Influence of changes in supply on the distribution of pediatric subspecialty care.

Objectives: To examine whether recently certified pediatric subspecialists enter markets that previously lacked subspecialists and to determine whether changes in overall supply are associated with changes in geographic availability of care.

Design: Multiple cross-sectional analyses.

Setting: United States.

Using BMI to determine cardiovascular risk in childhood: how do the BMI cutoffs fare?

Objective: Although adverse health outcomes are increased among children with BMI above the 85th (overweight) and 95th (obese) percentiles, previous studies have not clearly defined the BMI percentile at which adverse health outcomes begin to increase. We examined whether the existing BMI percentile cutoffs are optimal for defining increased risk for dyslipidemia, dysglycemia, and hypertension.

Methods: This was a cross-sectional analysis of the National Health and Nutrition Examination Survey from 2001 to 2006.

Distance to care and relative supply among pediatric surgical subspecialties.

Background/purpose: The aim of this study is to describe geographic proximity to and quantify relative supply of 7 pediatric surgical specialties in the United States.

Methods: Data from the 2005 American Medical Association Physician Masterfile and the Claritas Pop-Facts Database were used to calculate subspecialty-specific, population-weighted, straight-line distances between each zip code centroid and the nearest provider. These same data sources were used to calculate the percentage of hospital referral regions with a provider, the percentage of the younger than 18 years population living within selected distances of providers, and provider-to-population ratios for each of the pediatric surgical subspecialties.

An investment in health: anticipating the cost of a usual source of care for children.

Objectives: Among adults, having a usual source of care has been associated with lower health care expenditures primarily through decreased emergency department and inpatient expenditures. The extent of this effect among children is unknown. We hypothesized that children with a usual source of care would have greater odds of having any outpatient expenditures, lower odds of emergency department and inpatient expenditures, and lower expenditures overall.

A medical home for children with insulin-dependent diabetes: comanagement by primary and subspecialty physicians--convergence and divergence of opinions.

Objective: The purpose of this work was to examine pediatricians' and endocrinologists' views about management for routine preventive and acute care, diabetes-specific care, and family education and care coordination for children with insulin-dependent diabetes.

Methods: We conducted a mixed-mode survey of all of the pediatricians in 1 medicaid managed care network and all of the pediatric and adult endocrinologists who treat children with diabetes in North Carolina.

Results: Of the 201 pediatricians surveyed, 132 responded (65%).

Health status and health care expenditures in a nationally representative sample: how do overweight and healthy-weight children compare?

Objective: Childhood overweight is epidemic in the United States. Although limited, previous studies suggest that overweight children have chronic health problems. A more complete understanding of the effect of overweight on children's health requires a nationally representative, population-based sample.

Effects of insurance status on children's access to specialty care: a systematic review of the literature.

Background: The current climate of rising health care costs has led many health insurance programs to limit benefits, which may be problematic for children needing specialty care. Findings from pediatric primary care may not transfer to pediatric specialty care because pediatric specialists are often located in academic medical centers where institutional rules determine accepted insurance. Furthermore, coverage for pediatric specialty care may vary more widely due to systematic differences in inclusion on preferred provider lists, lack of availability in staff model HMOs, and requirements for referral.

Disparities in geographic access to pediatric subspecialty care.

Purpose: To identify correlates of geographic access to pediatric medical subspecialists in the United States and identify characteristics of populations at risk for poor geographic access.

Methods: Geographic access was operationalized as distance to care. Using data from the American Board of Pediatrics and the Claritas' Pop-Facts Database, the straight-line distance between each zip code in the United States and the nearest subspecialist was calculated for each pediatric subspecialty using zip code centroids.

Are we there yet? Distance to care and relative supply among pediatric medical subspecialties.

Objective: The objective of this study was to describe geographic proximity, quantify variation in supply, and estimate pediatric population increments that are needed to support providers across pediatric subspecialties.

Methods: Data from the American Board of Pediatrics and the Claritas Pop-Facts Database were used to calculate subspecialty-specific straight-line distances between each zip code and the nearest board-certified subspecialist. These data sources also were used to estimate the percentage of hospital referral regions with providers and calculate physician-to-population ratios for each of 16 pediatric medical subspecialties.

Availability of pediatric rheumatology training in United States pediatric residencies.

Objective: To characterize the availability of pediatric rheumatology training in general pediatric residencies.

Methods: We surveyed 195 pediatric residency program directors in the US using a combined Web-based and paper-based survey format. The survey asked directors about the availability of an on-site pediatric rheumatologist in their institution, the availability of formal pediatric rheumatology rotations, and the types of physicians involved in teaching curriculum components related to pediatric rheumatology.

Does clinical presentation explain practice variability in the treatment of febrile infants?

Background: Previous studies documented considerable variability in the treatment of febrile infants, despite the existence of practice guidelines for this condition. None of those studies documented the extent to which this variability is accounted for by differences in clinical severity.

Objective: To quantify the individual effects of the patient's clinical presentation, demographic, provider, and practice characteristics, and regional variables on practice variability in the evaluation and treatment of febrile infants.

The effect of rural residence on dental unmet need for children with special health care needs.

Background: Unmet need for dental care is the most prevalent unmet health care need among children with special health care needs (CSHCN), even though these children are at a greater risk for dental problems. The combination of rural residence and special health care needs may leave rural CSHCN particularly vulnerable to high levels of unmet dental needs.

Objective: To examine the effects of rural residence on unmet dental need for CSHCN.

The changing composition of the pediatric medical subspecialty workforce.

Objectives: To characterize the composition of the pediatric subspecialty workforce in terms of the distribution of women and international medical graduates (IMGs) across pediatric medical subspecialties and to determine whether the proportions of board-certified pediatric subspecialists who are women or IMGs differ between graduation cohorts.

Study Design: We used board certification data from the American Board of Pediatrics. Within each pediatric subspecialty, we classified physicians into 2 groups, ie, recent graduates, defined as those who completed medical school after January 1, 1987, and nonrecent graduates, who completed medical school before that date.

The effects of rural residence and other social vulnerabilities on subjective measures of unmet need.

To determine whether self-reports of unmet need are biased measures of access to health care, the authors examine the relationship between rural residence and perceived need for physician services. They perform logistic regression analyses to examine the likelihood of reporting a need for routine preventive care and/or specialty care using data from the National Survey of Children with Special Health Care Needs. Even after controlling for factors known to be associated with evaluated need, parents of rural children were less likely to report a need for routine or specialty services.

Too many, too few, too concentrated? A review of the pediatric subspecialty workforce literature.

Objectives: To summarize recent pediatric subspecialty workforce analyses and to highlight similarities and differences across studies.

Design: By using MEDLINE, we conducted a systematic search of the literature published from January 1, 1992, through December 31, 2002. We included research articles and task force reports, and abstracted author, year of publication, specialty, sample size, analytic perspective (eg, physician or academic department), inclusion of data on nonclinical activities, inclusion of an objective measure of demand, and workforce-related conclusions.

Unmet need for therapy services, assistive devices, and related services: data from the national survey of children with special health care needs.

Objective: To estimate the prevalence of unmet needs for therapy services, vision and hearing care or aids, mobility aids, and communication aids and to investigate the association between predisposing, enabling, need, and environmental factors and unmet needs.

Methods: Using the National Survey of Children with Special Health Care Needs, we generated national prevalence estimates and performed bivariate and logistic analyses, accounting for the complex survey design.

Results: Nationally, the prevalence of unmet needs ranged from 5.

Role of pediatric and internist rheumatologists in treating children with rheumatic diseases.

Objective: To quantify and describe the role of internist and pediatric rheumatologists in the care of children with rheumatic diseases and identify factors associated with internist rheumatologists' willingness to treat children.

Methods: We surveyed physician members of the American College of Rheumatology who currently practice in California (n = 589). Bivariate and logit analyses were used to examine the effects of training, provider, practice, and distance to the nearest pediatric rheumatologist on the likelihood that an internist rheumatologist treated children.

Unmet need for routine and specialty care: data from the National Survey of Children With Special Health Care Needs.

Objective: To assess the prevalence of unmet needs for routine and specialty care among children with special health care needs (CSHCN) and to identify factors associated with the likelihood of having unmet need for medical care.

Methods: Data come from the respondents for 38 866 children interviewed for the National Survey of Children With Special Health Care Needs. Bivariate analyses were used to assess differences in unmet need for medical care by various environmental, predisposing, enabling, and need factors.

Access to pediatric rheumatology care in the United States.

Objective: To describe rheumatology providers, depict their availability, and determine the extent to which internist rheumatologists may expand access to care for children with rheumatic diseases.

Methods: Using data from the American College of Rheumatology and the Bureau of Health Professions Area Resource File, we generated a national map of providers' practice locations and calculated distances between each county and the nearest rheumatologist. We also performed a logit analysis to identify provider and county characteristics that were associated with internist rheumatologists' willingness to treat children.

Hospital resource utilization among patients with sickle cell disease.

In the United States, sickle cell disease primarily affects African Americans and carries a high risk of disability, making its sufferers particularly vulnerable. Sickle cell patients often experience unexpected, intermittent, and life-threatening complications leading to high levels of emergency room use and frequent hospitalizations. Using national discharge data from not-for-profit hospitals, this study explores the relationship between patient and hospital characteristics and hospital resource use by sickle cell patients.

Agreement among measures of asthma status: a prospective study of low-income children with moderate to severe asthma.

Background: Because no validated "gold standard" for measuring asthma outcomes exists, asthma interventions are often evaluated using a large number of disease status measures. Some of these measures may be redundant, whereas others may be complementary. Use of multiple outcomes may lead to ambiguous results, increased type I error rates, and be an inefficient use of resources including caregiver and patient/participant time and effort.