Telehealth: Opportunities to Improve Access, Quality, and Cost in Pediatric Care.

The use of telehealth technology to connect with patients has expanded significantly over the past several years, particularly in response to the global coronavirus disease 2019 pandemic. This technical report describes the present state of telehealth and its current and potential applications. Telehealth has the potential to transform the way care is delivered to pediatric patients, expanding access to pediatric care across geographic distances, leveraging the pediatric workforce for care delivery, and improving disparities in access to care.

Telehealth: Improving Access to and Quality of Pediatric Health Care.

All children and adolescents deserve access to quality health care regardless of their race/ethnicity, health conditions, financial resources, or geographic location. Despite improvements over the past decades, severe disparities in the availability and access to high-quality health care for children and adolescents continue to exist throughout the United States. Economic and racial factors, geographic maldistribution of primary care pediatricians, and limited availability of pediatric medical subspecialists and pediatric surgical specialists all contribute to inequitable access to pediatric care.

180-day readmission risk model for older adults with acute myocardial infarction: the SILVER-AMI study.

Objective: To develop a 180-day readmission risk model for older adults with acute myocardial infarction (AMI) that considered a broad range of clinical, demographic and age-related functional domains.

Methods: We used data from ComprehenSIVe Evaluation of Risk in Older Adults with AMI (SILVER-AMI), a prospective cohort study that enrolled participants aged ≥75 years with AMI from 94 US hospitals. Participants underwent an in-hospital assessment of functional impairments, including cognition, vision, hearing and mobility.

An instrument for assessing the quality of informed consent documents for elective procedures: development and testing.

Objective: To develop a nationally applicable tool for assessing the quality of informed consent documents for elective procedures.

Design: Mixed qualitative-quantitative approach.

Setting: Convened seven meetings with stakeholders to obtain input and feedback on the tool.

Cultural influences on willingness to donate organs among urban native Americans.

Background: The need for organ donation is substantial among Native Americans, driven by the disproportionate burden of ESRD. Due to the dearth of knowledge about willingness to donate (WTD) among urban Native Americans, a group that represents over half of the US Native population, we aimed to examine factors affecting donation.

Methods: We conducted a cross-sectional survey of a convenience sample, using a questionnaire developed specifically for this study using community-based participatory research.

Noninferiority Designed Cardiovascular Trials in Highest-Impact Journals.

Background: Noninferiority trials are increasingly being performed. However, little is known about their methodological quality. We sought to characterize noninferiority cardiovascular trials published in the highest-impact journals, features that may bias results toward noninferiority, features related to reporting of noninferiority trials, and the time trends.

Acute Kidney Injury Among Older Patients Undergoing Coronary Angiography for Acute Myocardial Infarction: The SILVER-AMI Study.

Background: Among older adults (age ≥75 years) hospitalized for acute myocardial infarction, acute kidney injury after coronary angiography is common. Aging-related conditions may independently predict acute kidney injury, but have not yet been analyzed in large acute myocardial infarction cohorts.

Methods: We analyzed data from 2212 participants age ≥75 years in the Comprehensive Evaluation of Risk Factors in Older Patients with Acute Myocardial Infarction (SILVER-AMI) study who underwent coronary angiography.

2018 Update on Medical Overuse.

Importance: Overuse of medical care is a well-recognized problem in health care, associated with patient harm and costs. We sought to identify and highlight original research articles published in 2017 that are most relevant to understanding medical overuse.

Observations: A structured review of English-language articles published in 2017 was performed, coupled with examination of tables of contents of high-impact journals to identify articles related to medical overuse in adult care.

Enhancing the prediction of acute kidney injury risk after percutaneous coronary intervention using machine learning techniques: A retrospective cohort study.

Background: The current acute kidney injury (AKI) risk prediction model for patients undergoing percutaneous coronary intervention (PCI) from the American College of Cardiology (ACC) National Cardiovascular Data Registry (NCDR) employed regression techniques. This study aimed to evaluate whether models using machine learning techniques could significantly improve AKI risk prediction after PCI.

Methods And Findings: We used the same cohort and candidate variables used to develop the current NCDR CathPCI Registry AKI model, including 947,091 patients who underwent PCI procedures between June 1, 2009, and June 30, 2011.

Coverage of Novel Therapeutic Agents by Medicare Prescription Drug Plans Following FDA Approval.

Background: Regulatory approval of novel therapies by the FDA does not guarantee insurance coverage requisite for most clinical use. In the United States, the largest health insurance payer is the Centers for Medicare & Medicaid Services (CMS), which provides Part D prescription drug benefits to over 43 million Americans. While the FDA and CMS have implemented policies to improve the availability of novel therapies to patients, the time required to secure Medicare prescription drug benefit coverage-and accompanying restrictions-has not been previously described.

Evidence supporting FDA approval and CMS national coverage determinations for novel medical products, 2005 through 2016: A cross-sectional study.

Food and Drug Administration (FDA) and Centers for Medicare and Medicaid Services (CMS) rely on evidence from clinical trials when approving a therapeutic for marketing and insurance coverage in the US, respectively. No study has compared the quality and quantity of evidence examined by these agencies.To characterize evidence used by FDA and CMS to support marketing approval and National Coverage Determinations (NCDs), respectively, of novel therapeutics reviewed for CMS coverage from 2005 through 2016.

Assessment of Clinical Trial Evidence for High-Risk Cardiovascular Devices Approved Under the Food and Drug Administration Priority Review Program.

This study uses publicly available FDA summaries to analyze the quality of evidence in pivotal studies that support cardiovascular premarket device approval under FDA priority review from 2007 to 2017.

Association Between Purpose in Life and Glucose Control Among Older Adults.

Background: Greater purpose in life is associated with lower rates of certain chronic diseases. Whether purpose in life can protect against development of prediabetes or type 2 diabetes is unknown.

Purpose: To examine the association between purpose in life and blood glucose control among adults ≥50 years.

Trends in Use of Transcatheter Aortic Valve Replacement by Age.

This study uses National Inpatient Sample data to characterize trends in transcatheter aortic valve replacement (TAVR) in age groups 55 years and older in the United States from 2012 to 2015.

Health Care Use and Health Behaviors Among Young Adults With History of Parental Incarceration.

Objectives: To determine if longitudinal associations exist between parental incarceration (PI) and health care use or health behaviors among a national sample of young adults.

Methods: We used the National Longitudinal Survey of Adolescent to Adult Health to examine associations between history of mother incarceration (MI) and father incarceration (FI), health care use, and 3 dimensions of health behaviors (eg, general health behaviors, substance use, and other risky behaviors) ( = 13 084). Multivariable logistic regression models accounted for individual, family, and geographic factors and generated adjusted odds ratios (aORs).

Childhood adversity and parent perceptions of child resilience.

Background: Adverse childhood experiences (ACEs) negatively impact health throughout the life course. For children exposed to ACEs, resilience may be particularly important. However, the literature regarding resilience, particularly the self-regulation aspect of resilience, is not often described in children with ACEs.

Impact of Cost Display on Ordering Patterns for Hospital Laboratory and Imaging Services.

Background: Physicians "purchase" many health care services on behalf of patients yet remain largely unaware of the costs of these services. Electronic health record (EHR) cost displays may facilitate cost-conscious ordering of health services.

Objective: To determine whether displaying hospital lab and imaging order costs is associated with changes in the number and costs of orders placed.

Geographic variation in postpartum prescription opioid use: Opportunities to improve maternal safety.

Background: Obstetric delivery is among the most common in-hospital procedures experienced by reproductive-age women, yet there is little literature on patterns of postpartum opioid prescriptions after such episodes.

Methods: We used claims data from 871,195 vaginal deliveries to 768,455 privately-insured women with an in-hospital delivery between June 2001 and July 2013 to examine the state- and census division-level proportions of women who filled an opioid prescription within four days of hospital discharge after vaginal delivery. Our primary outcome examined the proportion of women who filled an opioid prescription after uncomplicated vaginal delivery (e.

Well-Child Visits of Medicaid-Insured Children with Medical Complexity.

Objective: Well-child visits (WCVs) help optimize children's health. We measured annual WCVs for children with medical complexity (CMC) and correlated WCVs with hospitalizations.

Study Design: This was a retrospective analysis of 93 121 CMC aged 1-18 years continuously enrolled in 10 state Medicaid programs in the Truven MarketScan Database between 2010 and 2014.

Financial Relationships between Urologists and Industry: An Analysis of Open Payments Data.

Introduction: The Open Payments Program was enacted to increase transparency of financial relationships between physicians and the medical device and pharmaceutical industry. We examined nonresearch related financial relationships between urologists and industry in the United States using the latest Open Payments data.

Methods: We performed a descriptive analysis of Open Payments data released by the Centers for Medicare and Medicaid Services for 2014.

Using the Children with Special Health Care Needs Screener with Immigrant Families: An Analysis of the National Survey of Children's Health.

Children in immigrant families are less likely to screen positive with the Children with Special Health Care Needs Screener (CSHCN-S). This may indicate that children in immigrant families are healthier or require fewer health services than non-immigrant peers. Alternatively, the screener may under-identify special healthcare needs in this population.

2017 Update on Pediatric Medical Overuse: A Review.

Importance: Medical overuse has historically focused on adult health care, but interest in how children are affected by medical overuse is increasing. This review examines important research articles published in 2016 that address pediatric overuse.

Observations: A structured search of PubMed and a manual review of the tables of contents of 10 journals identified 169 articles related to pediatric overuse published in 2016, from which 8 were selected based on the quality of methods and potential harm to patients in terms of prevalence and magnitude.