Addressing adverse social determinants of health in pediatric primary care: Study protocol for a hybrid type 2 effectiveness-implementation randomized controlled trial in two national pediatric practice-based research networks.

Background: Growing evidence linking social determinants of health (SDOH) to child health outcomes has prompted widespread recommendations for pediatricians to screen and refer for adverse SDOH at primary care visits. Yet there is little evidence to date demonstrating the effectiveness of practice-based SDOH screening and referral interventions on increasing family engagement with resources. This hybrid type 2 effectiveness-implementation trial aims to demonstrate the non-inferiority of a low-touch implementation strategy in order to facilitate dissemination of an existing SDOH screening and referral system (WE CARE) and demonstrate its effectiveness and sustainability in various pediatric practices.

Duration of US Residence And Resource Needs In Immigrant Families With Young Children.

To mitigate the negative impact of resource needs on child health, practices serving low-income immigrant families have implemented screening programs to connect families to community resources. Little is known about how duration of US residence relates to patterns of resource needs and indicators of acculturation such as community resource knowledge/experience or self-efficacy. We conducted a cross-sectional analysis of a convenience sample of immigrant families with young children at an urban primary care clinic.

Health Literacy Perceptions and Knowledge in Pediatric Continuity Practices.

Background: Low health literacy affects one-third of adults in the United States and can have a negative effect on health behavior and outcomes.

Objective: The goal of this study was to examine attitudes and knowledge of health literacy among pediatric residents and faculty in pediatric resident continuity clinics across the country.

Methods: An online mixed-methods survey was distributed to pediatric faculty and residents through the Academic Pediatric Association's Continuity Research Network.

Understanding Physicians' Preferences for Telemedicine During the COVID-19 Pandemic: Cross-sectional Study.

Background: In contrast to the current broad dissemination of telemedicine across medical specialties, previous research focused on the effectiveness of telemedicine in special populations and for behavioral health encounters, demonstrating that both physician and patient factors impact the efficacious use of telemedicine.

Objective: We aim to evaluate physician perceptions of the appropriateness of telemedicine for patients attending the primary care practices of a federally qualified health center in New York City.

Methods: We used an anonymous cross-sectional survey including closed- and open-ended questions.

Clinician Experiences With Reach Out and Read: An Exploratory Qualitative Analysis.

Background: Enhanced literacy and increased vocabulary related to Reach Out and Read (ROR) are well described. Less is known about clinicians' experience with the program.

Objective: Understand clinician experiences of implementing ROR.

Managing COVID-19 With a Clinical Decision Support Tool in a Community Health Network: Algorithm Development and Validation.

Background: The coronavirus disease (COVID-19) pandemic has resulted in significant morbidity and mortality; large numbers of patients require intensive care, which is placing strain on health care systems worldwide. There is an urgent need for a COVID-19 disease severity assessment that can assist in patient triage and resource allocation for patients at risk for severe disease.

Objective: The goal of this study was to develop, validate, and scale a clinical decision support system and mobile app to assist in COVID-19 severity assessment, management, and care.

Clinical Decision Support Tool and Rapid Point-of-Care Platform for Determining Disease Severity in Patients with COVID-19.

SARS-CoV-2 is the virus that causes coronavirus disease (COVID-19) which has reached pandemic levels resulting in significant morbidity and mortality affecting every inhabited continent. The large number of patients requiring intensive care threatens to overwhelm healthcare systems globally. Likewise, there is a compelling need for a COVID-19 disease severity test to prioritize care and resources for patients at elevated risk of mortality.

Clinical decision support tool and rapid point-of-care platform for determining disease severity in patients with COVID-19.

SARS-CoV-2 is the virus that causes coronavirus disease (COVID-19) which has reached pandemic levels resulting in significant morbidity and mortality affecting every inhabited continent. The large number of patients requiring intensive care threatens to overwhelm healthcare systems globally. Likewise, there is a compelling need for a COVID-19 disease severity test to prioritize care and resources for patients at elevated risk of mortality.

Literacy Promotion Training and Implementation in Pediatric Continuity Clinics.

Background: Despite endorsement by the American Academy of Pediatrics, there are no national data on literacy promotion (LP) training and behaviors.

Objective: To describe LP training experiences and behaviors of pediatric and internal medicine/pediatrics residents and faculty nationally, and the association between LP training and behaviors.

Methods: The Academic Pediatric Association's Continuity Research Network and Reach Out and Read National Center sent an online survey to faculty and residents at participating Continuity Research Network clinics.

CORNET Card Study #1: Do You See What I See? Provider Confidence in Caring for Children With Special Health Care Needs.

Objective: Understanding differences between trainee and faculty experience with and confidence caring for children with special health care needs (CSHCN) can inform pediatric resident education.

Methods: Residents and faculty across the continuity research network (CORNET) reported on a consecutive series of 5 primary care encounters. Respondents answered questions about visit characteristics, patient demographics, and applied the CSHCN Screener.

Factors Associated With Pickup of Pediatric Discharge Prescriptions.

Background And Objectives: Lack of medication pickup is associated with worse clinical outcomes for select patients. Identification of risk factors for not picking up discharge medications or approaches to this problem have received little study. We sought to identify factors associated with medication pickup rates after hospitalization at a tertiary care children's hospital.

Evaluation of Pediatric Human Papillomavirus Vaccination Provider Counseling Written Materials: A Health Literacy Perspective.

Background And Objectives: Despite recommendations supporting human papillomavirus (HPV) vaccination, pediatric vaccination rates remain suboptimal in the United States; lack of tools to support provider counseling is one barrier. We sought to evaluate HPV-related counseling materials for readability, suitability, and content, and assess parent perceptions of materials, using a health literacy perspective.

Methods: A systematic search was conducted for written materials developed for HPV vaccination counseling by examining state Department of Health Web sites and associated links to local and national organizations.

Interpretation Modalities Used on Family-Centered Rounds: Perspectives of Spanish-Speaking Families.

Background And Objectives: Limited-English-proficient (LEP) patients and families are at risk for worse hospital outcomes due to impaired communication. Family-centered rounds (FCR) have become the preferred format for information sharing among providers and families at pediatric institutions. However, there are limited data on FCR among LEP families, particularly regarding interpretation type.

General Pediatrician-Staffed Behavioral/Developmental Access Clinic Decreases Time to Evaluation of Early Childhood Developmental Disorders.

Objective: To describe and evaluate the effectiveness of a quality improvement project to decrease wait time to evaluation for children referred to Developmental Behavioral Pediatricians (DBPs).

Methods: The authors created a Behavioral/Developmental Access Clinic (BDAC) staffed by a general pediatrician (GP) and pediatric psychologist. Clinicians in the BDAC provided comprehensive developmental evaluations for children in a discrete age range (<5 yr old).

Strategies to Engage Community Partners in Research used by Delaware-CTR ACCEL.

Community-engagement is a key step in conducting research which is impactful for patients and communities. The Delaware Clinical and Translational Research (DE-CTR), Accelerating Clinical and Translational Research (ACCEL) program has implemented several successful approaches to engage our community, and to educate and motivate our researchers in this area. Increased participation in community-engaged research and community-based participatory research was accomplished through DE-CTR/ACCEL using multiple methods detailed in this manuscript.

Relationship between Teach-back and patient-centered communication in primary care pediatric encounters.

Objective: We proposed and tested a theoretical framework for how use of Teach-back could influence communication during the pediatric clinical encounter.

Methods: Audio-taped pediatric primary care encounters with 44 children with asthma were coded using the Roter Interaction Analysis System to measure patient-centered communication and affective engagement of the parent. A newly created Teach-back Loop Score measured the extent to which Teach-back occurred during the clinical encounter; parental health literacy was measured by Newest Vital Sign.

Domestic Sex Trafficking of Minors: Medical Student and Physician Awareness.

Study Objective: Our aim was to assess: (1) medical trainee and practicing physician awareness about domestic sex trafficking of minors; and (2) whether respondents believe that awareness of trafficking is important to their practice.

Design And Setting: We designed an anonymous electronic survey, and a convenience sample was collected from June through October 2013.

Participants: Voluntary participants were 1648 medical students, residents, and practicing physicians throughout the United States.

Correlates of type and quantity of child communication during pediatric subspecialty encounters.

Objectives: Understanding the factors associated with child communication during subspecialty encounters may inform interventions promoting shared decision-making in chronic disease management. Objectives were to (1) describe the quantity and quality of child communication during outpatient subspecialty encounters and (2) determine if and how the quantity and quality of child communication vary by demographic and visit characteristics.

Methods: We videotaped subspecialty clinic encounters involving 20 health care providers and 155 children with one of the following conditions: acute lymphoblastic leukemia (consolidation/maintenance), persistent asthma, cystic fibrosis, type 1 diabetes, and obesity.

Concomitant fundoplication increases morbidity of gastrostomy tube placement.

Background: Fundoplication is often performed in conjunction with gastrostomy tube (GT) placement in children, but there is a great deal of variation in rates of and indications for this procedure. Little is known about the impact of fundoplication on peri-operative outcomes. This study examines a national cohort of pediatric patients to compare risk-adjusted surgical outcomes in patients undergoing GT placement with or without concomitant fundoplication.

Outcomes and costs associated with hospitalist comanagement of medically complex children undergoing spinal fusion surgery.

Objective: The goal of this study was to assess outcomes and costs associated with hospitalist comanagement of medically complex children undergoing spinal fusion surgery for neuromuscular scoliosis.

Methods: A hospitalist comanagement program was implemented at a children's hospital. We conducted a retrospective case series study of patients during 2003-2008 to compare clinical and cost outcomes for 87 preimplementation patients, 40 patients during a partially implemented program, and 80 patients during a fully implemented program.

Pediatric hospitalist preoperative evaluation of children with neuromuscular scoliosis.

What's New: This is the first study of a pediatric hospitalist preoperative clinic. Pediatric hospitalists frequently make significant recommendations for patients with neuromuscular scoliosis prior to spinal surgery, especially those with medical complexity. Certain clinical criteria are statistically significantly associated with a hospitalist making a preoperative recommendation.

Association between health literacy and child and adolescent obesity.

Objective: We tested the association between child and parental health literacy (HL) and odds of child and adolescent obesity.

Methods: We conducted an anonymous cross-sectional survey of a convenience sample of English-speaking child-parent dyads. Newest Vital Sign (NVS) measured HL.