Disparities in Patient Portal Activation and Usage at a Large Pediatric Academic Institution.

Background And Objective: Access to personal medical information promotes patient understanding of health issues and enables patient self-advocacy of healthcare needs. The advent of electronic medical record systems and the 2016 21st Century CURES Act promoted and encouraged patient access to personal medical information, yet technology-dependent modalities have often disadvantaged certain communities. We sought to evaluate whether disparities existed in access to patient portals at our institution, the main pediatric care provider in an area serving one million children.

Cluster randomized trial of a team communication training implementation strategy for depression screening in a pediatric healthcare system: a study protocol.

Background: Pediatric depression is a global concern that has fueled efforts for enhanced detection and treatment engagement. As one example, the US Preventive Services Task Force recommends depression screening for adolescents ages 12-18 years. While many health systems have implemented components of depression screening protocols, there is limited evidence of effective follow-up for pediatric depression.

Improving Sexual History Documentation in Teenagers.

Background And Objectives: Teen access to sexual health care is essential. The 21st Century Cures Act mandates that most electronic health information be shared with patients; no standard exists for how to meet this mandate for teens and their proxy caregivers. Our confidential shared teen sexual history (SexHx) section, which is not note-based, allows clinicians to easily find information, promotes clinical decision support, and protects privacy.

Training pediatric physicians and staff to obtain data from the electronic health record.

Electronic health records (EHRs) have provided physicians with user-friendly self-service reporting tools to extract patient data from the EHR. Despite such benefits, physician training on how to use these tools has been limited. At our institution, physicians were faced with prolonged wait time for EHR data extraction requests and were unaware of self-service reporting tool availability in the EHR.

Counts and child protection reports of diagnosed child maltreatment before and after the COVID-19 pandemic onset.

Background: Mechanisms for reporting child maltreatment (CM) were affected by changes in service provision immediately following the onset of the COVID-19 pandemic.

Objective: To examine changes in counts and CPS reporting of CM medical encounters before and after the onset of COVID-19.

Participants And Setting: All emergency department and inpatient medical encounters with at least one CM diagnosis during the study period at Rady Children's Hospital San Diego, the largest pediatric hospital in California between 2016 and November 2021.

The Impact of COVID-19 on Infant Maltreatment Emergency Department and Inpatient Medical Encounters.

Objective: To assess the counts of infant maltreatment-related medical encounters at a large medical system during a 21-month span of the COVID-19 pandemic.

Methods: Retrospective data for this study came from all inpatient and emergency department medical encounters for infants from January 1, 2016, through November 30, 2021, at a single children's hospital system in California. Distributions of medical encounters were tabulated and plotted over time.

A Longitudinal Study of Health Care Utilization Among Infants Investigated for Maltreatment.

Objective: To evaluate whether maltreatment investigated during infancy affects high-acuity health care utilization patterns during early childhood.

Methods: Retrospective case-control study based on linked data between child protection and hospital encounter records conducted to review health records of infants investigated for abuse and/or neglect. Cases and controls were followed longitudinally through the Rady Children's Hospital electronic health records for 4 years starting at the age of 1 year.

Academic Health Centers and Humanitarian Crises: One Health System's Response to Unaccompanied Children at the Border.

University of California Health (UCH) provided a system-wide, rapid response to the humanitarian crisis of unaccompanied children crossing the southern U.S. border in the midst of the COVID-19 pandemic in 2021.

Disappearing Help Text: Implementing a Note-Based Tool for In-Line Clinical Decision Support and Note Bloat Reduction.

Objective: The authors describe a novel solution to the challenges of lengthy notes and poor note readability by creating an unobtrusive clinical decision support tool named "disappearing help text."

Methods: We designed this tool in Pediatric Hospital Medicine (PHM) note templates to provide in-line decision support on best documentation practices, note bloat reduction, billing compliance, and provider workflow enhancement.

Results: After template changes that utilized disappearing help text, we reduced the percent of notes utilizing any laboratory SmartLink from 90.

Organizational Perspectives on Technical Capabilities and Barriers Related to Pediatric Data Sharing and Confidentiality.

This qualitative study describes results from a semistructured interview investigating technical capabilities and barriers related to pediatric data sharing and confidentiality that was administered to health care organizations participating in the California Pediatric Informatics Collaborative.

Pre-Implementation Organizational Environment Associated with Pediatric Integrated Care Readiness in Primary Care.

Objective: To characterize pre-implementation organizational factors associated with Access To Tailored Autism Integrated Care (ATTAIN), an integrated care model for children with autism and identified or suspected co-occurring mental health needs.

Methods: Pediatric primary care providers (n=36) completed surveys as part of a pilot study testing ATTAIN feasibility. Measures assessed: background characteristics; implementation climate; organizational readiness; evidence-based practice (EBP) attitudes; knowledge, confidence and comfort caring for children with autism.

Mental health screening in pediatric primary care for children with autism.

Children with autism experience high rates of co-occurring mental health conditions like challenging behaviors and anxiety. However, these co-occurring mental health needs are often not identified when they first become problematic. Pediatricians and their care staff are in a good position to identify mental health needs early and support families to connect to needed services.

Implementation outcomes from a pilot of "Access to Tailored Autism Integrated Care" for children with autism and mental health needs.

Children with autism frequently experience co-occurring mental health needs. The "Access to Tailored Autism Integrated Care (ATTAIN)" model was co-created with caregivers, pediatric providers, and health care leaders to identify mental health needs and link to mental health care for autistic children. This article describes outcomes from a pilot study of Access to Tailored Autism Integrated Care with 36 pediatric primary care providers from seven clinics within three healthcare systems.

Assessment of Prevalence of Adolescent Patient Portal Account Access by Guardians.

Importance: Patient portals can be configured to allow confidential communication for adolescents' sensitive health care information. Guardian access of adolescent patient portal accounts could compromise adolescents' confidentiality.

Objective: To estimate the prevalence of guardian access to adolescent patient portals at 3 academic children's hospitals.

A Quality Improvement Initiative to Improve Discharge Timeliness and Documentation.

Introduction: Discharge communication is critical for the continuity of patient care. However, discharge summaries are often not available in time for follow-up visits, and the content is inconsistent. We aimed to decrease the average time to discharge summary completion by 25%, reduce deficiencies (information errors) by 50%, and increase discharge summary template use to >80% in 6 months.

Are You In or Are You Out? Provider Note Sharing in Pediatrics.

Background: The OpenNotes initiative launched an international movement aimed at making health care more transparent by improving communication with, and access to, information for patients through provider note sharing. Little has been written either on provider note sharing in pediatric and adolescent populations or on the impact of system default settings versus voluntary provider note sharing.

Objective: We describe our journey as a pediatric integrated delivery network to default share notes in ambulatory specialty practices not only with parent proxies but also with teens and discuss the methods that led to a successful implementation.

Medication Reconciliation Improvement Utilizing Process Redesign and Clinical Decision Support.

Background: Despite years of attention, hospitals continue to struggle to implement successful medication reconciliation. This study aimed to increase the percentage of hospital admission medication reconciliation (AdmMedRec) completion to ≥ 95% in 12 months at a large academic children's hospital.

Methods: A quality improvement (QI) project was initiated in April 2017 by an interdisciplinary team of physicians, nurses, pharmacists, and analysts, co-led by a pediatric hospitalist and chief medical information officer.

A mixed methods study to adapt and implement integrated mental healthcare for children with autism spectrum disorder.

Background: There is a critical need for effective implementation of integrated healthcare systems for children with autism spectrum disorder (ASD). Children with ASD have many service needs, including the need to access effective mental healthcare, given high rates of co-occurring psychiatric conditions. Pediatric primary care is an ongoing point of healthcare that is well positioned to identify mental health concerns and facilitate linkage to mental health services for children with ASD.

Clinician opioid prescribing practices and patient utilization of prescribed opioids in pediatrics.

Objective: Little is known regarding clinician prescribing of opioid medications and of patient use of prescribed opioid medications in pediatrics. The authors sought to learn more about pediatric clinician opioid prescribing practices and patient utilization and disposal of prescribed opioids.

Design: Cross-sectional, observational study.

Patient Portal Usage in Pediatric Urology: Is it Meaningful Use for Everyone?

Introduction: The Affordable Care Act promotes multiple directives for meaningful use of the Electronic Health Record, such as patient/provider portals, to increase patient engagement. Although portal use is common within adult healthcare, little information exists regarding pediatric portal use. We examined pediatric urology patient portal enrollment and activation patterns at a tertiary pediatric hospital in Southern California by race/ethnicity, preferred language, gender, and residential region.

Physician Perception of the Role of the Patient Portal in Pediatric Health.

The patient portal, increasingly available to patients, allows secure electronic communication with physicians. Although physician attitude toward the portal plays a crucial role in patient adoption, little information regarding physician opinion of the portal is available, with almost no information gathered in the pediatric environment. Using a mixed-methods approach, physicians in a large pediatric medical facility and integrated delivery network were surveyed using an online quantitative questionnaire and structured interviews.

Structured Data Entry in the Electronic Medical Record: Perspectives of Pediatric Specialty Physicians and Surgeons.

The Epic electronic health record (EHR) platform supports structured data entry systems (SDES), which allow developers, with input from users, to create highly customized patient-record templates in order to maximize data completeness and to standardize structure. There are many potential advantages of using discrete data fields in the EHR to capture data for secondary analysis and epidemiological research, but direct data acquisition from clinicians remains one of the largest obstacles to leveraging the EHR for secondary use. Physician resistance to SDES is multifactorial.