elements for enhancing assessment opportunities for early identification of deficiencies.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102600"},"PeriodicalIF":3.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606720","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}

{"title":"Infant Feeding Outcomes From a Culturally-Adapted Early Obesity Prevention Program for Immigrant Chinese American Parents","authors":"","doi":"10.1016/j.acap.2024.06.005","DOIUrl":"10.1016/j.acap.2024.06.005","url":null,"abstract":"<div><h3>Objective</h3><div>To examine whether a cultural adaptation of an early childhood obesity prevention program promotes healthy infant feeding practices.</div></div><div><h3>Methods</h3><div><span>Prospective quasi-experimental study of a community-engaged multiphasic cultural adaptation of an obesity prevention program set at a federally qualified health center serving immigrant Chinese American parent-child dyads (N = 298). In a group of historical controls, we assessed early infant feeding practices (breastfeeding, sugar-sweetened beverage intake) in 6-month-olds and then the same practices alongside early solid food feeding practices (bottle weaning, fruit, vegetable, sugary or salty </span>snack<span> consumption) in 12-month-olds. After implementation, we assessed these practices in an intervention cohort group at 6 and 12 months. We used cross-sectional groupwise comparisons and adjusted regression analyses to evaluate group differences.</span></div></div><div><h3>Results</h3><div>At 6 months, the intervention group had increased odds of no sugar-sweetened beverage intake (aOR: 5.69 [95% confidence interval (CI): 1.65, 19.63], <em>P</em> = .006). At 12 months, the intervention group also had increased odds of no sugar-sweetened beverage intake (aOR: 15.22 [95% CI: 6.33, 36.62], <em>P</em> &lt; .001), increased odds of bottle weaning (aOR: 2.34 [95% CI: 1.05, 5.23], <em>P</em><span> = .03), and decreased odds of sugary snack consumption (aOR: 0.36 [0.18, 0.70], </span><em>P</em> = .003). We did not detect improvements in breastfeeding, fruit, vegetable, or salty snack consumption.</div></div><div><h3>Conclusions</h3><div>A cultural adaptation of a primary care-based educational obesity prevention program for immigrant Chinese American families with low income is associated with certain healthy infant feeding practices. Future studies should evaluate cultural adaptations of more intensive interventions that better address complex feeding practices, such as breastfeeding, and evaluate long-term weight outcomes.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"24 8","pages":"Pages 1276-1284"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141332408","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}

{"title":"Recent Advances with Group Well-Child Care","authors":"Rheanna Platt MD, PhD, MPH ,&nbsp;Ashley Gresh PhD, CNM ,&nbsp;Sarah Polk MD, MSc ,&nbsp;Sara Johnson PhD, MPH ,&nbsp;Tamar Mendelson PhD","doi":"10.1016/j.acap.2024.07.007","DOIUrl":"10.1016/j.acap.2024.07.007","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"24 8","pages":"Pages 1192-1193"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621727","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}

{"title":"Fighting Spirit","authors":"","doi":"10.1016/j.acap.2024.04.010","DOIUrl":"10.1016/j.acap.2024.04.010","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"24 8","pages":"Pages 1179-1181"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870993","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}

{"title":"A Pilot Randomized Controlled Trial of Text Messages to Improve Well-Child Visit Attendance After No-Show","authors":"","doi":"10.1016/j.acap.2024.06.003","DOIUrl":"10.1016/j.acap.2024.06.003","url":null,"abstract":"<div><h3>Objective</h3><div>Evaluate the effectiveness of text messages to systematically engage parents/guardians (“caregivers”) to reschedule a well-child visit (WCV) that was missed (“no-show”) and attend that rescheduled WCV visits.</div></div><div><h3>Methods</h3><div><span>Patients &lt;18 years in one of five pediatrics or </span>family medicine<span> clinics, in one health system in the Southeast US, were eligible. Patients without a rescheduled WCV after a no-show were randomized into intervention (text messages) or care-as-usual comparison, stratified by language (English/Spanish). Enrollment occurred May–July 2022. Up to three text messages were sent to caregivers one week apart via REDCap and Twilio, advising how to reschedule the missed appointment by phone or health portal. Primary outcomes were 1) rescheduling a WCV within 6 weeks of no-show and 2) completing a rescheduled WCV within 6 weeks. Risk differences (RD) and odds ratios (OR) were used to evaluate the effect of text messages.</span></div></div><div><h3>Results</h3><div>Seven hundred and twenty patients were randomized and analyzed (texts: 361, comparison: 359). The proportion rescheduling WCV after text versus usual care was English: 18.85% versus 15.02%, respectively, and Spanish: 5.94% versus 8.14%, with overall RD<!--> <!-->+ 1.98% (95% CI: −1.85, 5.81) and OR 1.21 (95% CI: 0.79, 1.84; <em>P</em>-value .38). Completed WCV rates in text or usual care were English: 13.08% versus 6.59%, and Spanish: 5.81% versus 5.94% with texts associated with RD<!--> <!-->+ 2.83% (95% CI: 1.66, 4.00) and OR 1.86 (95% CI: 1.09, 3.19).</div></div><div><h3>Conclusion</h3><div>Text message follow-up after a no-show WCV may positively impact attendance at WCVs rescheduled in the subsequent 6 weeks.</div></div><div><h3>Trial registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> NCT05086237.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"24 8","pages":"Pages 1210-1219"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141297132","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}