Academic Pediatrics最新文献

{"title":"Illustrating the Role of Infant Well-Child Visits in the Association Between Transportation Insecurity and Acute Health Care Use","authors":"Jewel Park MD, MPH ,&nbsp;Michelle Gorecki MD, MPH ,&nbsp;Aaron Flicker MS, MA ,&nbsp;Allison Reyner MS ,&nbsp;Adrienne Henize JD ,&nbsp;Melissa Klein MD, MEd ,&nbsp;Andrew F. Beck MD, MPH","doi":"10.1016/j.acap.2025.102827","DOIUrl":"10.1016/j.acap.2025.102827","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the role of well-child visits (WCVs) in mediating associations between transportation insecurity and acute health care usage among infants.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study of 4114 infants seen for newborn visits at 3 primary care centers between February 1, 2019 and March 31, 2021. Each infant was followed through 15 months of age. The outcome of interest was acute health care usage, defined by high-acuity emergency department (ED) visits or hospitalization. The exposure was transportation insecurity as reported by parents through standardized questionnaires administered during WCVs. We stratified analyses by WCV attendance (≥6 WCVs vs &lt;6 WCVs in the first 15 months of life) to assess whether WCVs mediated associations between acute health care usage and transportation insecurity.</div></div><div><h3>Results</h3><div>Of 4114 eligible infants, 8.7% endorsed transportation insecurity. Patients reporting transportation insecurity, compared to those who did not, had higher rates of incomplete WCV attendance (60.3% vs 44.2%, <em>P</em> &lt; 0.001), ED visitation (38.0% vs 28.7%; <em>P</em> &lt; 0.001), and hospitalization (19.8% vs 14.1%; <em>P</em> = 0.004). Transportation insecurity, compared to no transportation security, was significantly associated with having &lt;6 WCVs (adjusted odds ratio [aOR] 1.64, 95% confidence interval [CI] 1.29, 2.09), ED visitation (aOR 1.45, 95% CI 1.14, 1.85), and hospitalization (aOR 1.52, 95% CI 1.13, 2.04). However, WCV attendance did not mediate associations between transportation insecurity and ED visits or hospitalizations.</div></div><div><h3>Conclusions</h3><div>Transportation insecurity was associated with fewer WCVs; however, WCV attendance did not mediate associations between acute health care usage and transportation insecurity. Future research could focus on mechanisms linking transportation insecurity to suboptimal health outcomes.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102827"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781374","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":"New York State’s Paid Family Leave Program and Children’s Health Care Use","authors":"Taryn W. Morrissey PhD ,&nbsp;Neko Michelle Castleberry PhD, MPH ,&nbsp;Daniel P. Miller PhD","doi":"10.1016/j.acap.2025.102822","DOIUrl":"10.1016/j.acap.2025.102822","url":null,"abstract":"<div><h3>Objective</h3><div>Prior research has linked paid family leave programs with improvements in maternal and infant health. This study assessed changes in children’s health care use following the implementation of New York State’s Paid Family Leave Program (NYSPFL) and whether these changes vary by socioeconomic status or the presence of children with chronic health conditions in the home.</div></div><div><h3>Methods</h3><div>We used difference-in-differences (DD) and synthetic control method (SCM) approaches with data from the 2016–19 waves of the National Survey of Children’s Health (n ∼24,000) to estimate the plausibly causal effects of NYSPFL on the health care use of children under age 18. We compared NYS residents to residents in states that implemented paid family leave after 2019.</div></div><div><h3>Results</h3><div>SCM analyses indicate a 3.3 percentage point (−16%) reduction in emergency department visits among children aged 0 to 17 following NYSPFL implementation; findings were similar in the DD models but not significant (−2.3pp; 95% confidence interval, −0.092, 0.061). DD models found large reductions in delays of necessary health care among parents whose children had chronic conditions, but not among the full sample.</div></div><div><h3>Conclusions</h3><div>Findings suggest that state paid family leave programs support families’ obtaining necessary health care for children with chronic conditions and reduce emergency department visits among families with children across the age spectrum.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102822"},"PeriodicalIF":3.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781566","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":"Life Is Calling","authors":"Cara Texler MD, MPH","doi":"10.1016/j.acap.2025.102823","DOIUrl":"10.1016/j.acap.2025.102823","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 5","pages":"Article 102823"},"PeriodicalIF":3.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774846","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":"Connecting Families: Poverty Screening and Financial Support Navigation for Families of Young Children in Primary Care: A Pilot Randomized Controlled Trial","authors":"Imaan Bayoumi MD ,&nbsp;Patricia C. Parkin MD ,&nbsp;Mary Martin MSc ,&nbsp;Charles D.G. Keown-Stoneman PhD ,&nbsp;Catherine S. Birken MD, MSc ,&nbsp;Jonathon L. Maguire MD, MSc ,&nbsp;Cornelia M. Borkhoff PhD","doi":"10.1016/j.acap.2025.102820","DOIUrl":"10.1016/j.acap.2025.102820","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the feasibility of a randomized controlled trial (RCT) evaluating the impact of community support worker (CSW) supported, structured review of financial supports and social system navigation.</div></div><div><h3>Methods</h3><div>A pilot RCT of parent-child dyads (1 parent and child aged 2–5 years old) endorsing the question “Do you ever have difficulty making ends meet at the end of the month?” was conducted in primary care in Kingston, Ontario, Canada. Interventions included CSW-supported social system navigation or control; both groups received a written summary of available resources. The primary outcome was feasibility, including recruitment, completion, and retention rates and intervention adherence and fidelity. Secondary outcomes were child social, emotional, and behavioral health (Strengths and Difficulties Scale [SDQ]) and parenting stress (Parenting Stress Index-IV [PSI]).</div></div><div><h3>Results</h3><div>Of 74 eligible dyads, 37 (50%) were enrolled, mean (standard deviation [SD]) child age 35.4 (11.1) months and 57% were female. Outcomes were assessed on 29 participants (78%) at 6 months and 22 participants (60%) at 12 months. Participants randomized to the intervention arm met with the CSW a mean of 1.71 (SD 1.68) times, with a range of 0 to 5 meetings, including 35.7% who did not attend any meetings with the CSW. Using analysis of covariance, the mean between-group difference in the baseline adjusted SDQ Total Difficulties Score at 6 months was −1.21 (95% confidence interval [CI] −3.82, 1.40) and at 12 months was 1.10 (95% CI −3.13, 5.34), and in the baseline adjusted PSI Total Score at 6 months was −12.88 (95% CI −21.63, −4.12) and at 12 months was 7.79 (95% CI −4.42, 20.00).</div></div><div><h3>Conclusions</h3><div>Conducting a trial enrolling families of young children experiencing financial strain is feasible. A definitive trial with modifications is warranted and is underway.</div></div><div><h3><strong>Clinical Trials Registration</strong></h3><div>clinicaltrials.gov NCT05667675.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 5","pages":"Article 102820"},"PeriodicalIF":3.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732659","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":"Parental, Patient, and Provider Perspectives on the Use of Artificial Intelligence in Pediatric Care","authors":"Jillian Gorski MD, MS ,&nbsp;James Rudloff MD ,&nbsp;Sriram Ramgopal MD","doi":"10.1016/j.acap.2025.102819","DOIUrl":"10.1016/j.acap.2025.102819","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102819"},"PeriodicalIF":3.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702027","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":"Clinical Coaching for In-The-Moment Skill Development","authors":"Zarina Norton MD ,&nbsp;Matthew Hazle MD ,&nbsp;Lindsay Koressel MD, MEd ,&nbsp;Margaret Wolff MD, MHPE ,&nbsp;On Behalf of the Association of Pediatric Program Directors Faculty and Professional Development Task Force","doi":"10.1016/j.acap.2025.102818","DOIUrl":"10.1016/j.acap.2025.102818","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 5","pages":"Article 102818"},"PeriodicalIF":3.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694316","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":"Socioeconomic Indicators and Low Body Mass Index Outcome Among Adolescents and Young Adults With Social Risks","authors":"Sophie H. Allende-Richter MD, MPH ,&nbsp;Aakansha Bagepally BA ,&nbsp;Jessica Addison MD, MS, MPH ,&nbsp;Patrice Melvin PhD ,&nbsp;Inyang Isong MD, ScD, MPH ,&nbsp;Christopher P. Landrigan MD, MPH ,&nbsp;Takara L. Stanley MD","doi":"10.1016/j.acap.2025.102814","DOIUrl":"10.1016/j.acap.2025.102814","url":null,"abstract":"<div><h3>Objective</h3><div>To describe clinical characteristics among adolescents and young adults with isolated low body mass index (BMI) and identify socioeconomic indicators in the lived environment associated with this outcome.</div></div><div><h3>Methods</h3><div>Using our electronic health record, we conducted a retrospective case-control study that included 135 adolescents and young adults ages 13 to 21 from an under-resourced neighborhood of Massachusetts with isolated diagnoses of failure to thrive or underweight status. We used the Centers for Disease Control and Prevention weight classification to allocate patients into low and normal BMI categories. We used chi-square and Fisher exact tests to compare differences in clinical characteristics and neighborhood socioeconomic indicators by BMI outcome and a 2-sample test of proportions or logistic regression to calculate the effect estimate and 95% confidence interval.</div></div><div><h3>Results</h3><div>Forty percent of the participants with low BMI were diagnosed with malnutrition and required nutritional supplements. Low BMI finding was positively associated with depression, anxiety, and unmet social drivers of health—primarily driven by housing insecurity.</div></div><div><h3>Conclusions</h3><div>Our findings indicate that a significant proportion of adolescents and young adults with low BMI experience housing insecurity and unmet social needs in their lived environment and suffer from malnutrition at a critical time of their growth and development. Further research is needed to understand the role of the lived environment and outcome of low BMI, the underlying mechanisms at play, and its impact on adolescents' and young adults' growth and development.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 5","pages":"Article 102814"},"PeriodicalIF":3.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665308","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":"Evaluation and Utility of an Electronic Consultation Program in a Children’s Health System","authors":"Dinesh S. Pashankar MD, MBA ,&nbsp;Daniel Prior MD ,&nbsp;Anita Arora MD, MBA, MHS ,&nbsp;Renee Fekieta PhD, MA ,&nbsp;Karla Marco MPH, MS ,&nbsp;Erica Spatz MD, MHS ,&nbsp;Mona Sharifi MD, MPH ,&nbsp;Babar Khokhar MD, MBA","doi":"10.1016/j.acap.2025.102815","DOIUrl":"10.1016/j.acap.2025.102815","url":null,"abstract":"<div><h3>Objective</h3><div>Electronic consultations (e-consults) are asynchronous communication between primary care providers (PCPs) and specialists. Studies in adults show that e-consults improve specialty access, but the data in pediatrics are limited. We report the evaluation and utility of a large pediatric e-consult program.</div></div><div><h3>Methods</h3><div>We reviewed our database for the number of e-consults per specialty, indications, and completion time. We determined the utility of e-consults by assessing health care utilization for the same clinical problem within 2 months following completed e-consults. PCPs and specialists were surveyed to assess time spent on e-consults and satisfaction with the e-consult program.</div></div><div><h3>Results</h3><div>Thirty-four specialists from 13 specialties completed 2192 e-consults requested by 45 PCPs over 55 months. An average response time for e-consult completion was 0.8 days. Dermatology (42%), endocrinology (16.6%), and neurology (8.2%) were the top 3 specialties with rashes, puberty questions, and seizures as common indications, respectively. Within the 2 months, 85% of patients did not present to the clinics or the emergency room for the same clinical problems addressed in the e-consults. Time spent on the e-consult was less than 20 minutes for PCPs (80%) and specialists (77%). High satisfaction was reported in PCPs (97%) and specialists (85%) with the e-consult program.</div></div><div><h3>Conclusions</h3><div>In the largest study on pediatric e-consults so far, prompt specialty advice was provided with e-consults to the PCPs by specialists. In most cases, patients did not present to our health system for the same clinical problems within 2 months. Both PCPs and specialists reported high satisfaction with the e-consult program.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 5","pages":"Article 102815"},"PeriodicalIF":3.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634715","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":"Seeking Optimal, Integrated Pediatric Medical and Social Care: A Qualitative, Peer Researcher-Driven Study","authors":"Margaret N. Jones MD, MS ,&nbsp;Clare Heaney BS ,&nbsp;Jessica Obayan LMSW ,&nbsp;Daniela Vollmer MSc ,&nbsp;Monica Arenas MPH ,&nbsp;Malika Muhammad C-CHW ,&nbsp;Raffel Prophett MA ,&nbsp;Patricia White EdD ,&nbsp;Moshe Seid BS ,&nbsp;Elizabeth B. Quinonez MHA, PMP, CHES ,&nbsp;Lauren Lipps MA ,&nbsp;Adrienne W. Henize JD ,&nbsp;Ndidi I. Unaka MD, MEd ,&nbsp;Andrew F. Beck MD, MPH ,&nbsp;on behalf of the Responding to Identified Sociomedical risks with Effective Unified Purpose Team (full team listed in Acknowledgments section)","doi":"10.1016/j.acap.2025.102816","DOIUrl":"10.1016/j.acap.2025.102816","url":null,"abstract":"<div><h3>Objective</h3><div>To generate qualitative insights with patients, families, and community partners to catalyze nimble, aligned medical-social care responses.</div></div><div><h3>Methods</h3><div>This study employed qualitative and co-design methods. We partnered with 4 peer researchers who interviewed individuals living in Greater Cincinnati with recent experience as pediatric patients or caregivers of pediatric patients. Interviews assessed ways in which health care, human services, patients, families, and communities do (or do not) collaborate to provide medical-social care. Interview transcripts were independently reviewed by an analytic team, inclusive of peer researchers, co-design experts, and pediatric clinicians and researchers. Findings were validated during community discussions, facilitating identification of themes and opportunity areas for intervention.</div></div><div><h3>Results</h3><div>Peer researchers conducted 19 interviews (14 English and 5 Spanish). Interviewees included individuals ranging from young adults (recent patients) to older adults with lived experience as caregivers of pediatric patients. Most identified as minority race and ethnicity and lived in socioeconomically disadvantaged Cincinnati neighborhoods. Themes related to structural barriers included 1) services are difficult to navigate; 2) medical and social care are often reactive (or nonexistent) when they could be proactive; and 3) medical and social care could be more closely integrated. Themes related to human factors included 4) medical and social service institutions are often untrustworthy; 5) diversified care teams with shared lived experiences could improve care delivery; and 6) optimal care requires empathy, clear communication, and partnership.</div></div><div><h3>Conclusions</h3><div>Patients, families, and community members identified themes and opportunity areas for improving medical and social care delivery. Next steps include the implementation and evaluation of prototype interventions.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 5","pages":"Article 102816"},"PeriodicalIF":3.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634808","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":"Geospatial Accessibility of Pediatric Resources by Child Opportunity, Racial and Ethnic Composition and Urbanicity","authors":"Emily M. Bucholz MD ,&nbsp;R. Thomas Day Jr MD ,&nbsp;Rohan Khazanchi MD MPH ,&nbsp;Faraz Alizadeh MD ,&nbsp;Jeff Blossom MA ,&nbsp;Dakota Bailey MA ,&nbsp;Steven Worthington PhD ,&nbsp;Jinjie Liu PhD ,&nbsp;Ravi Thiagarajan MBBS ,&nbsp;Valerie L. Ward MD, MPH ,&nbsp;Katie M. Moynihan MBBS","doi":"10.1016/j.acap.2025.102817","DOIUrl":"10.1016/j.acap.2025.102817","url":null,"abstract":"<div><h3>Objective</h3><div>We analyze drive times to pediatric inpatient and intensive care services in the US according to Child Opportunity Index (COI), racial/ethnic composition, and urbanicity.</div></div><div><h3>Methods</h3><div>Geospatial information system analyses delineated drive-time catchments of 0–30, 31–60, 61–120 and 120–240 minutes around hospitals with ≥5 inpatient pediatric and pediatric intensive care unit (PICU) beds. For each catchment, population-weighted COI, percent pediatric population of underrepresented races and ethnicities (%UR), and urbanicity were calculated and compared between the four drive-time catchments and for &gt;60 versus ≤60-minute drive-times. Prevalence ratios (PR) were calculated for &gt;60 versus ≤60-minute drive-times to compare the prevalence of longer drive-times for catchments with lower COI and lower %UR (vs higher), and rural versus urban areas.</div></div><div><h3>Results</h3><div>Overall, 8.1% and 20.5% of children reside &gt;60-minutes from pediatric and PICU services. Catchments within 60-minutes of inpatient or PICU services had higher COI (4.8, [95% CI 3.2, 6.5] and 6.1 [7.7, 4.5] respectively) compared with those &gt;60-minutes. Very low quintile COI catchments (vs very high) were more likely to be &gt;60-minutes from pediatric inpatient care (PR 2.89 [2.30, 3.61]) and PICU (PR 2.48 [1.92, 3.20]). %UR was 2.7% higher in ≤60-minute drive-time catchments (95% CI 0.1, 5.23, <em>P</em> <!-->=<!--> <!-->0.043) versus those &gt;60-minutes. Greater prevalence of &gt;60-minute drive-times was seen in catchments with a lower %UR (vs higher) and for rural (vs urban) catchments for pediatric and PICU services.</div></div><div><h3>Conclusions</h3><div>Children living further from pediatric care tend to have less resources and reside in rural areas. These data inform public health solutions for equitable resource distribution as care consolidates.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 5","pages":"Article 102817"},"PeriodicalIF":3.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634806","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}