Advanced imaging use and payment trends in a large pediatric accountable care organization.

Background: Pediatric imaging use and payment trends in accountable care organizations (ACOs) are seldom studied but are important for health policy decisions and resource allocation.

Objective: To evaluate patterns of advanced imaging use and associated payments over a 7-year period at a large ACO in the USA serving a Medicaid population.

Materials And Methods: We reviewed paid claims data from 2011 through 2017 from an ACO, analyzing the MRI, CT and US use trends and payments from emergency department (ED) and outpatient encounters.

Left behind again: Rural home health services in a Medicaid pediatric accountable care organization.

Purpose: To contrast trends in rural and urban pediatric home health care use among Medicaid enrollees.

Methods: Medicaid administrative claims data were used to assess differences in home health care use for child members in a large pediatric accountable care organization (ACO) in Ohio. Descriptive statistics assessed rural and urban differences in health care use over a 10-year period between 2010 and 2019.

Trends in healthcare utilisation for firearm-related injuries among a cohort of publicly insured children in Ohio.

Objective: To examine healthcare utilisation for all firearm-related injuries among publicly insured children.

Methods: A retrospective analysis of firearm injury medical claims among paediatric (<21 years) Medicaid beneficiaries in Ohio from 2010 to 2018. Factors associated with unintentional and intentional firearm injury were explored using multivariable logistic regression.

Contribution of Social Determinant of Health Factors to Rural-Urban Preventive Care Differences Among Medicaid Enrollees.

Objective: 1) Assess whether rural-urban disparities are present in pediatric preventive health care utilization; and 2) use regression decomposition to measure the contribution of social determinants of health (SDH) to those disparities.

Methods: With an Ohio Medicaid population served by a pediatric Accountable Care Organization, Partners For Kids, between 2017 and 2019, we used regression decomposition (a nonlinear multivariate regression decomposition model) to analyze the contribution of patient, provider, and SDH factors to the rural-urban well-child visit gap among children in Ohio.

Results: Among the 453,519 eligible Medicaid enrollees, 61.

Providers' Behaviors and Beliefs on Prescribing Antipsychotic Medication to Children: A Qualitative Study.

Fragmentation in behavioral and mental health care to children has resulted in suboptimal care and high rates of psychotropic medication use, especially antipsychotic medications (APM). A qualitative study, based on the Theory of Planned Behavior (TPB), aimed to better understand prescribing practices, barriers to optimal treatment, and potential interventions to safeguard the use of APM for children in Kentucky. The most common barrier to optimal care was access to mental health specialists.

Zinc deficiency exacerbates while zinc supplement attenuates cardiac hypertrophy in high-fat diet-induced obese mice through modulating p38 MAPK-dependent signaling.

Childhood obesity often leads to cardiovascular diseases, such as obesity-related cardiac hypertrophy (ORCH), in adulthood, due to chronic cardiac inflammation. Zinc is structurally and functionally essential for many transcription factors; however, its role in ORCH and underlying mechanism(s) remain unclear and were explored here in mice with obesity induced with high-fat diet (HFD). Four week old mice were fed on either HFD (60%kcal fat) or normal diet (ND, 10% kcal fat) for 3 or 6 months, respectively.

Up-regulation of Nrf2 is involved in FGF21-mediated fenofibrate protection against type 1 diabetic nephropathy.

The lipid lowering medication, fenofibrate (FF), is a peroxisome proliferator-activated receptor-alpha (PPARα) agonist, possessing beneficial effects for type 2 diabetic nephropathy (DN). We investigated whether FF can prevent the development of type 1 DN, and the underlying mechanisms. Diabetes was induced by a single intraperitoneal injection of streptozotocin in C57BL/6J mice.

Data visualization for truth maintenance in clinical decision support systems.

Background And Objectives: The goal is to inform proactive initiatives to expand the knowledge base of clinical decision support systems.

Design And Setting: We describe an initiative in which research informationists and health services researchers employ visualization tools to map logic models for clinical decision support within an electronic health record.

Materials And Methods: We mapped relationships using software for social network analysis: NodeXL and CMAP.

The obesity epidemic in children: Latino children are disproportionately affected at younger ages.

Background And Objectives: National surveillance clearly illustrates that U.S. children are becoming increasingly overweight.

Creating a safe place for pediatric care: A no hit zone.

Objectives: Our goal was to create and implement a program, Kosair Children's Hospital's No Hit Zone, which trains health care workers in de-escalation techniques to address parental disruptive behaviors and physical discipline of children commonly encountered in the hospital environment.

Methods: The Child Abuse Task Force, a multidisciplinary group, along with key hospital administrators developed specific content for the policy, as well as marketing and educational materials. The No Hit Zone policy designates Kosair Children's Hospital as "an environment in which no adult shall hit a child, no adult shall hit another adult, no child shall hit an adult, and no child shall hit another child.

When Informationists Get Involved: the CHICA-GIS Project.

Child Health Improvement through Computer Automation (CHICA) is a computer decision support system (CDSS) that interfaces with existing electronic medical record systems (EMRS) and delivers "just-in-time" patient-relevant guidelines to physicians during the clinical encounter and accurately captures structured data from all who interact with the system. "Delivering Geospatial Intelligence to Health Care Professionals (CHICA-GIS)" (1R01LM010923-01) expands the medical application of Geographic Information Systems (GIS) by integrating a geographic information system with CHICA. To provide knowledge management support for CHICA-GIS, three informationists at the Indiana University School of Medicine were awarded a supplement from the National Library Medicine.

Gender differences in the association between perceived discrimination and adolescent smoking.

Objectives: We examined associations between perceived racial/ethnic discrimination, gender, and cigarette smoking among adolescents.

Methods: We examined data on Black and Latino adolescents aged 12 to 19 years who participated in the Moving to Opportunity study (N = 2561). Perceived discrimination was assessed using survey items asking about unfair treatment because of race/ethnicity in the prior 6 months.

The role of perceived parent monitoring and support on urban child and adolescent problem behavior.

Parental practices on problem behavior based on gender and age effects with urban youth were studied. Participants were 8-17 years old (N = 3,658; 66% African-American) and logistic regression models were conducted. For pre-teen females, decreased friend monitoring was related to high problem behavior; for teen females, lower maternal support and decreased home monitoring were significant.

Neighborhood greenness and 2-year changes in body mass index of children and youth.

Background: Available studies of the built environment and the BMI of children and youth suggest a contemporaneous association with neighborhood greenness in neighborhoods with high population density. The current study tests whether greenness and residential density are independently associated with 2-year changes in the BMI of children and youth.

Methods: The sample included children and youth aged 3-16 years who lived at the same address for 24 consecutive months and received well-child care from a Marion County IN clinic network within the years 1996-2002 (n=3831).

Using GPS-enabled cell phones to track the travel patterns of adolescents.

Background: Few tools exist to directly measure the microsocial and physical environments of adolescents in circumstances where participatory observation is not practical or ethical. Yet measuring these environments is important as they are significantly associated with adolescent health-risk. For example, health-related behaviors such as cigarette smoking often occur in specific places where smoking may be relatively surreptitious.

Adolescent travel patterns: pilot data indicating distance from home varies by time of day and day of week.

We conducted a pilot study using new technology to track adolescent "place." Using Global Positioning System (GPS)-enabled cell phones, we recruited and tracked 15 female adolescents for a 1-week period. Distance away from home was greatest in the evenings on weekends or holidays.

Use of unstructured parent narratives to evaluate medical student competencies in communication and professionalism.

Objective: Medical education programs across the country are now required to conduct meaningful assessments of trainees' competencies, although uniform standards for conducting these evaluations have yet to be established. In 1999, the Indiana University School of Medicine introduced a comprehensive competency-based undergraduate curriculum. The overall goal of the curriculum is to make medical students' day-to-day experiences of training a source of learning about professionalism, communication, and aspects of medicine beyond factual knowledge.

Green neighborhoods, food retail and childhood overweight: differences by population density.

Purpose: This study examines relationships between overweight in children and two environmentalfactors--amount of vegetation surrounding a child's place of residence and proximity of the child's residence to various types of food retail locations. We hypothesize that living in greener neighborhoods, farther from fast food restaurants, and closer to supermarkets would be associated with lower risk of overweight.

Design: Cross-sectional study.

Shortcomings in infant iron deficiency screening methods.

Background: Screening for iron deficiency anemia is a well-established practice in pediatrics, but numerous challenges surrounding current recommendations raise questions about the effectiveness of this strategy.

Objective: To evaluate iron deficiency anemia screening approaches, by assessing rates of follow-up testing and resolution among patients meeting screening criteria in a primary care setting.

Methods: A retrospective cohort study was performed.

Training young pediatricians as leaders for the 21st century.

Objective: To conduct a needs assessment with young pediatricians who participate in a leadership training program and to evaluate the effectiveness of that program.

Methods: In concert with the Johnson & Johnson Pediatric Institute, LLC, the American Academy of Pediatrics developed a 1-year strategy to train pediatricians who are <40 years old or <5 years in practice in leadership skills. Participants were nominated by American Academy of Pediatrics chapters and/or sections and were required to complete a detailed needs assessment, attend a 3-day training program, and commit to 1 leadership-related behavior change to be implemented within 6 months.

Race, urban community stressors, and behavioral and emotional problems of children with special health care needs.

Objectives: This study examined the relationship of community-level stressors to behavioral and emotional problems among African-American and white children with special health care needs.

Methods: The authors interviewed 257 low-income caregivers of children with special health care needs in an urban Midwestern city who brought their child for a primary health care visit to a community health center between September 2001 and May 2002. Sociodemographic characteristics as well as information about the children's behavioral and emotional problems, the health status of the children, perceptions of urban community stress, access to health care, and satisfaction with health care were collected to determine racial differences in the impact of urban stress on behavioral and emotional problems.

A spatial analysis of obesogenic environments for children.

In this study, we use spatial analysis techniques to explore environmental and social predictors of obesity in children. We constructed a merged database, incorporating clinical data from an electronic medical record system, the Regenstrief Medical Record System (RMRS) and societal & environmental data from a geographical information system, the Social Assets and Vulnerabilities Indicators (SAVI) Project. We used the RMRS to identify cohorts of children that were normal weight, overweight, or obese.