National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
101 to 125 of 1566 Research Studies DisplayedBorah L, Zebib L, Sanders HM
State restrictions and geographic access to gender-affirming care for transgender youth.
This research letter described a study that estimated changes in geographic access and drive times to gender clinics after 20 states enacted legislation to restrict puberty-suppressing medications and hormones for those under the age of 18. Access to appropriate medical and social services for transgender youths was associated with mental health benefits and decreased levels of suicidality.
AHRQ-funded; HS028748.
Citation: Borah L, Zebib L, Sanders HM .
State restrictions and geographic access to gender-affirming care for transgender youth.
JAMA 2023 Jul 25; 330(4):375-78. doi: 10.1001/jama.2023.11299..
Keywords: Children/Adolescents, Vulnerable Populations, Access to Care, Policy
Guirguis-Blake JM, Evans CV, Coppola EL
Screening for lipid disorders in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this study was to examine benefits and harms of screening and treatment of pediatric dyslipidemia due to familial hypercholesterolemia (FH) and multifactorial dyslipidemia. Forty-three studies were included (n = 491,516). The study found that No RCTs directly addressed screening effectiveness and harms. Three US studies (n = 395,465) reported prevalence of phenotypically defined FH of 0.2% to 0.4% (1:250 to 1:500). Five studies (n = 142,257) reported multifactorial dyslipidemia prevalence; the prevalence of elevated total cholesterol level was 7.1% to 9.4% and of any lipid abnormality was 19.2%. Ten RCTs in children and adolescents with FH (n = 1,230) demonstrated that statins were related with an 81- to 82-mg/dL higher mean reduction in levels of total cholesterol and LDL-C compared with placebo at up to 2 years. Nonstatin-drug trials showed statistically significant lowering of lipid levels in FH populations, but few studies were available for any single drug. Observational studies indicate that starting statin treatment for FH in childhood or adolescence decreases long-term cardiovascular disease risk. Two multifactorial dyslipidemia behavioral counseling trials (n = 934) showed 3- to 6-mg/dL greater reductions in total cholesterol levels compared with the control group, but findings did not continue at longest follow-up. Harms reported in the short-term drug trials were similar in the intervention and control groups.
AHRQ-funded; 75Q80120D00004.
Citation: Guirguis-Blake JM, Evans CV, Coppola EL .
Screening for lipid disorders in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2023 Jul 18; 330(3):261-74. doi: 10.1001/jama.2023.8867..
Keywords: U.S. Preventive Services Task Force (USPSTF), Screening, Prevention, Evidence-Based Practice, Guidelines, Children/Adolescents
Bushnell G, Lloyd J, Olfson M
Antipsychotic medication use in Medicaid-insured children decreased substantially between 2008 And 2016.
In the early 2000s there was a rapid growth of pediatric antipsychotic prescribing, especially in the Medicaid population, and concerns grew about the safety and appropriateness of such prescribing. Numerous states implemented policy and educational programs focused on safer and more stringent utilization of antipsychotics. Antipsychotic utilization leveled off toward the end of the 2000s, but no recent national trend estimates of antipsychotic utilization in children enrolled in Medicaid exist. The authors of this study report a substantial decrease in antipsychotic use among children ages 2-17 between 2008 and 2016. Declines existed across foster care status, age, sex, and racial and ethnic groups studied. The rate of children with an antipsychotic prescription who received any diagnosis related to a pediatric indication that was approved by the Food and Drug Administration increased from 38 percent in 2008 to 45 percent in 2016.
AHRQ-funded; HS02600.
Citation: Bushnell G, Lloyd J, Olfson M .
Antipsychotic medication use in Medicaid-insured children decreased substantially between 2008 And 2016.
Health Aff 2023 Jul; 42(7):973-80. doi: 10.1377/hlthaff.2022.01625..
Keywords: Children/Adolescents, Medication, Medicaid, Behavioral Health
Geanacopoulos AT, Neuman MI, Lipsett SC
Association of chest radiography with outcomes in pediatric pneumonia: a population-based study.
This study’s objective was to evaluate the association of performing a chest radiograph (CXR) with 7-day hospitalization after emergency department (ED) discharge among pediatric patients with community-acquired pneumonia (CAP). This retrospective cohort study included 206,694 children aged 3 months to 17 years discharged from any ED within 8 states from 2014 to 2019. Secondary outcomes included 7-day ED revisits and a 7-day hospitalization with severe CAP. Among these children diagnosed with CAP, rates of 7-day ED revisit, hospitalization, and severe CAP were 8.9%, 1.6%, and 0.4%, respectively. After adjusting for illness severity, CXR was associated with fewer 7-day hospitalizations (1.6% vs 1.7%). CXR performance varied somewhat between EDs (median 91.5%). EDs in the highest quartile had fewer 7-day hospitalizations (1.4% vs 1.9%), ED revisits (8.5% vs 9.4%), and hospitalizations for severe CAP (0.3% vs 0.5%) as compared to EDs with the lowest quartile of CXR utilization.
AHRQ-funded; HS026503.
Citation: Geanacopoulos AT, Neuman MI, Lipsett SC .
Association of chest radiography with outcomes in pediatric pneumonia: a population-based study.
Hosp Pediatr 2023 Jul; 13(7):614-23. doi: 10.1542/hpeds.2023-007142..
Keywords: Children/Adolescents, Imaging, Pneumonia, Respiratory Conditions, Community-Acquired Infections
Hoopes AJ, Cushing-Haugen KL, Coley RY
Characteristics of adolescents who use secure messaging on a health system's patient portal.
Drupal date: Jul 1, 2023
The purpose of this study was to identify and describe adolescent characteristics related with patient portal secure messaging use within a health system. The researchers analyzed monthly data from patients aged 13 to 17 who met study eligibility criteria from 2019 to 2021. The primary study outcome was any secure messages sent from an adolescent's account during each observed study month. The study found that of 667,678 observed months, 50.8% occurred among non-transgender males, 51.5% among those identifying as non-Hispanic white, and 83.3% among the privately insured. The adjusted relative risks of secure messaging use were significantly higher for individuals with female sex and transgender identities, those with prior portal use and those with a recent preventive care visit. The adjusted relative risks of portal secure messaging use were significantly lower among those with public insurance.
The purpose of this study was to identify and describe adolescent characteristics related with patient portal secure messaging use within a health system. The researchers analyzed monthly data from patients aged 13 to 17 who met study eligibility criteria from 2019 to 2021. The primary study outcome was any secure messages sent from an adolescent's account during each observed study month. The study found that of 667,678 observed months, 50.8% occurred among non-transgender males, 51.5% among those identifying as non-Hispanic white, and 83.3% among the privately insured. The adjusted relative risks of secure messaging use were significantly higher for individuals with female sex and transgender identities, those with prior portal use and those with a recent preventive care visit. The adjusted relative risks of portal secure messaging use were significantly lower among those with public insurance.
AHRQ-funded; HS026369.
Citation: Hoopes AJ, Cushing-Haugen KL, Coley RY .
Characteristics of adolescents who use secure messaging on a health system's patient portal.
Pediatrics 2023 Jul 1; 152(1). doi: 10.1542/peds.2022-060271..
Keywords: Children/Adolescents, Health Information Technology (HIT)
Michelson KA, McGarghan FLE, Waltzman ML
Community validation of an approach to detect delayed diagnosis of appendicitis in big databases.
This study’s goal was to further validate a trigger tool that has been used in community emergency departments (EDs) to detect delayed diagnosis of pediatric appendicitis. The authors studied patients <21 years old diagnosed with appendicitis from 2008 to 2019 in 8 eastern Massachusetts EDs. Eligible patients had 2 ED encounters within 7 days, the second time ending with an appendicitis diagnosis. Trained reviewers evaluated medical records that showed delayed diagnosis. The previously validated trigger tool was applied to participants’ electronic medical record data, with the tool assigning a probability of delayed diagnosis for each patient. Four confidence thresholds were determined, and the area under the receiver operating curve was calculated. The authors analyzed 68 children with 2 encounters leading to a diagnosis of appendicitis (i.e., possible delay). A delayed diagnosis prediction was assigned to patients at 4 thresholds of confidence (>0%, >50%, >75%, and >90% confident), the positive predictive values were respectively 74%, 89%, 92%, and 89%; the negative predictive values were respectively 100%, 57%, 50%, and 33%. The area under the receiver operating curve was 0.837.
AHRQ-funded; HS026503.
Citation: Michelson KA, McGarghan FLE, Waltzman ML .
Community validation of an approach to detect delayed diagnosis of appendicitis in big databases.
Hosp Pediatr 2023 Jul; 13(7):e170-e74. doi: 10.1542/hpeds.2023-007204..
Keywords: Children/Adolescents, Diagnostic Safety and Quality
Anderson NW, Russ SA, Eisenberg D
Dashboards as mechanisms for community empowerment: developing a prototype for child and adolescent well-being in California.
This study’s objective was to develop a measurement framework of young peoples' well-being that would be engaging and actionable to a broad and diverse set of stakeholders in California. The authors began with a scan of relevant literature documenting previous efforts to measure young peoples' well-being, both within the United States and internationally. They then individually interviewed a set of key informants and convened a multidisciplinary panel of experts to solicit feedback on their approach. Findings suggested that data dashboards were the most promising approach of presenting a parsimonious yet holistic picture of young peoples' well-being. Their framework organized indicators over 5 types: child-centric, subjective well-being, contextual determinants, developmental, and equity-focused. Dashboards have flexibility that can also highlight important gaps in data collection that are of interest to end users such as indicators not yet collected among the broader population. They can also include interactive features, such as selecting key data elements, and helping communities articulate priority areas for policy action, thereby generating momentum and enthusiasm for future iterations and improvements.
AHRQ-funded; HS000046.
Citation: Anderson NW, Russ SA, Eisenberg D .
Dashboards as mechanisms for community empowerment: developing a prototype for child and adolescent well-being in California.
J Public Health Manag Pract 2023 Jul-Aug; 29(4):529-38. doi: 10.1097/phh.0000000000001746..
Keywords: Children/Adolescents
Darling KE, Hayes JF, Evans EW
Engaging stakeholders to adapt an evidence-based family healthy weight program.
The purpose of this study was to describe the procedure of utilizing qualitative data from community and intervention stakeholders, children with overweight or obesity from low-income backgrounds, and caregivers to inform adaptations to the JOIN for ME pediatric weight management intervention. The researchers conducted qualitative interviews with 21 key community and intervention stakeholders, and conducted focus groups in both Spanish and English with 35 children with overweight or obesity from low-income backgrounds and 71 caregivers of children with overweight or obesity from low-income backgrounds. The results of the qualitative data analysis guided intervention modifications including content revisions to simplify and tailor materials, contextual revisions to improve intervention engagement and framing, resource awareness, and modality of delivery, training adaptations, and implementation/scale-up activities to improve community partner connections.
AHRQ-funded; HS02707.
Citation: Darling KE, Hayes JF, Evans EW .
Engaging stakeholders to adapt an evidence-based family healthy weight program.
Transl Behav Med 2023 Jul; 13(7):423-31. doi: 10.1093/tbm/ibac113..
Keywords: Obesity, Family Health and History, Evidence-Based Practice, Children/Adolescents
Giuliano J, Krishna A, Napolitano N
Implementation of video laryngoscope-assisted coaching reduces adverse tracheal intubation-associated events in the PICU.
The purpose of this study was to assess the implementation of a video laryngoscope (VL) as a coaching device to decrease adverse tracheal intubation associated events (TIAEs). Between 2016 and 2020 the researchers implemented VLs as coaching devices with standardized coaching language. Laryngoscopists were encouraged to perform direct laryngoscopy with video images only available in real-time for experienced supervising clinician-coaches. The study found that a VL was used in 71% of 5,060 tracheal intubations. VL utilization increased from a baseline of 29.7% to an implementation phase level of 89.4%. VL utilization was related with lower TIAEs compared with standard laryngoscope (SL). VL utilization was related with lower severe TIAE rate, but not related with a reduction in severe hypoxemia. VL utilization was related with greater first attempt success. In the primary analysis after adjusting for site clustering, VL utilization was related with lower adverse TIAEs. In secondary analyses, VL utilization was not significantly related with severe TIAEs, severe hypoxemia, or first attempt success. After additional controlling for patient and provider characteristics, VL utilization was independently related with a lower TIAE rate.
AHRQ-funded; HS024511.
Citation: Giuliano J, Krishna A, Napolitano N .
Implementation of video laryngoscope-assisted coaching reduces adverse tracheal intubation-associated events in the PICU.
Crit Care Med 2023 Jul; 51(7):936-47. doi: 10.1097/ccm.0000000000005847..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Adverse Events, Patient Safety
Congdon M, Rauch B, Carroll B
Opportunities for diagnostic improvement among pediatric hospital readmissions.
The purpose of this retrospective cohort study was to: 1) identify and describe diagnostic errors, termed "missed opportunities for improving diagnosis" (MOIDs) in general pediatric patients who experienced hospital readmission, 2) outline improvement opportunities, and 3) explore factors associated with increased risk of MOID. The researchers included unplanned readmissions within 15 days of discharge from a freestanding children's hospital between October 2018 and September 2020. Health records were reviewed and discussed by practicing inpatient physicians to identify MOIDs using SaferDx, an established instrument. MOIDs were evaluated using a diagnostic-specific tool to identify improvement opportunities within the diagnostic process. The study found that MOIDs were identified in 6.3% of 348 readmissions. Opportunities for improvement included: delay in considering the correct diagnosis (50%) and failure to order needed test (45%). Patients with MOIDs were older than patients without MOIDs but similar in gender, primary language, race, ethnicity, and insurance type. The researchers did not identify conditions related with higher risk of MOID. Lower respiratory tract infections accounted for 26% of admission diagnoses but only 1 (4.5%) case of MOID.
AHRQ-funded; HS028682.
Citation: Congdon M, Rauch B, Carroll B .
Opportunities for diagnostic improvement among pediatric hospital readmissions.
Hosp Pediatr 2023 Jul; 13(7):563-71. doi: 10.1542/hpeds.2023-007157..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Hospitals, Hospital Readmissions
Michelson KA, Bachur RG, Grubenhoff JA
Outcomes of missed diagnosis of pediatric appendicitis, new-onset diabetic ketoacidosis, and sepsis in five pediatric hospitals.
This study’s objective was to determine 90-day complication rates and hospital utilization after a missed diagnosis of pediatric appendicitis, new-onset diabetic ketoacidosis (DKA), or sepsis. The authors evaluated patients under 21 years of age visiting five pediatric emergency departments (EDs) with a study condition. Case patients included had a preceding ED visit within 7 days of diagnosis and underwent case review to confirm a missed diagnosis. The authors compared complication rates and utilization between case and control patients after adjusting for age, sex, and insurance. They analyzed 29,398 children with appendicitis, 5366 with DKA, and 3622 with sepsis, of whom 429, 33, and 46, respectively, had a missed diagnosis. Patients with a missed appendicitis or DKA diagnosis had more hospital days and readmissions, but there were no significant differences for those with sepsis. Those with missed appendicitis were more likely to have abdominal abscess drainage or perforated appendicitis. Those with missed DKA were more likely to have cerebral edema, mechanical ventilation, or death. Those with missed sepsis were less likely to have mechanical ventilation.
AHRQ-funded; HS026503.
Citation: Michelson KA, Bachur RG, Grubenhoff JA .
Outcomes of missed diagnosis of pediatric appendicitis, new-onset diabetic ketoacidosis, and sepsis in five pediatric hospitals.
J Emerg Med 2023 Jul; 65(1):e9-e18. doi: 10.1016/j.jemermed.2023.04.006..
Keywords: Children/Adolescents, Sepsis, Diabetes, Diagnostic Safety and Quality
Lenz KB, Nishisaki A, Lindell RB
Peri-intubation adverse events in the critically ill child after hematopoietic cell transplant.
The goal of this study was to investigate whether adverse peri-intubation associated events occur at increased frequency in pediatric patients with hematopoietic cell transplant (HCT) compared with non-HCT oncologic or other pediatric ICU (PICU) patients and therefore might contribute to increased mortality. This retrospective cohort study of critically ill children who underwent tracheal intubation (TI) was conducted between 2014 and 2019. Data was merged from local airway management quality databases and Virtual Pediatric Systems. Data was supplemented with a retrospective chart review for HCT-related data, including HCT indication, transplant-related comorbidity status, and patient condition at the time of TI procedure. There was a total of 1,931 children identified who underwent TI, of which 92 (4.8%) were post-HCT, while 319 (16.5%) had history of malignancy without HCT, and 1,520 (78.7%) had neither HCT nor malignancy. Children post-HCT were older, more often had respiratory failure, use of catecholamine infusions peri-intubation, and use of noninvasive ventilation prior to intubation. There was no difference in hemodynamic tracheal intubation-associated adverse events (TIAEs) or peri-intubation hypoxemia across three groups (HCT 16%, non-HCT with malignancy 10%, other 15%). The authors did not find an association between HCT status and the adverse TI outcome after adjusting for age, difficulty airway feature, provider type, device, apneic oxygenation use, and indication for intubation.
AHRQ-funded; HS024511.
Citation: Lenz KB, Nishisaki A, Lindell RB .
Peri-intubation adverse events in the critically ill child after hematopoietic cell transplant.
Pediatr Crit Care Med 2023 Jul; 24(7):584-93. doi: 10.1097/pcc.0000000000003243..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Adverse Events
Hoffman JA, Pergjika A, Liu L
Standardizing and improving care for pediatric agitation management in the emergency department.
In the U.S., pediatric mental health emergency department (ED) visits are increasing, with a greater number of visits involving the prescription of medication for acute agitation. Well timed, consistent application of behavioral strategies and medications may decrease the need for physical restraint of pediatric patients. The purpose of this study was to standardize agitation management in a pediatric ED and decrease pediatric patient time in physical restraints. From September 2020 to August 2021, researchers implemented a quality improvement initiative followed by a 6-month maintenance period. A barrier evaluation discovered that agitation triggers were not adequately recognized, there were few activities provided for children during lengthy ED visits, ED staff did not have confidence in techniques for verbally deescalating events, choices for medication were not consistent, and medication administered took time to take effect. Consecutive interventions included the development of a pathway and order set for agitation care, optimization of workflows for child life and psychiatry, implementation of personalized de-escalation plans, and adding the medication droperidol to the ED formulary. The measures utilize din the study included standardization of medication choice for severe agitation and time in physical restraints. The study found that during the intervention and maintenance components, there were 129 ED visits with medication administered for severe agitation and 10 ED visits where physical restraints were used. Among ED visits with medication given for severe agitation, there was an increase from 8% to 88% in standardized medication choice (olanzapine or droperidol), and a decrease in mean minutes in physical restraints from 173 to 71.
AHRQ-funded; HS026385.
Citation: Hoffman JA, Pergjika A, Liu L .
Standardizing and improving care for pediatric agitation management in the emergency department.
Pediatrics 2023 Jul 1; 152(1). doi: 10.1542/peds.2022-059586..
Keywords: Children/Adolescents, Emergency Department, Behavioral Health, Quality Improvement, Quality of Care
King C, Beetham T, Smith N
Treatments Used Among Adolescent Residential Addiction Treatment Facilities in the US, 2022.
This study is a survey of US adolescent residential addiction treatment facilities to assess treatments used for adolescents younger than 18 years seeking treatment for opioid use disorder (OUD). The authors posed as an aunt or uncle of a 16-year-old with a recent non-fatal fentanyl overdose to make calls to treatment facilities more plausible if they did not have all requested information about an adolescent. Four investigators called facilities included in the SAMHSA Treatment Indicator in random order and asked to speak with someone about residential treatment. They asked specific questions about buprenorphine use and open-ended questions about other available treatments. They identified 354 facilities, reached 327, and confirmed that 160 provided residential treatment to patients younger than 18 years. Of the 160 facilities identified 39 (24.4%) offered buprenorphine, including through partnerships with outside clinicians. Rates varied by US region (18% in the West to 40% in the Northeast). Among the 121 facilities that did not offer buprenorphine or were unsure, 57 indicated that adolescents who were prescribed buprenorphine by their own clinician could continue receiving it, at least temporarily, although some facilities indicated that would discontinue it before discharged, and 22.3% required adolescents to not be receiving it at admission. Of 160 facilities, 140 had someone available who could prescribe medications for psychiatric comorbidities. Overall, 124 facilities had naloxone, 24 did not, and 11 were unsure. Over half of the facilities included family members in adolescent treatment. Leading approaches for adolescent treatment included mutual help frameworks (eg, 12-step program, n = 59), cognitive behavior therapy (n = 52), community reinforcement/adolescent community approach (n = 44), art therapy (n = 40), and equine therapy (n = 40).
AHRQ-funded; HS017589.
Citation: King C, Beetham T, Smith N .
Treatments Used Among Adolescent Residential Addiction Treatment Facilities in the US, 2022.
JAMA 2023 Jun 13; 329(22):1983-85. doi: 10.1001/jama.2023.6266..
Keywords: Children/Adolescents, Substance Abuse, Behavioral Health
Mooney AC, Jackson KE, Hamad R
Experiences of distress and gaps in government safety net supports among parents of young children during the COVID-19 pandemic: a qualitative study.
This study examined the experiences and challenges of families with low incomes caring for young children during the COVID-19 pandemic. The authors conducted semi-structured qualitative interviews from August 2020 to January 2021 with 34 parents of young children in California that were then analyzed using thematic analysis. They identified three key themes related to parents' experiences during the pandemic: (1) positive experiences with government support programs, (2) challenging experiences with government support programs, and (3) distress resulting from insufficient support for childcare disruptions. Program expansions helped alleviate food insecurity, and those attending community colleges reported accessing a range of supports through supportive counselors. However, there were many reported gaps in childcare and distance learning support, pre-existing housing instability, and parenting stressors.
AHRQ-funded; HS022241.
Citation: Mooney AC, Jackson KE, Hamad R .
Experiences of distress and gaps in government safety net supports among parents of young children during the COVID-19 pandemic: a qualitative study.
BMC Public Health 2023 Jun 7; 23(1):1099. doi: 10.1186/s12889-023-16037-4..
Keywords: Children/Adolescents, COVID-19, Public Health
Stiles-Shields C, Archer J, Zhang J
A scoping review of associations between cannabis use and anxiety in adolescents and young adults.
This review sought to examine the association between anxiety and cannabis in adolescents and young adults. Forty-seven studies were identified that examined the relationship between anxiety and cannabis use via a database search; 23 studies found a positive association that greater anxiety was associated with greater cannabis use and 7 found a negative association. The remainder found no clear association. The authors concluded that further research is needed to understand the relationship between anxiety and cannabis use.
AHRQ-funded; HS026385.
Citation: Stiles-Shields C, Archer J, Zhang J .
A scoping review of associations between cannabis use and anxiety in adolescents and young adults.
Child Psychiatry Hum Dev 2023 Jun; 54(3):639-58. doi: 10.1007/s10578-021-01280-w..
Keywords: Children/Adolescents, Anxiety, Substance Abuse, Behavioral Health
Chang L, Stewart AM, Kester K
Association of homelessness with emergency department use among children in New York.
This research letter describes a cross-sectional study that was conducted to evaluate the association of homelessness with emergency department (ED) use among children in New York. The study used the HCUP State Emergency Department Database and State Inpatient Database for New York including children 18 years and younger with an ED visit between 2014 and 2018. The primary outcome was frequent ED use, defined as 4 or more visits per calendar year. The authors determined visit incident rates for all children for ambulatory care-sensitive conditions (asthma, diabetes, gastroenteritis, urinary tract infection), injuries and poisonings, and mental health problems based on ICD-9 and ICD-10 codes. Frequent ED use was more common among children experiencing homelessness, occurring in 22.1% vs 4.3% of children who were housed. Children experiencing homelessness had higher incidences of asthma, diabetes, urinary tract infections, and mental health problems and lower incidences of injuries and poisonings, which lead to higher admission rates overall (42.1% vs 0.7%) and to ICUs (4.1% vs 0.7%). Admission rates were higher across all diagnoses and to ICUs for asthma, gastroenteritis, and injuries and poisonings. ED usage rates were highest for homeless children aged 12-17 (40.2% of all children).
AHRQ-funded; HS026503.
Citation: Chang L, Stewart AM, Kester K .
Association of homelessness with emergency department use among children in New York.
JAMA Pediatr 2023 Jun; 177(6):637-40. doi: 10.1001/jamapediatrics.2023.0478..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Vulnerable Populations, Emergency Department
Vasan A, Kenyon CC, Fiks AG
Continuous eligibility and coverage policies expanded children's Medicaid enrollment.
Researchers examined children's participation in Medicaid during 2019-21. Their findings found that states that had adopted continuous Medicaid coverage for children during the COVID-19 pandemic experienced a 4.62 percent relative increase in children's Medicaid participation when compared with states with existing continuous eligibility policies.
AHRQ-funded; HS028555.
Citation: Vasan A, Kenyon CC, Fiks AG .
Continuous eligibility and coverage policies expanded children's Medicaid enrollment.
Health Aff 2023 Jun; 42(6):753-58. doi: 10.1377/hlthaff.2022.01465..
Keywords: Children/Adolescents, Medicaid, Policy, Health Insurance, Access to Care
Teixeira da Silva D, Makeneni S, Wall H
Measuring quality STI care among adolescent female primary care patients in Philadelphia.
The purpose of this study was to develop and apply a cross-setting, sexually transmitted infection (STI) Care Continuum to improve STI care quality, to assess adherence to guideline-recommended care, and to standardize progress measurement toward National Strategic goals. Review of the CDC STI treatment guidelines identified seven distinct steps of care for gonorrhea, chlamydia, and syphilis; researchers used Youth Risk Behavior Surveillance Survey data to estimate step 1, and electronic health record data for steps 2, 3, 4, 6 and 7. The researchers concluded that local application of an STI Care Continuum identified STI testing, retesting, and HIV testing as areas for improvement. Similar methods may be applied to target resources, standardize data collection and reporting, and improve STI care quality.
AHRQ-funded; HS026116.
Citation: Teixeira da Silva D, Makeneni S, Wall H .
Measuring quality STI care among adolescent female primary care patients in Philadelphia.
Sex Transm Infect 2023 Jun; 99(4):272-75. doi: 10.1136/sextrans-2022-055623..
Keywords: Children/Adolescents, Sexual Health, Infectious Diseases, Primary Care, Women, Human Immunodeficiency Virus (HIV), Quality Measures, Quality of Care
Mehta SD, Congdo M, Phillips CA
Opportunities to improve diagnosis in emergency transfers to the pediatric intensive care unit.
This study’s objective was to apply diagnostic process improvement frameworks to identify missed opportunities for improvement in diagnosis (MOID) in pediatric emergency transfers (ETs) and evaluate their association with outcomes. ET is defined as hospitalized patients who require ICU interventions within 1 hour of ICU transfer, which is a proximal measure of late recognition associated with increased mortality and length of stay (LOS). This single-center retrospective cohort study was conducted from January 2015 to June 2019. Primary outcome was the presence of missed opportunities for improvement in diagnosis (MOID), determined using SaferDx. MOID was identified in 37 of 129 ETs (29%). Cases with MOID differed in originating service, but not demographically, with failure to recognize urgency of an identified condition the most common diagnostic process opportunity. ET cases with MOID had higher odds of mortality and longer post-transfer LOS.
AHRQ-funded; HS028682.
Citation: Mehta SD, Congdo M, Phillips CA .
Opportunities to improve diagnosis in emergency transfers to the pediatric intensive care unit.
J Hosp Med 2023 Jun; 18(6):509-18. doi: 10.1002/jhm.13103..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Intensive Care Unit (ICU)
Rees CA, Stewart AM, Portillo EN
Reporting of important social determinants of health in pediatric clinical trials.
The purpose of this study was to assess the rates and trends in the reporting of sexual orientation, gender identity, preferred language, and socioeconomic factors in published pediatric clinical trials. The researchers conducted a cross-sectional study of pediatric clinical trials in the United States published from January 1, 2011 through December 31, 2020 in 5 general pediatric and 5 general medical journals with the highest impact factor in their respective fields. Outcomes included reporting of sexual orientation, gender identity, socioeconomic factors, and preferred language. The study found that in 612 trials, 29.6% reported preferred language. Among these, 64.6% exclusively enrolled participants whose preferred language was English. From 2011 to 2020, there was a relative increase in the reporting of preferred language. Socioeconomic factors were reported in 47.9% of trials. There was no significant change in the reporting of socioeconomic factors of published trial results among adolescent participants reported any measure of sexual orientation, and 1.1% reported gender identity. The researchers concluded that despite sexual orientation, gender identity, preferred language, and socioeconomic factors being increasingly recognized as social determinants of health these variables were infrequently included in pediatric clinical trial results reporting.
AHRQ-funded; HS026503.
Citation: Rees CA, Stewart AM, Portillo EN .
Reporting of important social determinants of health in pediatric clinical trials.
Am J Prev Med 2023 Jun; 64(6):918-26. doi: 10.1016/j.amepre.2022.12.004..
Keywords: Children/Adolescents, Social Determinants of Health, Health Services Research (HSR)
Kim KC, Khouja T, Burgette JM
Trends in dispensed prescriptions for opioids, sedatives, benzodiazepines, gabapentin, and stimulants to children by general dentists, 2012-2019.
This study examined trends in prescription fills for opioids, benzodiazepines, gabapentin, and stimulants to children <18 years from 2012 to 2019 in a national dataset comprising 92% of dispensed outpatient prescriptions by dentists. During this time, 3.8 million children filled prescriptions for high-alert drugs from general dentists. Opioids accounts for 69.4% of high-alert prescriptions, however from 2012 to 2019 fills for opioids, sedatives, benzodiazepines, and stimulants decreased by 65.2%, 43.4%, 43.6% and 89.3%, respectively. Gabapentin prescriptions increased by 8.1%. Older teenagers (15-17 years) received 42.5% of high-alert prescriptions. Low-income counties in Southern states were overrepresented among top-prescribing areas in 2019.
AHRQ-funded; HS025177.
Citation: Kim KC, Khouja T, Burgette JM .
Trends in dispensed prescriptions for opioids, sedatives, benzodiazepines, gabapentin, and stimulants to children by general dentists, 2012-2019.
Pharmacoepidemiol Drug Saf 2023 Jun; 32(6):625-34. doi: 10.1002/pds.5589..
Keywords: Children/Adolescents, Dental and Oral Health, Opioids, Medication, Practice Patterns
McDaniel CE, Leyenaar JK, Bryan MA
Urban-rural disparities in interfacility transfers for children during COVID-19.
This study’s goal was to identify temporal trends and differences in urban and rural pediatric interfacility transfers (IFTs) before and during the COVID-19 pandemic. The authors conducted a cross-sectional analysis of IFT among children <18 years from January 2019 to June 2022 using the Pediatric Health Information System. They calculated observed-to-expected (O-E) ratios of pre-pandemic (March 2019-Feb 2020) transfers compared to pandemic year 1 (March 2020-Feb 2021) and year 2 (March 2021-February 2022) using Poisson modeling. The O-E ratio of IFT in year 1 for urban children was 14.0% and 14.8% for rural children compared to pre-pandemic. In year 2, transfers rebounded with IFTs for rural-residing children increasing more than urban-residing children (101.7%) compared to 90.7%. For mental-health indications in year 2, rural transfer ratios were higher than urban, 126% compared to 113.7%.
AHRQ-funded; HS028683.
Citation: McDaniel CE, Leyenaar JK, Bryan MA .
Urban-rural disparities in interfacility transfers for children during COVID-19.
J Rural Health 2023 Jun; 39(3):611-16. doi: 10.1111/jrh.12746..
Keywords: COVID-19, Children/Adolescents, Disparities, Rural Health, Urban Health, Rural/Inner-City Residents
Short VL, Abatemarco DJ, Sood E
The Child Healthcare at MATER Pediatric Study (CHAMPS): a 2-arm cluster randomized control trial of group well child care for mothers in treatment for opioid use disorder and their children.
Group-based well child care is a shared medical appointment where families join as a group to receive pediatric primary care. Prior research indicates that this method of receiving care increases patient-reported satisfaction and adherence to recommended care. There is little evidence supporting the use of group well child care for mothers with opioid use disorder. The purpose of the Child Healthcare at MATER Pediatric Study (CHAMPS) is to assess a group model of well child care for mothers with opioid use disorder and their children to determine if a group well child care offered on-site at an opioid treatment program for pregnant and parenting women is beneficial over individual well child care. A total of 108 mother-child dyads will be enrolled into the study. In the intervention branch, group well child care will be provided on-site at a maternal substance use disorder treatment program. Mother-child dyads in the control branch will receive individual well child care from one nearby pediatric primary care clinic. Dyads in both study branches will be followed for 18 months, and their resulting data will be compared. Primary outcomes will include well child care quality and utilization, child health knowledge, and parenting quality.
AHRQ-funded; HS027399.
Citation: Short VL, Abatemarco DJ, Sood E .
The Child Healthcare at MATER Pediatric Study (CHAMPS): a 2-arm cluster randomized control trial of group well child care for mothers in treatment for opioid use disorder and their children.
Trials 2023 May 17; 24(1):333. doi: 10.1186/s13063-023-07357-2..
Keywords: Children/Adolescents, Opioids, Substance Abuse, Behavioral Health
Ahmad FA, Chan P, McGovern C
Adapting an electronic STI risk assessment program for use in pediatric primary care.
This study’s goal was to evaluate the usability of an electronic risk assessment tool to support sexually transmitted disease (STI) testing in the authors’ pediatric emergency department that they had previously designed and implemented. They conducted qualitative interviews of pediatricians, clinic staff, and adolescents from 4 pediatric practices as part of a study whose goal is to ultimately implement STI screening in pediatric primary care. The goal of the interviews was (1) to understand contextual factors related to STI screening in primary care, which they reported previously, and (2) to obtain feedback on their electronic platform, the questionnaire content, and their perspective on implementing it in primary care settings. They received quantitative feedback using the System Usability Scale (SUS). The SUS is a validated, reliable tool to measure the usability of hardware, software, websites, and applications, with a score of 68 (range 0-100) being average usability. They recruited 14 physicians, 9 clinic staff, and 12 adolescents. Participants rated the tool with a median score of 92.5, which shows a high level of usability.
AHRQ-funded; HS026704.
Citation: Ahmad FA, Chan P, McGovern C .
Adapting an electronic STI risk assessment program for use in pediatric primary care.
J Prim Care Community Health 2023 Jan-Dec; 14:21501319231172900. doi: 10.1177/21501319231172900..
Keywords: Children/Adolescents, Sexual Health, Infectious Diseases, Primary Care, Health Information Technology (HIT), Screening, Prevention