Developing an Approach to Health-Related Social Needs Screening Across Settings in a Pediatric Health System.

Increasingly, health-related social needs (HRSNs) screening is being implemented across multiple settings within a single hospital or across health care systems, including outpatient clinics, emergency departments, and inpatient units. This rise in HRSN screening is driven in part by the Centers for Medicare & Medicaid Services' and The Joint Commission's health equity regulatory and accreditation requirements, effective January 1, 2023. These requirements necessitate intentionality in the development and coordination of hospital and health care system-wide processes to meaningfully implement screening and address reported HRSNs.

A decision methodology for site-level ecosystem accounting.

The United Nations System of Environmental-Economic Accounting Ecosystem Accounting (SEEA EA) framework is the international standard for ecosystem accounting. To date, application of SEEA EA has been predominantly at large scales, usually at landscape and national levels. However, many environmental management decisions are taken locally, in site-specific contexts.

A Mixed-Methods Assessment of Coronavirus Disease of 2019-Era Telehealth Acute Care Visits in the Medical Home.

Objectives: To compare acute care virtual visits with in-person visits with respect to equity of access, markers of quality and safety, and parent and provider experience, before and during the coronavirus disease 2019 pandemic.

Study Design: We compared patient demographics, antimicrobial prescribing rates, emergency department (ED) use, and patient-experience scores for virtual visits and in-person care at 2 academic pediatric primary care practices using χ testing and interrupted time series analyses. Parent and provider focus groups explored themes related to virtual visit experience and acceptability.

Randomized Controlled Trial of Health Coaching for Parents of Children With Medical Complexity.

Background And Objective: Parents of children with medical complexity (CMCs) struggle with managing their children's care needs. Health coaching provides patients with tools to take ownership of their care. We sought to assess the impact of health coaching for parents of CMCs on activation, child's health related quality of life (HRQL), and utilization.

Improving delivery of preventative care services using population management strategies.

Background: Consistent and timely delivery of comprehensive preventative care services is a challenge, particularly in underserved patient populations. Previous quality improvement (QI) research has focused on the development of bundled measures of preventative services delivery, but these bundles have not been studied on a population level. We aimed to improve preventative care service delivery on a clinic population level through the use of a bundled measure that includes immunisations, lead screening and use of screening tools among underserved patients under 2 years old.

Machine learning approaches to predicting no-shows in pediatric medical appointment.

Patients' no-shows, scheduled but unattended medical appointments, have a direct negative impact on patients' health, due to discontinuity of treatment and late presentation to care. They also lead to inefficient use of medical resources in hospitals and clinics. The ability to predict a likely no-show in advance could enable the design and implementation of interventions to reduce the risk of it happening, thus improving patients' care and clinical resource allocation.

Moving the needle on primary care burnout: Using a driver diagram to accelerate impact.

Prior to the COVID-19 pandemic, studies demonstrated an alarming prevalence of burnout in primary care. In the midst of the pandemic, primary care clinician wellbeing deteriorated and burnout rates increased, yet many organizational efforts to reduce burnout were put on hold due to the urgency of the pandemic. In this article, we present the "Reducing Burnout Driver Diagram" as a tool that clinical leaders and policy makers can use to address and mitigate primary care clinician burnout.

Pediatric Primary Care-Based Social Needs Services and Health Care Utilization.

Objective: To evaluate the relationship between use of primary care-based social needs services and subsequent utilization of ambulatory, emergency, and inpatient services.

Methods: This retrospective 2012 to 2015 cohort study uses electronic medical record data from an academic pediatric primary care practice that screens universally for social needs and delivers services via in-house social work staff. Logistic regression (N = 7300) examines how patient characteristics relate to practice-based social service use.

Improving rates of ferrous sulfate prescription for suspected iron deficiency anaemia in infants.

Background: Iron deficiency anaemia (IDA) in infancy is prevalent and associated with impaired neurodevelopment; however, studies suggest that treatment and follow-up rates are poor.

Objectives: To improve the rate of ferrous sulfate prescription for suspected IDA among infants aged 8-13 months to 75% or greater within 24 months.

Methods: We implemented a multidisciplinary process improvement effort aimed at standardising treatment for suspected IDA at two academic paediatric primary care clinics.

Association of Perceived Maternal Stress During the Perinatal Period With Electroencephalography Patterns in 2-Month-Old Infants.

Importance: Variation in child responses to adversity creates a clinical challenge to identify children most resilient or susceptible to later risk for disturbances in cognition and health. Advances in establishing scalable biomarkers can lead to early identification and mechanistic understanding of the association of early adversity with neurodevelopment.

Objectives: To examine whether maternal reports of stress are associated with patterns in resting electroencephalography at 2 months of age and whether unique electroencephalographic profiles associated with risk and resiliency factors can be identified.

A Parenting and Life Skills Intervention for Teen Mothers: A Randomized Controlled Trial.

Unlabelled: : media-1vid110.1542/5985300176001PEDS-VA_2018-2303 BACKGROUND: Teen mothers often present with depression, social complexity, and inadequate parenting skills. Many have rapid repeat pregnancy, which increases risk for poor outcomes.

Use of Social Psychology to Improve Adherence to National Bronchiolitis Guidelines.

Objectives: The American Academy of Pediatrics' bronchiolitis guidelines recommend against albuterol and corticosteroids for treating and chest radiographs (CRs) for diagnosing infants with bronchiolitis. However, high rates of nonadherence have been documented. Our objective was to improve guideline adherence in infants with bronchiolitis.

Associations Between Patient-Reported Outcome Measures of Asthma Control and Psychosocial Symptoms.

There is growing emphasis on using patient-reported outcome measures to enhance clinical practice. This study was a retrospective review of scores on the Childhood Asthma Control Test (C-ACT) and the Pediatric Symptom Checklist-17 (PSC-17) at a pediatric primary care center in Boston, Massachusetts. A total of 218 patients were selected at random using billing codes for well-child (WC) care and asthma, excluding complex medical conditions.

Ensuring Timely Connection to Early Intervention for Young Children With Developmental Delays.

Background And Objectives: Timely provision of developmental services can improve outcomes for children 0 to 3 years old with developmental delays. Early Intervention (EI) provides free developmental services to children under age 3 years; however, data suggests that many children referred to EI never connect to the program. We sought to ensure that 70% of patients referred to EI from an academic primary care clinic serving a low-income population were evaluated within 120 days of referral.

Utilization of Patient Navigators in an Urban Academic Pediatric Primary Care Practice.

Navigating health care systems can be a challenge for families. A retrospective descriptive cohort analysis was conducted assessing referrals to patient navigators (PNs) in one urban academic pediatric primary care practice. PNs tracked referral processes and a subset of PN referrals was assessed for markers of successful referrals.

Screening for Social Determinants of Health Among Children and Families Living in Poverty: A Guide for Clinicians.

Approximately 20% of all children in the United States live in poverty, which exists in rural, urban, and suburban areas. Thus, all child health clinicians need to be familiar with the effects of poverty on health and to understand associated, preventable, and modifiable social factors that impact health. Social determinants of health are identifiable root causes of medical problems.

Redesigning Health Care Practices to Address Childhood Poverty.

Child poverty in the United States is widespread and has serious negative effects on the health and well-being of children throughout their life course. Child health providers are considering ways to redesign their practices in order to mitigate the negative effects of poverty on children and support the efforts of families to lift themselves out of poverty. To do so, practices need to adopt effective methods to identify poverty-related social determinants of health and provide effective interventions to address them.

Development and validation of the Composite Asthma Severity Index--an outcome measure for use in children and adolescents.

Background: Asthma severity is reflected in many aspects of the disease, including impairment and future risks, particularly for exacerbations. According to the Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma, however, to assess more comprehensively the severity of asthma the level of current treatment needed to maintain a level of control should be included.

Objective: Development and validation of a new instrument, the Composite Asthma Severity Index (CASI), which can quantify disease severity by taking into account impairment, risk, and the amount of medication needed to maintain control.

Relationships among environmental exposures, cord blood cytokine responses, allergy, and wheeze at 1 year of age in an inner-city birth cohort (Urban Environment and Childhood Asthma study).

Background: The Urban Environment and Childhood Asthma study was established to investigate the immunologic and environmental causes of asthma in inner-city children.

Objective: We sought to evaluate potential atopic outcomes in the first 12 months and their relationships to environmental exposures and immune development.

Methods: A birth cohort of 560 children with at least 1 parent with allergy or asthma was established in Baltimore, Boston, New York, and St Louis.

Poverty grown up: how childhood socioeconomic status impacts adult health.

Socioeconomic status and health status are directly related across the world. Children with low-socioeconomic status not only experience greater health problems in childhood but also aspects of their socioeconomic status become biologically incorporated through both critical periods of development and cumulative effects, leading to poor health outcomes as adults. We explore 3 main influences related to child's socioeconomic status that impact long-term health: the material environment, the social environment, and the structural or community environment.

Human papillomavirus vaccine uptake, predictors of vaccination, and self-reported barriers to vaccination.

Objective: To describe human papillomavirus (HPV) vaccine uptake, predictors of vaccination, and barriers to vaccination in young women.

Methods: Participants were 13-26-year-old girls and women recruited from an urban, hospital-based clinic. Between June and December 2007, 6 months after they had completed a baseline survey, they were recontacted to assess receipt of at least one HPV vaccine dose and barriers to receiving the vaccine.

High levels of adherence do not prevent accumulation of HIV drug resistance mutations.

Objectives: To assess the relationship between development of antiretroviral drug resistance and adherence by measured treatment duration, virologic suppression, and the rate of accumulating new drug resistance mutations at different levels of adherence.

Methods: Adherence was measured with unannounced pill counts performed at the participant's usual place of residence in a prospective cohort of HIV-positive urban poor individuals. Two genotypic resistance tests separated by 6 months (G1 and G2) were obtained in individuals on a stable regimen and with detectable viremia (> 50 copies/ml).